Second Opinion Before Surgery
Surgery is sometimes the right answer. Before you commit to it, an independent evaluation of your imaging and clinical findings by Dr. Dean Mammales, DC gives you the information you need to make that decision. Cobblestone Spine has been doing these evaluations in Royal Palm Beach since 2006.
If you have been told you need back surgery, neck surgery, or a joint replacement, a second evaluation is worth the time. Some surgical recommendations are appropriate and necessary. Others are made before conservative options have been genuinely exhausted. The purpose of a second opinion at Cobblestone is to give you an honest clinical picture of what your imaging actually shows, what non-surgical options have a realistic chance of success, and when surgery is the right answer.
Dr. Dean Mammales, DC has been evaluating spine and joint conditions in Royal Palm Beach since 2006. He has seen the full range of what surgical recommendations look like in this community: some that are overdue and appropriate, some that are premature, and some where the diagnosis driving the surgery recommendation is incorrect. Each situation is different. The evaluation at Cobblestone does not assume the surgical recommendation was wrong. It determines independently what the examination and imaging actually show.
What a Second Opinion at Cobblestone Involves
Bring your imaging. MRI reports and the actual images on disc or film are both useful, but the images themselves are more informative. Bring any prior treatment records you have, including physical therapy discharge summaries, specialist notes, and the surgical consultation itself. Bring the name of the diagnosis and the proposed procedure if you have it in writing.
Dr. Mammales reviews the imaging directly and performs his own orthopedic and neurological examination. He then explains what he found and whether it aligns with the surgical recommendation. This is not a pro-chiropractic or anti-surgery evaluation. It is a clinical evaluation. If the imaging shows pathology that genuinely requires surgery, that is what he will tell you. If there are non-surgical options that have not been tried, those will be identified specifically, with realistic expectations about outcomes and timelines.
Conditions Most Commonly Brought for Second Opinions
Lumbar disc herniation with sciatica is the most common presentation. Surgery is appropriate for lumbar disc herniation with severe neurological deficit, progressive weakness, or bowel and bladder involvement. It is frequently recommended before these thresholds are met. Spinal decompression therapy produces documented improvement in lumbar disc herniation in a significant proportion of patients who have not undergone surgery, and many patients with a herniation and radiculopathy recover fully without surgical intervention when given adequate conservative care.
Cervical disc surgery is the second most common. A C5-C6 or C6-C7 disc herniation with radiculopathy into the arm responds to cervical decompression therapy and chiropractic in a meaningful percentage of cases. The surgical recommendation for cervical disc pathology often comes earlier than it does for lumbar pathology because the proximity to the spinal cord makes surgeons more conservative. A second opinion helps determine whether your specific imaging and neurological findings warrant that urgency.
Knee and hip replacement consultations are the third category. For patients with moderate to advanced osteoarthritis who are younger than typical replacement candidates or who cannot tolerate the surgical recovery, PRP therapy and stem cell therapy administered by Yuleisy Coto, MSN, APRN, FNP-C represent the most powerful non-surgical biological interventions available. These do not replace surgery in all cases. They delay it in some and avoid it in others. The honest answer depends on your specific imaging and candidacy.
When Surgery Is the Right Answer
Dr. Mammales refers patients for surgery when the clinical and imaging findings indicate that surgery is the appropriate next step. Cauda equina syndrome, progressive neurological deficit, spinal instability, and certain fracture patterns are conditions where conservative care is not appropriate and where a referral is made immediately. A second opinion at Cobblestone is not an obstacle to surgery when surgery is indicated. It is a check on whether surgery is indicated before a decision that cannot be undone is made. Call (561) 753-2225 or request an evaluation here.