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Referring Clinicians: Spine Surgery Referrals to Nicholas J. Clark, MD

Nicholas J. Clark, MD is a board-certified orthopedic spine surgeon at HSS at NCH in Naples, Florida. He evaluates adults with cervical, thoracic, and lumbar spine conditions referred by primary care physicians, physiatrists (PM&R), pain management physicians, chiropractors, physical therapists, and other clinicians across Southwest Florida. This page outlines what Dr. Clark treats, when a referral makes sense, how to send one, and what to expect after the patient is seen.

Fax referrals: 239-624-0311 | Scheduling and urgent referrals: (239) 624-0306

About Dr. Clark

  • ​Board-certified orthopedic spine surgeon (American Board of Orthopaedic Surgery)

  • MD, University of Wisconsin School of Medicine and Public Health (2015)

  • Orthopedic surgery residency, Mayo Clinic (2015 to 2020)

  • Spine surgery fellowship, Hospital for Special Surgery, New York (2020 to 2021)

  • Practicing in Naples at HSS at NCH since May 2024; hospital privileges at NCH facilities

  • Clinical focus: minimally invasive and robotic-assisted spine surgery, motion preservation when appropriate, revision surgery, and second opinions

Dr. Clark works with Jorge Monje, APRN, who sees patients in English and Spanish. More detail on training and publications is on the About and Publications pages.

Conditions Evaluated

Procedures Offered When Surgery Is Indicated

Many referred patients do not need surgery. When nonoperative care remains reasonable, the plan returns to the referring clinician with specific recommendations. When an operation is indicated, the least invasive option that can still complete the mechanical goal safely is preferred.

Cervical spine

Lumbar spine

Across the spine

When to Refer

​Emergency: send to the emergency department first
These findings need same-day emergency evaluation rather than an office referral. After emergency transfer, a call to (239) 624-0306 is welcome.

  • Suspected cauda equina syndrome: new urinary retention or incontinence, bowel incontinence, or saddle anesthesia

  • Rapidly progressive motor weakness in the arms or legs

  • Suspected spinal infection: fever with severe spine pain, especially with immunosuppression, recent procedures, or IV drug use

  • Suspected spinal fracture or tumor with a new neurologic deficit

Urgent: call (239) 624-0306 and fax the referral marked URGENT

  • Signs of cervical myelopathy: hand clumsiness, dropping objects, gait imbalance, hyperreflexia, a positive Hoffmann sign, or clonus

  • MRI showing spinal cord compression or cord signal change

  • New or progressive motor deficit, such as foot drop or grip weakness

  • Severe radicular pain that cannot be controlled despite appropriate treatment

Routine: fax the referral

  • Cervical or lumbar radicular pain that persists despite a reasonable trial of conservative care, often around six weeks or more of activity modification, medications, and therapy

  • Neurogenic claudication from lumbar stenosis that limits walking or daily activity

  • Symptomatic spondylolisthesis or spondylolysis, including pars defects in younger, active patients

  • Recurrent or persistent symptoms after prior spine surgery

  • An imaging finding that would benefit from a surgical opinion

  • A patient requesting a second opinion about a recommended spine operation

An MRI and a trial of physical therapy are preferred before the first visit for routine referrals, but neither is required. Injections are not a requirement before referral. Patients with red-flag findings listed under Emergency or Urgent above should be referred urgently regardless of whether imaging or therapy has been completed. Referral for a surgical opinion does not commit a patient to surgery.
For chiropractors and physical therapists
Patients with signs of myelopathy, a progressive neurologic deficit, or bowel or bladder changes should be referred before further manual therapy. Dr. Clark's nonoperative and postoperative protocols are available for therapists:

How to Refer

  1. Fax a referral note with the reason for referral, plus imaging reports and supporting records, to 239-624-0311. No special referral form is required.

  2. Call surgery scheduling at (239) 624-0306 for urgent referrals, scheduling questions, or to confirm receipt of a fax.

  3. Patients may also self-schedule by calling (239) 624-0306 or completing the patient registration form.

Most routine new consults are seen within about a week to 10 days. Urgent referrals can be seen sooner as needed; call (239) 624-0306 to arrange an urgent visit.

Spanish-speaking patients can be seen by Jorge Monje, APRN. Insurance referral or authorization requirements vary by plan, so checking the patient's plan before sending is recommended. Coverage questions are covered on the insurance page.

What to Send

  • Referral order with the reason for referral and urgency

  • Recent office notes, including the neurologic exam (strength, reflexes, sensation, gait, and Hoffmann sign when relevant)

  • Conservative care history: physical therapy or chiropractic dates, medications tried, and any injections with dates and response

  • MRI report, plus image access (CD, image-sharing link, or portal) whenever possible

  • X-ray reports and images; standing lumbar films with flexion and extension views are helpful when spondylolisthesis or instability is suspected

  • CT report and images if obtained

  • EMG or nerve conduction study results if obtained

  • Prior operative notes and implant records for patients with previous spine surgery

  • Demographics, insurance card copy, and any referral or authorization number required by the plan

  • For routine referrals, an MRI and a trial of physical therapy are preferred before the first visit but are not required. When an MRI has not been done, it can be ordered at the consultation if it will change the plan. Red-flag cases should be referred urgently without waiting for imaging or therapy.

Communication Back to the Referring Clinician

  • A consult note with the assessment and recommended plan is faxed to the referring clinician after the initial visit. Including the practice fax number on the referral helps the note reach the right office.

  • When nonoperative care is recommended, the note includes specific suggestions, such as a therapy focus or a referral for injections, and the patient continues care with the referring clinician.

  • When surgery is planned, the consult note includes the surgical plan, and postoperative updates are provided to the referring clinician after surgery.

  • Therapists receive postoperative or nonoperative protocol guidance with the therapy order.

  • For questions about a shared patient, call (239) 624-0306.

Location

HSS at NCH
11190 Health Park Blvd, Building 2, Suite 2102
Naples, FL 34110

The office is on the NCH campus in North Naples, near Immokalee Road, with convenient access from I-75 (Exit 111) and US 41 for patients coming from Naples, Bonita Springs, Estero, Marco Island, Fort Myers, and the surrounding area. Surgery is performed at NCH facilities, where Dr. Clark holds hospital privileges. Directions are on the office information page.

Phone (scheduling): (239) 624-0306
Fax: 239-624-0311

More Resources

Call (239) 624-0306

​Frequently Asked Questions

How is a patient referred to Dr. Clark?

Fax a referral note with the reason for referral, plus imaging reports and recent records, to 239-624-0311. No special referral form is required. For urgent referrals or scheduling questions, call surgery scheduling at (239) 624-0306.

How soon are referred patients seen?

Most routine new consults are seen within about a week to 10 days. Urgent referrals can be seen sooner as needed by calling (239) 624-0306.

Which findings should be referred urgently?

Signs of cervical myelopathy, MRI evidence of spinal cord compression, or a new or progressive motor deficit warrant an urgent referral by phone at (239) 624-0306 along with a faxed referral. Suspected cauda equina syndrome, rapidly progressive weakness, or suspected spinal infection should go to the emergency department first.

Does a patient need an MRI or physical therapy before the first visit?

For routine referrals, an MRI and a trial of physical therapy are preferred before the first visit, but neither is required. Patients with red-flag findings, such as signs of myelopathy or progressive weakness, should be referred urgently regardless of whether imaging or therapy has been completed.

Will the referring clinician receive a consult note?

Yes. A consult note with the assessment and plan is faxed to the referring clinician after the initial visit. When surgery is performed, postoperative updates are provided to the referring clinician. Patients who do not need surgery return to the referring clinician with specific nonoperative recommendations.

Does Dr. Clark see Spanish-speaking patients?

Yes. Dr. Clark works with Jorge Monje, APRN, who sees patients in English and Spanish at HSS at NCH in Naples.

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