Start the Disc Treatment Quiz!

It only takes 3 minutes to complete!

After you complete the quiz, one of our patient coordinators will reach out via phone, text, or email to discuss your results and help you schedule an appointment if appropriate.

Your responses are completely confidential and will help guide you toward the right next step in your care.

Let’s get started!

Nature & Location of Your Symptoms

We’ll ask about the specific sensations and "traveling" pain you may be experiencing. Identifying how pain moves through your limbs helps better address your condition.

Where are you experiencing the most pain?

Neck or Upper Back

Middle Back

Lower Back

Does your pain travel specifically into your shoulders, arms, or hands?

Does your pain travel specifically into your buttocks, thighs, or down to your feet?

Do you experience "clumsiness" with your hands, such as difficulty buttoning a shirt or writing?

Is your pain primarily "mechanical" (hurts when you move) or "neurological" (burning/numbness regardless of position)?

What is your age range? *

Imaging & Diagnosis

Your previous diagnoses and imaging results provide a roadmap of your spinal health. This information helps us determine if your condition is localized to the disc or involves other structures like the facet joints or spinal canal.

Has a medical professional ever mentioned "loss of disc height" to you?

Has a doctor ever mentioned that your facet joints (the small joints behind the discs) are severely arthritic?

Have you been told you have "Spinal Stenosis" (narrowing of the spinal canal)?

Have you had a recent MRI or CT scan of your spine (within the last 6–12 months)?

Candidacy & Contraindications

Tell us about your medical history and lifestyle habits. Certain factors, such as bone density or previous surgeries, are critical in determining if Artificial Disc Replacement is the safest and most effective path for you.

Are you currently a smoker or do you use nicotine products daily?

Do you have any known allergies to metals (specifically Chrome, Cobalt, or Titanium)?

Have you ever been diagnosed with a spinal infection?

On a scale of 1–10, how much does your spinal condition limit your ability to perform your job or hobbies?

1–3 (Mildly annoying)

4–6 (I’ve had to give up some activities)

7–9 (I can barely work or enjoy life)

10 (I am completely disabled/homebound)

What is your primary goal for seeking treatment?

Functional Impact

Understanding how your symptoms limit your movement and sleep allows us to assess the severity of your condition. This helps us measure the potential impact a motion-preserving procedure could have on your quality of life.

Are you currently taking any prescription-strength nerve pain medications?

Do you find yourself leaning forward while walking to find pain relief?

Yes

Occasionally

Does coughing, sneezing, or straining make the pain in your spine significantly worse?

Does your pain prevent you from getting a full night's sleep?

How many steps or minutes can you walk before you need to sit down due to back or leg pain?

Less than 5 minutes

5–15 minutes

15–30 minutes

I can walk for over 30 minutes

Tell Us About You!

Let us know how to reach you so we can provide personalized recommendations and connect you with the right spine and disc care options!

You can expect to hear from us via phone call, text message, or email within 1-2 business days.

First Name *

Last Name *

Email *

Phone

Best Time to Call

What is your primary insurance type? *

Provider Preference *

Location Preference *

By submitting this form, I agree to receive SMS communications and marketing messages at the phone number provided above from The Advanced Spine Center via the phone number 973-791-4101. I understand that in addition to responses to any queries I send to The Advanced Spine Center, I may receive up to one marketing message per week. Data rates may apply. Reply STOP at any time to opt-out of all SMS messages from The Advanced Spine Center.