FAQ – Frequently Asked Questions

What makes Austin Integrative Spine (AIS) different from other spine practices?

Austin Integrative Spine is the vision of a spine surgeon with world-class biological/cell treatments, endoscopic, and conventional surgical training. Dr. Madera’s care model produces success, even when conventional spine care has failed. Answering your calls personally, Dr. Madera is wholly invested in your healing and strives to see you exit her care better in your whole life than when you started.

How do I know if I am a good fit for Austin Integrative Spine?

Our ideal patients have several things in common. Some of these characteristics are:

  • You want concierge service from your neurosurgeon
  • You want more time with your neurosurgeon
  • Conventional spinal care or surgery has failed you already
  • You have residual symptoms after spine surgery for which you have been told “there is nothing more to do.”
  • You want a holistic approach to your spine care
  • You want surgical and spinal expertise that goes beyond the operating room

What if I don’t want surgery or a procedure at all? Is it worth it to see Dr. Madera?

Dr. Madera founded this practice to be able to offer much broader options for her patients than conventional surgery and insurance-reimbursed care. Her model includes a wide spectrum of holistic spine care modalities for her patients. During your consultation, she will offer guidance on a whole range of treatment options to exhaust before planning surgery.

What is a concierge practice?

Have you ever wanted to get ahold of your surgeon or physician and felt like you were getting the runaround? As Dr. Marcella delivered conventional medical care prior to opening AIS, she noted over and over that patients deserved more access, less hassle, and a smoother medical experience. This awareness led her to develop a concierge practice, Austin Integrative Spine. She built this practice model to serve you! Current patients have said that Austin Integrative Spine represents the future of healthcare.

As a patient at Austin Integrative Spine, you have direct access to Dr. Marcella and her team via phone, text, and email, providing unprecedented care and efficient communications. If you decide to become a patient of the practice, there is a monthly concierge fee for each additional month you continue to be under the care of Dr. Marcella.

What is the average cost of a procedure?

Pricing is individualized based on the specific problems being treated and how many areas of the spine need to be treated. Regenerative procedures in isolation start at $9000, and surgery done with regenerative procedures starts at $10,000.

How can I get more information?

More information on her treatment options can be obtained by filling out the form on the Contact page. Pricing for consultation is also included in the information packet you will receive by submitting your story.

Does Austin Integrative Spine accept insurance?

In order to provide the highest level of personalized care, we have chosen to be out of network with all insurance companies, including Medicare, as of September 18, 2020. We accept all major credit cards and provide estimates for costs of services up front. We strive to give you transparent data so that you can make well-informed health care decisions! Please read through the additional information below to fully understand your options.

Will commercial/private insurance pay for my office visit?

As a patient of our practice you receive individualized, concierge care. AIS is considered out of network for insurance. Options for payment and reimbursement for commercial/private insurance companies and health sharing plans are below:

  • You simply pay AIS directly for your appointment. Upon request, we will provide you with a bill which you may submit to your insurance company for reimbursement. Any out of network conditions for your insurance plan will apply.
  • You may use your HSA (healthcare savings account) to pay our fees anytime.
  • Our fees can go toward out-of-pocket maximums under health sharing plans.

Will Medicare pay for my office visit?

As a patient of our practice you receive individualized, concierge care. No, Medicare will not pay for your visit. You will have the opportunity to review and sign a private contract with Dr. Marcella. This contract, required by Medicare, allows you to pay AIS directly and confirms that you will not submit your bills to Medicare.

Will commercial/private insurance pay for my surgical procedure?

Yes, your plan will often pay for a substantial portion (and sometimes for all) of your surgery.

  • Hospital Fees: If you are undergoing a surgery deemed medically necessary by your insurance company, that company will likely pay for the hospital fees.
  • Dr. Marcella’s Fees: Your insurance plan’s out of network policies and deductible requirements for Dr. Marcella’s professional fees will apply. Our billing department will verify what your plan covers and will give you up-front pricing for surgery before you are scheduled for your procedure.

Will Medicare pay for my surgical procedure?

Medicare will pay for a portion of your surgical procedure.

  • Hospital Fees: If you are undergoing a surgery deemed medically necessary, Medicare will pay for the hospital fees associated with surgery.
  • Dr. Marcella’s Fees: These fees are not covered by Medicare. AIS will provide an estimate for any additional costs. You will have the opportunity to review and sign a private contract with Dr. Marcella. This contract, required by Medicare, allows you to pay AIS directly for Dr. Marcella’s professional fees and confirms that you will not submit your bills to Medicare.

Click here for more information on services.

Will insurance or a health sharing plan pay for my biologic/cell procedure?

Often health sharing plans or plans that are associated with self-insured employers do cover or reimburse for these procedures. Because biologic/cell procedures are considered experimental, conventional insurance typically does not yet cover them. In Texas, with the passage of House Bill 810 (effective 9/2017), biologic/cell medicine practitioners are optimistic that these procedures will become more widely accepted one day, and eventually paid for by insurance. Until then, Dr. Marcella keeps diligent records of clinical outcomes so as to be able to contribute to the collective knowledge on biologic/cell treatments for future lawmakers and insurers.

What is endoscopic spine surgery?

Dr. Madera trained both in Germany and in the U.S. with several master surgeons to perform the Joimax ILLESYS, TESSYS, and CESSYS procedures. Pioneered in Germany, and now fully adopted as the standard in Asia, endoscopic spine surgery using the Joimax system is the cutting edge in the USA. Dr. Madera is the only surgeon in Central Texas performing these procedures.

The Joimax procedures employ a small scope (6-7 mm, or less than 1/3 inch) that is inserted directly over the area needing treatment, sparing all of the stabilizing structures of the spine. Surgery to relieve nerve compression from disc herniation or arthritic disease utilizing the tiny Joimax endoscope is often able to be performed under awake anesthesia.

Is endoscopic surgery better than conventional open surgery or minimally invasive surgery using a tube?

In general, there is significantly less blood loss with endoscopic surgery versus open or MIS Surgery. Long-term back pain outcomes are also better with endoscopic surgery, as shown in this study.

That said, not all problems are candidates for endoscopic decompression. Studies have shown conflicting results, and Dr. Madera feels this is due to some surgeons attempting to treat all spine pathologies with one approach. Some nerve compression is better handled with an open approach, and some can be adequately treated with an endoscope. She also uses a minimally invasive tubular retractor in some cases.

How does Dr. Madera decide whether to perform surgery endoscopically, minimally invasively with a tube and microscope, or open with a microscope?

Dr. Madera will discuss the treatment options during your consultation. Your anatomy and the extent of your disease will dictate the optimum approach. The two of you will decide together the best method of treatment for your individual case.

Where can I find more information on the special endoscopic surgeries Dr. Madera performs?

Please explore the treatment options page below from Joimax, the company whose instruments Dr. Madera uses to perform endoscopic discectomies and decompressions to learn more.


Please download the brochures below pertaining to endoscopic decompression and discectomy by clicking on the brochure title.

What surgeries does Dr. Madera perform?

Dr. Madera is skilled and experienced in all surgeries for spine disease. This includes surgery for disc herniation, spinal stenosis, neck pain, back pain, nerve compression, spinal cord compression, and arthritis of the spine.

What other procedures does Dr. Madera perform?

Dr. Madera is one of very few surgeons in the U.S. who performs biological/cell treatment procedures for spine degenerative disease. These procedures can be done alone or in combination with the most state of the art and least invasive surgeries. Detailed discussion with Dr. Madera will help the two of you determine the best plan for your specific situation.

Regenerative procedures can be done instead of surgery, or they can be combined with a smaller surgical procedure to spare you a larger surgery.

What is preparation for surgery and recovery from surgery like?

At Austin Integrative Spine, Dr. Madera uses a pre- and post-operative protocol employing the latest evidence based mind-body methods and full health optimization in order to speed your healing and minimize stress and pain. You will receive instruction on diet, daily physical and mental practices, and non-narcotic medications and supplements to prepare you for your procedure and relieve pain. If pain is not controlled by these, narcotics are an option; however, they are rarely needed. When needed, most patients are able to stop narcotic pain medications after 1-2 weeks.

When can I go back to work, driving, sexual activity, outdoor chores?

Dr. Madera will discuss your specific goals for recovery with you before your procedures. Many patients are able to go back to some work in 1-2 weeks. The demands of your job and daily activities will dictate your restrictions. All patients are asked to limit lifting to 5-10 pounds during the first 2 weeks after surgery.

Will surgery cure my condition?

Very often surgery cures the symptoms for which it is performed. Dr. Madera has a proven track record of success with all forms of spinal disease and their treatments. She is conservative in choosing what scale of surgery to offer each patient, and her patients can attest to the personal investment Dr. Madera makes in ensuring patients heal well after surgery.

The spine is a complex organ, and due to the nature of spinal degenerative disease, Dr. Madera’s aim is to halt the disease process, eliminate your current symptoms, and give you the tools to prevent recurrence. Her goal is that you live an optimal, healthy life. The goals of the work she is doing with regenerative medicine are to perform smaller surgeries and maintain spine health with less invasive procedures.

What are Mesenchymal Stem Cells (MSC’s)?

Pericytes, cells that live on the surface of blood vessels in every tissue in the body, have different characteristics when they are activated. In the spine and many other tissues, these cells become mesenchymal stem cells when signaled by injury to stimulate healing. Stem cell expert and scientist Dr. Arnold Caplan named mesenchymal stem cells and has actually proposed that the name be changed to medicinal signaling cells in light of their effects in live tissue. These cells have not been shown to differentiate into other tissues in live tissue, but rather to modulate their environment towards healing.

To learn even more, please explore the videos of mesenchymal stem cell (MSC) expert Dr. Arnold Caplan describing science behind these miraculous cells:

The Science of Mesenchymal Stem Cells and Regenerative Medicine (Part 2) – Arnold Caplan PhD

The Science of Mesenchymal Stem Cells and Regenerative Medicine (Part 3) – Arnold Caplan PhD

How can bone marrow aspirate concentrate improve healing of degenerative spine disease?

A chronic imbalance in the micro injury and repair mechanisms of the spinal joints is the basis of spine degenerative disease. Other terms used are conditions like spondylosis and arthritis. Bone marrow has been found to have a high concentration of MSCs that can be easily harvested and delivered to the areas of degeneration to potentially stimulate local cells to repair the arthritic damage. MSCs secrete thousands of molecules that modulate the immune response of the local environment and stimulate your body’s natural repair mechanisms.

Are there other sources of cells or healing molecules that can be used in my procedure?

Yes. Platelet rich plasma, umbilical cord derived MSCs, and exosomes are options to be added to your biological/cell treatments. We will discuss a personalized plan for your procedure based on what conditions are being treated and your personal preferences.

Will my follow-up MRI images show resolution of degeneration?

This has not yet been shown definitively in scientific studies; however, there are promising studies underway that may prove this to be true over many years. Clinical improvement when it occurs is expected to happen well ahead of imaging improvement.

Many scientific studies have shown that imaging findings do not always correlate with clinical symptoms. Dr. Madera sees this mismatch daily in her practice. She is more interested in your functional outcome than your imaging. That said, when there is severe nerve or spinal cord compression on imaging, she will include in our consultation discussion of performing decompression surgery in conjunction with biological/cell treatments treatment.

How do you decide whether to do a biological/cell treatment procedure, surgery, or both?

In your consultation we will discuss the options in detail based on the severity of your symptoms and your overall treatment goals. Conventional surgery is tried and true for some conditions, and biological/cell treatments can optimize recovery. Biological/cell treatments can also potentially spare patients a fusion in some circumstances when added to decompression surgery, including minimally invasive endoscopic decompression.

Biological/cell treatments alone are used worldwide for degenerative spine disease. You will discuss Dr. Madera’s practice pattern based on available literature and clinical experience at the time of your consultation.

Are these procedures FDA approved?

Not at this time; however, these procedures fall under the physician’s practice of medicine, wherein the physician and patient are free to decide on the course of treatment. AIS meets FDA “minimal manipulation” regulations by providing a same-day procedure done entirely in a procedure room or operating room at a hospital with the patient’s own cells which are then immediately injected locally into the spine of that patient.

Will these procedures ever be covered by insurance?

In Texas, with the passage of House Bill 810 (effective 9/2017), regenerative medicine practitioners are optimistic that these procedures will become more widely accepted and eventually paid for by insurance. The rules under which physicians may work under the bill are still being written. Until then, Dr. Madera keeps diligent records of clinical outcomes so as to be able to contribute to the collective knowledge on regenerative treatments for future lawmakers and insurers.

Is there medical literature that I can review if I want to understand more about biological/cell treatments?


  • Caplan, A. I., Sorrell, J. M. (2015). The MSC curtain that stops the immune system. Immunology Letters, 168(2), 136-9. doi: 10.1016/j.imlet.2015.06.005
  • Crisan, M. (2008) A perivascular origin for mesenchymal stem cells in multiple human organs. Cell Stem Cell, 3(3), 301-13. doi:10.1016
  • Gellhorn, A. C., Katz, J. N., Suri, P. (2013). Osteoarthritis of the spine: the facet joints. Nature Reviews Rheumatology, 9(4), 216-24. doi:10.1038/nrrheum.2012.199
  • Hofer, H. R., & Tuan, R. S. (2016). Secreted trophic factors of mesenchymal stem cells support neurovascular and musculoskeletal therapies. Stem Cell Research & Therapy,7(1). doi:10.1186/s13287-016-0394-0
  • Loebel, C., Burdick, J. A. (2018). Engineering stem and stromal cell therapies for musculoskeletal tissue repair. Cell Stem Cell, 22(3), 325-39. doi:10.1016/j.stem.2018.01.014
  • Meirelles, L. D. (2006). Mesenchymal stem cells reside in virtually all post-natal organs and tissues. Journal of Cell Science, 119(11), 2204-13. doi:10.1242/jcs.02932