John had an L5-S1 spinal fusion with a surgeon 15 years ago.
The surgery helped relieve his symptoms, but his back and leg pain have come back. John tried to cope with the symptoms for some time. He finds it difficult to sit at his desk and to drive for long periods. As a salesman, John needs to do a lot of driving.

John’s GP recommends he sees Dr Scott-Young and gives him a specialist referral.

John speaks with one of our Patient Coordinators who has him complete some forms about himself and his condition and provide his previous radiology reports.

He also speaks with one of our nurses who collects a full picture of John’s history relevant to his spine and general health. The nurse notes that ceasing smoking and working towards a healthy weight are health goals we encourage for our patients.

Dr Scott-Young reviews John’s information and MRI scan and refers him for an EMG and an EOS scan. Our Patient Coordinator then books John’s first appointment with Dr Scott-Young.

Before his appointment, John has the EMG and EOS scan performed.

On the day of his appointment with Dr Scott-Young, the nurse checks in again with John to see how he is progressing with his health goals and update any information since the Nurse Health Check.

John then attends his first appointment with Dr Scott-Young. Dr Scott-Young listens to the history of John’s condition and previous surgery, examines John and reviews his radiology. The surgeon discusses his views with John, answers John’s questions and discusses his treatment options with him.

Dr Scott-Young explains that revision spine surgery is only appropriate if John cannot find other ways to manage his symptoms. He explains that simple measures like avoiding the activities that aggravate his symptoms, losing weight, quitting smoking, gentle exercise, and using the medication his GP prescribes can be enough for many patients to manage their symptoms. He explains that revision spine surgery should be considered only if other measures are not successful.

John explains that he is worried he would have to stop work as he is unable to manage the 3-4 hours a day he needs to spend in the car.  He is concerned that, due to his age, he may find it difficult to find a new job.

Dr Scott-Young tells John that revision spine surgery may be appropriate in his case. But he explains that he would need to make some lifestyle changes before he would be ready for more spinal surgery.  The surgeon explains that his risk of having an adverse event is increased by smoking and being overweight. He stresses that John needs to be as fit as possible before having surgery.

Dr Scott-Young outlines the surgery he has in mind that would match the right technology with John’s condition. He explains that the surgery would involve inserting a total disc replacement at L4-5 above the previous L5-S1 fusion. He explains that the disc above the previous surgery has worn out and this is called ‘adjacent segment disease’.

At the end of the appointment, John is given an information pack, detailing the recommended surgery. He is also given a referral to Physio Next Door who will work with him to achieve the goals he needs to meet before being ready to have surgery.

A detailed letter outlining the surgeon’s recommendations goes to John’s GP.  Each time Dr Scott-Young reviews John, he updates his GP in writing.

Later, John is sent information relating to the costs of the recommended surgery.

John attends his first appointment at Physio Next Door.  He leaves with an exercise program he can do at home and a healthy eating plan to assist him in losing weight.

With the physiotherapist’s guidance and a renewed commitment to his physical health, John follows his exercise plan. He also visits his GP to get help to quit smoking.  The GP also arranges for John to see a dietician to assist with his weight loss.

John loses 21kg over six months. He also quits smoking.

After his final review with Physio Next Door, John gets the all clear to return to see his surgeon.

John returns to see Dr Scott-Young and tells him that his symptoms have improved with exercise and weight loss. But he still struggles to get through a full day’s work because of his back and leg pain. He also needs to use strong medication to manage his symptoms.

Revision spinal surgery is recommended by Dr Scott-Young.   They discuss the recommended procedure again and agree to proceed with the surgery once John organises someone to cover for him at work.

Once John is ready to have his surgery, he attends a consent appointment with Dr Scott-Young.  He brings a list of any questions he has about the surgery and his return to work.  Dr Scott-Young answers his questions and completes a detailed consent form with John.

After his appointment with his surgeon, John is assisted by one of our Surgical Coordinators to book a surgery date and make the arrangements for his admission to hospital.

Before his surgery, John attends the hospital’s pre-admission clinic and has some blood tests and radiology performed. The nurse at the clinic answers his questions about what to expect during his hospital stay.


John also attends a pre-admission appointment with Physio Next Door. They will be looking after him in hospital.

Prior to surgery, John clears his bowels with a bowel prep solution.

On the morning of his surgery, John is admitted to the hospital and Dr Scott-Young performs the L4-5 total disc replacement with his surgical team.

During his hospital stay, John actively participates in his recovery under the guidance of Physio Next Door. He is discharged after 5 days.

John continues his rehabilitation after being discharged from hospital and attends regular appointments at Physio Next Door.

Two weeks after John leaves hospital, he attends his first post-operative appointment with Dr Scott-Young.  He is still sore from the surgery and taking the medication he was sent home with. But John reports that he is moving well and performing all the exercises his physiotherapist has given him.

After three weeks, John adds daily walks back into his routine. He starts doing a few hours of work from home a couple of days a week.

John returns to see his surgeon for a three-month post-operative appointment.  He has been back at work part time and his surgeon gives him the all clear to return to full duties at work.

At six months post-op John has some x-rays and a CT scan performed and returns to see his surgeon.  He feels good and has returned to all his usual activities.  Dr Scott-Young says the radiology shows the total disc replacement implant is well placed and is moving well.

John is followed up by Gold Coast Spine one year after his surgery and he completes some questionnaires about the result of his surgery.