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Surgical Procedures

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Procedures

Patient Information


Discogram/Discography

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What is a Discogram?

A Discogram is a diagnostic test in which small needles are placed into the discs in the spine and medicines are injected to determine the source of back or neck pain.

How does it help the pain?

The procedure itself does not reduce pain. The procedure is a test to determine the source of back or neck pain. By determining the source of pain, more specific treatments designed to reduce the pain can be offered at a later date.

Who can benefit from Discography?

Patients with degenerative or herniated discs who suffer from back or neck pain can make good candidates for discography. By determining which disc (if any) is painful more specific treatments can be offered at a future time to relieve pain. Patients having a Discogram have often failed conservative treatments including physical therapy, medications, or Epidural Steroid Injections.

What happens during the procedure?

You will be given medicine to make you feel sleepy, therefore, eating or drinking after midnight is not permitted. You will lie on your stomach and your back will be cleaned and draped with sterile dressings. The skin over the area is numbed and thin needles are inserted into several discs using x-ray guidance. A small amount of x-ray dye is injected into the disc and you will be asked to tell your doctor if this causes your pain to worsen.

What happens after the procedure?

You will be monitored in the office for 1 hour following the procedure. Rest is encouraged the day of the procedure and ice may be applied to the site of the injection. You may feel more discomfort over the next few days, however, your pain will generally return to baseline within 1-2 weeks. You will be seen two weeks after the procedure for a follow up visit. Driving is not permitted on the day of the procedure.

What are the possible side effects?

As with any procedure, a small number of patients may experience side effects which will be explained in more detail by your doctor. A few potential side effects are listed below, however, the vast majority of patients experience no side effects at all.

What if I am taking blood thinning medications? (Eg., Coumadin, Plavix, Ticlid, Aggronox 100):

Coumadin must be stopped 5 days before your procedure and you must have some laboratory studies taken immediately before your procedure (Eg., PT, INR). Your doctor may ask you to stop other medications before your procedure as well.

Does the procedure hurt?

Because the area is numbed with local anesthetic you should experience only modest discomfort. You will also be slightly sedated during the procedure.


Epidural Steroid Injections (ESIs)

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What is an Epidural Steroid Injection (ESI)?

An Epidural Steroid Injection is an injection of steroid medication into the epidural space.

What is the epidural space?

The epidural space is the area next to the spinal cord and the bony vertebral canal.

Who can benefit from ESIs?

Patients with back pain, neck pain, arm or leg pains may benefit from ESIs. A few common examples of problems which can be helped are:

How do ESIs help?

Steroids are potent anti-inflammatory medicines which can decrease swelling and pain. Because the medications are delivered to the site of pain, smaller doses can be given, generally with more relief than medicines given by mouth.

How often can these injections be given?

Your doctor will determine how many injections should be given, however, 5 to 6 injections can usually be given per year. Your relief from each injection will determine how many injections can be given.

What are the possible side effects?

As with any procedure, a small number of patients may experience side effects which will be explained in more detail by your doctor. A few potential side effects are listed below, however, the vast majority of patients experience no side effects at all.

What if I am a diabetic?

Your blood sugars may be increased for a few days following the injection and may require closer monitoring.

What if I am taking blood thinning medications?(Eg., Coumadin, Plavix, Ticlid, Aggronox)

Coumadin must be stopped 5 days before your procedure and you must have some laboratory studies taken immediately before your procedure (Eg., PT, INR). Your doctor may ask you to stop other medications before your procedure as well.

Does the injection hurt?

The area is numbed with local anesthetic before the injection, thus most patients experience only moderate discomfort.

Will I have any restrictions?

You should take it easy on the day of an injection. Driving is generally not permitted on the day of a procedure. Otherwise no restrictions are present.

Facet Joint Injection

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What is a Facet Joint Injection?

A Facet Joint Injection is the injection of numbing medicine and steroid into the facet joint.

What are facet joints?

Facet joints are small joints found throughout the spine which enable movement.

Who can benefit from Facet Joint Injections?

Patients with back and neck pain due to arthritis of the spine as well as certain types of headaches may benefit from Facet Joint Injections.

How do Facet Joint Injections help?

Steroids are potent anti-inflammatory medicines which can decrease swelling and pain. Because the medications are delivered to the site of pain, smaller doses can be given, generally with more relief than medicines given by mouth.

How often can these injections be given?

Your doctor will determine how many injections should be given, however, 5 to 6 injections can usually be given per year. Your relief from each injection will determine how many injections can be given.

What are the possible side effects?

As with any procedure, a small number of patients may experience side effects which will be explained in more detail by your doctor. A few potential side effects are listed below, however, the vast majority of patients experience no side effects at all.

What if I am diabetic?

Your blood sugars may be increased for a few days following the injection and may require closer monitoring. h3>What if I am taking blood thinning medications? (Eg., Coumadin, Plavix, Ticlid, Aggronox) Coumadin must be stopped 5 days before your procedure and you must have some laboratory studies taken immediately before your procedure (Eg., PT, INR). Your doctor may ask you to stop other medications before your procedure as well.

Does the injection hurt?

The area is numbed with local anesthetic before the injection, thus most patients experience only moderate discomfort.

Will I have any restrictions?

You should take it easy on the day of an injection. Driving is generally not permitted on the day of a procedure. Otherwise no restrictions are present.

What if I have other questions?

Your doctor will be happy to answer any questions you may have either before or on the day of your procedure.

Facet Joint Injection-Medial Branch Block

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What is a Facet Nerve Injection?

A Facet Nerve block (Medial Branch Block) is the injection of numbing medicine onto the nerves which supply sensation to the facet joint in order to reduce pain.

What are facet joints?

Facet joints are small joints found throughout the spine which enable movement.

Who can benefit from Facet Nerve Blocks?

Patients with back and neck pain due to arthritis of the spine as well as certain types of headaches may benefit from facet nerve injections.

How do Facet Nerve Blocks help?

Facet Nerve Blocks are diagnostic procedures designed to determine the sources of back pain, neck pain, and certain headaches. The degree of pain relief you obtain from these injections will be helpful to your doctor in devising a treatment plan.

How often can these injections be given?

Your doctor will determine how many injections should be given

What are the possible side effects?

As with any procedure, a small number of patients may experience side effects, which will be explained in more detail by your doctor. A few potential side effects are listed below, however, the vast majority of patients experience no side effects at all.

What if I am taking blood thinning medications? (Eg., Coumadin, Plavix, Ticlid, Aggronox)

Coumadin must be stopped 5 days before your procedure and you must have some laboratory studies taken immediately before your procedure (Eg., PT, INR). Your doctor may ask you to stop other medications before your procedure as well.

Does the injection hurt?

The area is numbed with local anesthetic before the injection, thus most patients experience only moderate discomfort.

Will I have any restrictions?

You should take it easy on the day of an injection. Driving is generally not permitted on the day of a procedure. Otherwise no restrictions are present.

What if I have other questions?

Your doctor will be happy to answer any questions you may have either before or on the day of your procedure.

What if I obtain relief?

If you obtain relief (even temporary) from these nerve blocks, then a more permanent nerve block called Radiofrequency Ablation can be performed to provide prolonged pain relief. This procedure may be offered to you at a later date and will be explained to you separately.

Facet Nerve Rhizotomy/Radiofrequency Ablation

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What is a Facet Nerve Rhizotomy

A Facet Nerve Rhizotomy is a procedure whereby a needle is placed on the small nerves supplying sensation to the joints of the spine. After proper needle placement, the nerve is heated to produce a prolonged numbing effect by destroying the nerve. The purpose of the procedure is to reduce pain for en extended period of time (several months to years).

What are facet joints?

Facet joints are small joints found throughout the spine which enable movement. Like other joints in the body, these joints may become arthritic with aging. Who can benefit from Facet Nerve Rhizotomy? Patients with back and neck pain due to arthritis of the spine as well as certain types of headaches may benefit from Facet Nerve Rhizotomy. Prior to Facet Nerve Rhizotomy, facet nerve blocks are performed to determine whether these joints are the source of your pain.

How do Facet Nerve Rhizotomies help?

Facet Nerve Rhizotomies destroy small nerves which carry painful signals to the spinal cord. By destroying these nerves, pain caused by spinal arthritis can be reduced.

How often can these injections be given?

Your doctor will determine how many injections should be given based on your treatment response.

What are the possible side effects?

As with any procedure, a small number of patients may experience side effects, which will be explained in more detail by your doctor. A few potential side effects are listed below, however, the vast majority of patients experience no side effects at all.

What if I am taking blood thinning medications? (Eg., Coumadin, Plavix, Ticlid, Aggronox)

Coumadin must be stopped 5 days before your procedure and you must have some laboratory studies taken immediately before your procedure (Eg., PT, INR). Your doctor may ask you to stop other medications before your procedure as well.

Does the injection hurt?

The area is numbed with local anesthetic before the injection, thus most patients experience only moderate discomfort.

Will I have any restrictions?

You should take it easy on the day of an injection. Driving is generally not permitted on the day of a procedure. Otherwise no restrictions are present.

Intercostal Nerve Block

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What is an Intercostal Nerve Block?

An Intercostal Nerve Block is an injection of anesthetic medication onto intercostal nerves.

What are intercostal nerves?

Intercostal nerves are nerves which leave the middle of the spine and travel around to the front of the chest under the ribs. The nerves are responsible for controlling sensation to the chest wall. Blocking these nerves can reduce pain in the chest and help determine the cause of your pain.

What happens during the procedure?

You will lie on your stomach and 3 or 4 thin needles will be placed into your back under x-ray guidance under the appropriate ribs.

Who can benefit from Intercostal Nerve Blocks?

Patients with chest wall pain can benefit from Intercostal Nerve Blocks. Other painful conditions such as rib fractures can also obtain relief.

How often can these injections be given?

Your doctor will determine how many injections should be given, however, 5 to 6 injections can usually be given per year. Your relief from each injection will determine how many injections can be given.

What are the possible side effects?

As with any procedure, a small number of patients may experience side effects which will be explained in more detail by your doctor. A few potential side effects are listed below, however, the vast majority of patients experience no side effects at all.

What if I am taking blood thinning medications? (Eg., Coumadin, Plavix, Ticlid, Aggronox)

Coumadin must be stopped 5 days before your procedure and you must have some laboratory studies taken immediately before your procedure (Eg., PT, INR). Your doctor may ask you to stop other medications before your procedure as well.

Does the injection hurt?

The area is numbed with local anesthetic before the injection, thus most patients experience only moderate discomfort.

Will I have any restrictions?

You should take it easy on the day of an injection. Driving is generally not permitted on the day of a procedure. Otherwise no restrictions are present.

What if I have other questions?

Your doctor will be happy to answer any further questions you may have either before or on the day of your procedure.

Lumbar Sympathetic Block

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What is a Lumbar Sympathetic Block (LSB)?

A LSB is an injection of anesthetic medication onto nerves in the spine called the lumbar sympathetic nerves.

What are lumbar sympathetic nerves?

Lumbar sympathetic nerves are nerves which are next to the lower spinal bones. The nerves are responsible for controlling the amount of blood flow to the lower extremities. Blocking these nerves generally increases the amount of blood which goes to the legs and feet. These are not the nerves which control sensation or strength to the legs, therefore, blocking these nerves does not usually weaken your legs.

Who can benefit from LSBs?

Patients with leg pain as a result of certain conditions can benefit from LSBs. Patients with poor blood flow may also be candidates for LSBs in order to increase blood flow to the legs and feet.

How do LSBs help?

LSBs can reduce pain by improving blood flow in the affected extremity. In certain pain conditions the lumbar sympathetic nerves do not function properly and blocking them can provide pain relief and allow patients to perform physical therapy. Your doctor will determine whether you should participate in physical therapy after your LSBs.

How often can these injections be given?

Your doctor will determine how many injections should be given, however, 5 to 6 injections can usually be given per year. Your relief from each injection will determine how many injections can be given.

What are the possible side effects?

As with any procedure, a small number of patients may experience side effects which will be explained in more detail by your doctor. A few potential side effects are listed below, however, the vast majority of patients experience no side effects at all.

What if I am taking blood thinning medications? (Eg., Coumadin, Plavix, Ticlid, Aggronox)

Coumadin must be stopped 5 days before your procedure and you must have some laboratory studies taken immediately before your procedure (Eg., PT, INR). Your doctor may ask you to stop other medications before your procedure as well.

Does the injection hurt?

The area is numbed with local anesthetic before the injection, thus most patients experience only moderate discomfort.

Will I have any restrictions?

You should take it easy on the day of an injection. Driving is generally not permitted on the day of a procedure. Otherwise no restrictions are present. You may be asked to participate in physical therapy after the procedure.

Nucleoplasty

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What is Nucleoplasty?

Nucleoplasty is a procedure with involves placing a needle into a herniated disc and removing a small portion of the disc through the needle.

How does it help the pain?

By removing a portion of the disc, the size of the disc herniation can be reduced. By reducing the size of the disc herniation, pressure on nearby nerves is reduced often provding relief of pain.

Who can benefit from Nucleoplasty?

Patients with herniated discs who suffer from back or leg pain can make good candidates for nucleoplasty. Patients having a nucleoplasty have often failed other conservative treatments including physical therapy, medications, or epidural steroid injections.

What happens during the procedure?

An IV will be started prior to the procedure and you will be given medicine to make you feel sleepy. You will lie on your stomach and your back will be cleaned and draped with sterile dressings. The skin over the area is numbed and a thin needle is inserted into the herniated disc using x-ray guidance. A special probe is inserted through the needle which attaches to a machine. A small amount of tissue is removed from the disc. The procedure takes approximately 30 minutes.

What happens after the procedure?

You will be monitored in the office for 1 hour following the procedure. Rest is encouraged the day of the procedure and ice may be applied to the site of the injection. You may feel more discomfort over the next few days, however, your pain will generally improve within 1-2 weeks. You will be seen two weeks after the procedure for a follow up visit.

What are the possible side effects?

As with any procedure, a small number of patients may experience side effects which will be explained in more detail by your doctor. A few potential side effects are listed below, however, the vast majority of patients experience no side effects at all.

What if I am taking blood thinning medications? (Eg., Coumadin, Plavix, Ticlid, Aggronox)

Coumadin must be stopped 5 days before your procedure and you must have some laboratory studies taken immediately before your procedure (Eg., PT, INR). Your doctor may ask you to stop other medications before your procedure as well.

Does the procedure hurt?

Because you will be slightly sedated, you may not remember the procedure. In addition, the area is numbed with local anesthetic before the procedure, thus most patients experience only modest discomfort.

Will I have any restrictions?

Driving is not permitted on the day of the procedure. You should take it easy on the day of the procedure.

Percutaneous Vertebroplasty

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What is Percutaneous Vertebroplasty?

Percutaneous Vertebroplasty is an injection of bone cement into fractured vertebral bodies.

What is a vertebral compression fracture?

A vertebral compression fracture is a partial collapse of a vertebrae or spine bone.

Who can benefit from Percutaneous Vertebroplasty?

Patients with vertebral compression fractures may benefit from Percutaneous Vertebroplasty. Patients with compression fractures may have back pain or leg pain. Fractures may occur suddenly or over time. Patients with osteoporosis are at increased risk of developing compression fractures. Fractures may also occur in patients with malignancy (cancer).

How does Percutaneous Vertebroplasty help?

During the procedure a small amount of liquid bone cement is injected into the collapsed bone thru a needle. The cement quickly hardens inside the bone and causes the fracture to heal.

How many fractures can be treated?

Generally speaking, two (2) fractures can be treated during one session.

What are the possible side effects?

As with any procedure, a small number of patients may experience side effects, which will be explained in more detail by your doctor. A few potential side effects are listed below, however, the vast majority of patients experience no side effects at all.

What if I am taking blood-thinning medications? (Eg., Coumadin, Plavix, Ticlid, Aggronox)

Coumadin must be stopped 5 days before your procedure and you must have some laboratory studies taken immediately before your procedure (Eg., PT, INR). Your doctor may ask you to stop other medications before your procedure as well.

Does the injection hurt?

The area is numbed with local anesthetic before the injection, thus most patients experience only moderate discomfort. Patients are also given sedation during the procedure. The procedure takes approximately 30 minutes to perform.

Will I have any restrictions?

You should take it easy on the day of an injection. Driving is generally not permitted on the day of a procedure. Otherwise no restrictions are present.

Sacroiliac (SI) Joint Injection

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What is a SI Joint Injection?

A SI joint injection is an injection of steroid medication into the sacroiliac joint.

What is the sacroiliac joint?

The sacroiliac (SI) joint is a joint which separates hipbone and the tailbone.

Who can benefit from Sacroiliac Joint Injections?

Patients with back pain, buttuck pain or hip pain can benefit from SI Joint Injection. Patients with continued back pain after surgery may also benefit from SI Joint Iinjection.

How do SI joint injections help?

Steroids are potent anti-inflammatory medicines which can decrease swelling and pain. Because the medications are delivered to the site of pain, smaller doses can be given, generally with more relief than medicines given by mouth.

How often can these injections be given?

Your doctor will determine how many injections should be given, however, 5 to 6 injections can usually be given per year. Your relief from each injection will determine how many injections can be given.

What are the possible side effects?

As with any procedure, a small number of patients may experience side effects which will be explained in more detail by your doctor. A few potential side effects are listed below, however, the vast majority of patients experience no side effects at all.

What if I am diabetic?

Your blood sugars may be increased for a few days following the injection and may require closer monitoring.

What if I am taking blood thinning medications? (Eg., Coumadin, Plavix, Ticlid, Aggronox)

Coumadin must be stopped 5 days before your procedure and you must have some laboratory studies taken immediately before your procedure (Eg., PT, INR). Your doctor may ask you to stop other medications before your procedure as well..

Does the injection hurt?

The area is numbed with local anesthetic before the injection, thus most patients experience only moderate discomfort.

Will I have any restrictions?

You should take it easy on the day of an injection. Driving is generally not permitted on the day of a procedure. Otherwise no restrictions are present.

What if I have other questions?

Your doctor will be happy to answer any questions you may have either before or on the day of your procedure.

Stellate Ganglion Block

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What is a Stellate Ganglion Block?

A Stellate Ganglion Block is a procedure in which a small needle are placed into the neck under x-ray guidance. Anesthetic medicines are injected in order to numb a group of nerves called the Stellate Ganglion.

How does it help the pain?

In some pain conditions, certain nerves in the body can function improperly. By blocking the Stellate Ganglion nerves, patients can obtain pain relief of these conditions for variable lengths of time. Patients can obtain relief of neck, arm or facial pains with this procedure. Additionally, blood flow to the arm and face can be increased for a temporary period of time after the block.

Who can benefit from Stellate Ganglion Blocks?

Patients with nerve pain related to Reflex Sympathetic Dystrophy can obtain relief with these blocks. Patients with poor blood flow or decreased circulation to the hand may also obtain relief.

What happens during the procedure?

An IV will be started prior to the procedure and removed at the end of the procedure. You will lie on your back and your neck will be cleaned and draped with sterile dressings. The skin over the area is numbed and a thin needle is inserted near the spine using x-ray guidance. The procedure takes approximately 10 minutes.

What happens after the procedure?

You will be monitored in the office for 15 minutes following the procedure. The temperature of your hands will be monitored during the procedure. Rest is encouraged the day of the procedure, however, you may be asked to participate in a physical therapy program after your injection. Ice may be applied to the site of the injection. You may feel some locoalized discomfort over the next few days, however, this will generally resolve within 1-2 weeks. You will be seen 2 weeks after the procedure for a follow up visit.

What are the possible side effects?

As with any procedure, a small number of patients may experience side effects which will be explained in more detail by your doctor. A few potential side effects are listed below, however, the vast majority of patients experience no side effects at all.

What if I am taking blood thinning medications? (Eg., Coumadin)

You must notify your doctor and discontinue the medicine 5 days before your injection and have appropriate laboratory studies taken prior to your injection (Eg., PT, INR).

Will I have any restrictions?

Driving is not permitted on the day of the procedure. You should not eat solid food for 3 hours after the procedure.

Trigger Point Injection (TPI)

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What is a Trigger Point Injection (TPI)?

A TPI is an injection of anesthetic medication into an area of muscle called a trigger point.

What is a Trigger Point?

A trigger point is an area of localized muscle spasm or pain. Such painful areas can be caused from muscle damage or from damage to nearby ligaments or joints.

Who can benefit from TPIs?

Patients with neck pain, back pain, buttock pain or hip pain can benefit from TPIs. Patients with continued back pain after surgery may also benefit from trigger point injections.

How do TPIs help?

By blocking the painful signals from the muscle, TPIs can help by allowing patients to stretch the affected muscle with less pain. Blood flow to the area may also be increased thus promoting tissue healing. A mixture of numbing medicine sometimes combined with steroids is used for the injection. Steroids are potent anti-inflammatory agents. The injections can therefore decrease swelling and pain. Because the medications are delivered to the site of pain, smaller doses can be given, generally with more relief than medicines given by mouth.

How often can these injections be given?

Your doctor will determine how many injections should be given, however, 5 to 6 injections can usually be given per year. Your relief from each injection will determine how many injections can be given.

What are the possible side effects?

As with any procedure, a small number of patients may experience side effects which will be explained in more detail by your doctor. A few potential side effects are listed below, however, the vast majority of patients experience no side effects at all.

What if I am a diabetic?

Your blood sugars may be increased for a few days following the injection and may require closer monitoring.

What if I am taking blood thinning medications? (Eg., Coumadin, Plavix, Ticlid, Aggronox)

Coumadin must be stopped 5 days before your procedure and you must have some laboratory studies taken immediately before your procedure (Eg., PT, INR). Your doctor may ask you to stop other medications before your procedure as well.

Does the injection hurt?

The area is numbed with local anesthetic before the injection, thus most patients experience only moderate discomfort.

Will I have any restrictions?

You should take it easy on the day of an injection. Otherwise no restrictions are present.

Pre-Procedure Instructions

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Before your Procedure: Transportation: Diet: After: If you have any questions regarding these instructions or any part of your procedure, please call our office at 610-954-9040 during regular hours Monday - Friday, 8:30 A.M. - 4:00 P.M. It is important to tell your doctor and others involved in your health care if you are taking or have been taking any non-prescription drugs, vitamins, minerals, herbals or other nutritional supplements. Any of these may interact with some foods or medicines and cause a reaction.

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Post-Procedure Instructions

Medicines: Diet: Activity: Dressing: If you experience any of the following symptoms, please call the office: If you have any questions regarding these instructions or any part of your procedure, please call our office at 610-954-9040 during regular hours. Monday - Friday, 8:30 a.m. - 4:00 p.m.