About the practice
Surgery is one tool. It has to earn its place.
Academy Orthopaedics exists because the decision about whether to operate on a spine is harder, and matters more, than the operation itself.
A patient with leg pain and a disc herniation on an MRI can reasonably be offered physical therapy, an injection, a microdiscectomy, an endoscopic decompression, or nothing at all for another six weeks. All five are defensible on the same film. What separates them is the exam, the history, how the symptoms have moved over time, and what the patient needs to get back to.
That gap, between what the imaging shows and what the patient needs, is where this practice does its work. The principles below are how it gets closed.
How decisions get made
Five commitments.
- 01
A diagnosis, before a recommendation
Almost everyone arrives with an MRI and a theory. The MRI is useful and the theory is often wrong, because imaging finds wear in most adult spines whether or not it hurts. Disc bulges, facet arthritis and degenerative changes are common findings in people with no symptoms at all.
So the first job is not reading the film. It is working out which structure is producing the symptoms, and then checking whether the film agrees. When the exam and the imaging point at the same nerve, the plan is usually clear. When they do not, more surgery is rarely the answer to the disagreement.
- 02
Most spine problems are not surgical problems
Most patients seen here do not need an operation, and are told so. Time, targeted therapy, activity modification and sometimes an injection resolve a great many disc herniations and a good deal of back pain.
Declining to operate is a treatment decision, not a delay or a hedge. A patient who leaves without a surgical date should leave with a plan, a timeframe, and a clear description of what would change the recommendation.
- 03
The least invasive approach that actually solves it
When an operation is warranted, the questions are how much of the spine has to be disturbed to fix the problem, and how much of its function can be kept. Minimally invasive and motion-preserving techniques are used where the anatomy supports them.
The order matters: complete first, small second. An operation that spares tissue but leaves the nerve compressed has not helped anyone. Where a smaller approach cannot do the whole job, the larger one is the right choice and is presented that way.
- 04
Evidence, including where it runs out
Dr. Sayari publishes in spine surgery and sits on the editorial board of a spine journal. That work is the reason the practice can be specific about what the research supports rather than gesturing at it.
It is also why it can say when the evidence does not settle a question. Some spine decisions genuinely sit on a knife edge, with good trials pointing in different directions. Those get described as the judgement calls they are, not dressed up as certainties.
- 05
The decision is shared, and second opinions are welcome
A patient who does not understand why an operation is being recommended cannot meaningfully consent to it. So the reasoning is laid out: which structure, which nerve, what the alternatives are, and what happens if nothing is done.
A substantial part of the practice is second opinions, including on operations recommended elsewhere. They are welcome for their own sake. If another surgeon's plan is the right one, that is a useful answer too.
The surgeon
Good surgery is decision-making, not just technique. The best operation is often the one not performed.
Arash J. Sayari, MD
Questions patients ask about the approach
- Is Academy Orthopaedics against spinal fusion?
- No. Fusion is the right operation for genuine instability, for a slip that moves, and for deformity, and it is offered when that is what the problem calls for. What the practice avoids is fusing a segment that did not need it, which is a different thing. The emphasis on motion preservation is about candidate selection, not about ruling out an operation.
- Will I be pressured into surgery?
- Most patients seen here for neck or back pain do not need an operation, and are told so directly. When surgery is recommended, the reasoning is explained in terms of a specific structure and a specific problem. A recommendation you cannot follow is one worth questioning.
- What makes this different from any other spine practice?
- Two things that are checkable rather than claimed. The diagnosis is worked out before a treatment is proposed, and outside imaging is reviewed directly rather than from the radiologist's summary. And the treatment recommendations are tied to published evidence, including an honest account of the questions that evidence has not settled.
- Can Academy Orthopaedics take on more physicians and specialties?
- Yes. The practice is built to grow beyond one surgeon and beyond spine, across the offices it already operates. The clinical emphasis today is spine care.