Care close to home
Central Valley Advanced Spine is a Fresno practice. Dr. Devan Higginbotham grew up in Fresno and came back to practice here after his spine fellowship at UC Davis. If you live in the city, you do not need to plan an out-of-town trip for spine care. Consultations, imaging review, surgery and follow-up visits all happen in Fresno.
That said, Fresno is a big city. It had about 542,000 residents in the 2020 census, and a drive from one side to the other on Highway 41, 99, 168 or 180 can take longer than people expect at rush hour. Give yourself extra time for each visit, and plan a ride for surgery day even if the drive home is short.
What the procedure is
Endoscopic spine surgery removes whatever is pressing on a nerve through a tube that is usually less than half an inch wide. A small camera with its own light goes down the tube and shows a magnified picture on a screen. Fine tools pass down the same tube to take out whatever is pressing on the nerve. Most often that is a herniated piece of disc, though a thick ligament or bone spur can be removed the same way. The muscles along the spine are moved aside rather than cut. The full guide to endoscopic spine surgery explains the two main approaches, recovery ranges and risks in more detail.
In 2025 Dr. Higginbotham performed what was reported as the first endoscopic spine surgery in Fresno.
Who in Fresno it may help
This operation is aimed at one or two pinched nerves in a small area of the spine. The most common reason is a herniated disc in the low back that sends pain down one leg, often called sciatica. Some people with narrowing where the nerve exits the spine, a form of lumbar spinal stenosis, may also be candidates.
Fresno patients come from many kinds of work. Health care is the largest employer group in Fresno County, with long shifts on hard floors and a lot of lifting and turning patients. The city also has school districts, Fresno State, warehouse and delivery jobs, and farm work across the county, which led the nation in farm production value in 2024. Lifting, bending and long hours on your feet or behind the wheel do not cause every disc problem, and many people with desk jobs herniate a disc too. Still, the type of work you do matters when we plan surgery, because it shapes how soon and how safely you can go back.
Endoscopic surgery is usually not the right choice for an unstable spine, a large curve or problems at many levels. Most people also try physical therapy, activity changes and time before surgery comes up. If you are not sure you need a surgeon yet, read signs it may be time to see a spine surgeon.
What the visits usually look like
Every plan is different, but a common pattern for a Fresno patient is:
- ConsultationHistory, exam and a look at your MRI. If you have no MRI yet, one may be ordered.
- Imaging review or second visitSometimes needed if new images are taken or if we want to talk through options again.
- Pre-surgery checkLab work and a health review, often with your own primary care doctor.
- Surgery dayMany patients go home the same day. Some stay one night.
- Follow-up visitsUsually a wound check in the first couple of weeks and one or two visits after that.
Planning your care from Fresno
Because you are local, you can often drop off paperwork or pick up forms in person. It still helps to have your records sent before the first visit so the time is spent on you, not on searching for reports.
- Imaging. Many Fresno patients have scans done at one of the city's hospitals or at an outpatient imaging center. Ask that center to send the actual images as well as the written report. A disc on CD or an online image link both work.
- Records. Notes from physical therapy, injection records and your medication list help show what has already been tried.
- What to bring. Your ID, insurance card, a list of medicines and allergies, and a short note about when the leg or arm pain started and what makes it worse.
- Surgery day. You will need an adult to drive you home and ideally stay with you the first night. You should not drive yourself while you are taking opioid pain medicine.
- At home. Set up a spot where you can lie down and get up easily. Short, frequent walks around the block or inside the house are usually encouraged.
Our spine surgery preparation checklist covers the week before surgery in more detail.
Questions Fresno patients ask
Do I need to go to a different city for endoscopic surgery?
No. Our office is in Fresno, and Dr. Higginbotham does these procedures at Fresno Surgical Hospital, also in the city. We will go over the arrival details when your date is set.
I work a physical job in Fresno. How long will I be off?
People with desk jobs often return in one to three weeks. Jobs with heavy lifting, patient handling or long hours standing usually take longer, often six weeks or more, with lifting limits in the meantime. We will write down your limits so you can share them with your employer.
Can I keep seeing my physical therapist near my home?
Often, yes. If you need therapy after surgery, many patients use a clinic close to where they live or work. We can send a therapy order to the clinic you choose.
My MRI was done a year ago. Is that too old?
It may still be useful for the first visit. If your symptoms have changed or it has been a long time, a newer MRI may be needed before any surgery is planned. Bring the old one anyway so we can compare.
Is a smaller incision always better?
No. A small incision is only helpful if it can safely reach the problem. For some spines, a microdiscectomy or a fusion is the better operation, and we will tell you when that is the case.