MILD


This new procedure is the least invasive surgical procedure to treat symptomatic lumbar spinal stenosis (LSS) patients, and many report immediate relief.


GENICULAR NERVE BLOCKS & ABLATIONS

Genicular Nerves are located around the knee and hip joints. The procedure is utilized to control pain from conditions for which there is no treatment (like pain after Knee Replacement). A diagnostic test is performed by injecting local anesthetic adjacent to those nerves. If the test  provides relief for the duration of the local anesthetic, a Radiofrequency Ablation (cauterization) of the nerves is recommended.

KYPHOPLASTY

This is a procedure performed for painful compression fractures of the spine. A needle is placed in the affected level, a balloon is placed through the needle. The balloon is then inflated to generate a cavity and regain the lost height. The cavity is filled with an injectable cement to act as an internal scaffolding mechanism. Procedure is performed under sedation with little or no pain involved.

SACROPLASTY

This procedure is performed for Sacral Insufficiency Fractures. A needle is expertly placed adjacent to the fracture, cement is then injected to bridge the gap and stabilize the fracture.

ULTRASOUND GUIDED PROCEDURES

Ultrasound is used to guide soft tissue injections to render them more accurate. Ultrasound guidance is relied upon in various Abdominal Wall Injections, Joint injections and Peripheral Nerve Injection

DISCOGRAPHY (DISCOGRAM)

Discogram is a diagnostic procedure (a test), that is considered if a physician suspects that the patient’s pain originates from an inflamed disc. A small needle is expertly inserted into the middle of the suspected disc under X-Ray guidance. Contrast is then injected under pressure to simulate increase pressure during various daily activities (lifting, bending and twisting which increase the pain). If increasing the pressure in the disc reproduces the patient’s symptoms, the test is considered positive.

MEDIAL BRANCH BLOCK

Medial Branch Blocks are used as a diagnostic tool and usually give temporary relief of pain symptoms. Medial branch nerves are small nerves that feed out from the facet joints in the spine and carry pain signals from those joints. Facet joint injections are often used to identify a pain source; however, these injections do not always provide lasting pain relief. In such cases, it is beneficial to confirm that the facet joint is the source of a patient's pain. A medial branch nerve block temporarily interrupts the pain signal being carried by the medial branch nerves that supply a specific facet joint. If the patient has the appropriate duration of pain relief after the medial branch nerve block, that individual may be a candidate for radiofrequency neurolysis.

RADIOFREQUENCY ABALTION OR NEUROLYSIS

In modern medical practice, radiofrequency nerve ablation is a useful treatment option for certain types of chronic pain including head and neck pain from whiplash injury, chronic lumbar facet joint pain, and certain types of neuralgia. Diagnostic nerve blocks are routinely performed as a screening test before nerve ablation by radiofrequency is considered. Radiofrequency neurolysis can be performed as an outpatient procedure.

DISCOGRAM- Lumbar or cervical discogram is a pre-surgical diagnostic study used to determine if your pain is generated by a disc. The study is designed to provide a pain "road map" and can help your doctor decide whether or not surgery is necessary. You will be given light sedation and x-ray guidance will be used to assure accurate placement of the needle. After proper placement has been established, x-ray contrast is injected into the disc. The pressure in the disc is monitored and recorded during the injection. The discogram is positive if the painful disc  is concordant with the patient’s usual pain during provocative injection of contrast.
PERCUTANEOUS DISC DECOMPRESSION - uses a minimally invasive device to relieve pain from bulging spinal discs which is painful in itself or it compresses the exiting radicular nerve.


 SPINAL CORD STIMULATION

This involves placement of catheters in the epidural space (outside the Dura which is the sac that surrounds the spinal cord and spinal fluid). A tiny electric current is delivered through the catheter which interrupts the pain signals on their way to the brain. Patients experience tingling sensation instead of pain at the targeted area. Candidates for the procedure undergo a trial that lasts a few days. If the trial is successful a permanent system is implanted a few weeks later.

LUMBAR SYMPATHETIC BLOCKS

This chain of nerves is located in the back of the abdominal cavity. It is part of the autonomic nervous system which helps regulate temperature, blood flow and other autonomic functions. The procedure is performed in painful conditions of the lower extremities, known as Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD).

SELECTIVE NERVE ROOT BLOCK

A nerve root block is an injection placed into the sheath surrounding a nerve root in the spine under X-Ray guidance. The exam uses therapeutic steroid and local anesthetic to decrease pain and inflammation. Pain relief from the procedure varies from minimal to long-term, depending on the specific symptoms.

CERVICAL/LUMBAR STEROID INJECTION: Steroid is injected into the epidural space, which is located outside of the spinal cord area, to treat symptoms secondary to nerve root irritation or central spinal canal stenosis.
FACET INJECTION- CERVICAL/LUMBAR: Select forms of neck and back pain may be reduced or eliminated by injections of steroid around the joints of the spine. This is a great treatment for pain resulting from arthritis of the spine.
SACROILIAC JOINT  INJECTION: Injection of steroid into the sacroiliac joint that targets a reduction in referred pain to the lower back, buttock and leg. The SI Joint can become inflamed and painful for some patients.
TRIGGER POINT INJECTION: Injection of local anesthetic and steroid into painful areas of muscle spasm.
OCCIPITAL NERVE BLOCK: Injection of anesthetic targeting the occipital nerves at the base of the skull offering relief to patients suffering from a multitude of different headache types and/or occipital neuralgia.
PERIPHERAL NEREV BLOCK: Injection of steroid at painful peripheral nerves for both diagnostic and therapeutic benefit. Injections can target intercostal (rib), ilioinguinal, iliohypogastric, lateral femoral cutaneous, femoral or sciatic nerves.
CELIAC PLEXUS BLOCK  (fluoroscopically guided) - used to treat upper abdominal pain related to the internal organs.
SUPERIOR HYPOGASTRIC  PLEXUS BLOCK - used most commonly for the treatment of pelvic pain related to the internal organs.
STELLATE GANGLION BLOCK - used to decrease pain in the face or arm and increase the circulation and blood supply to the affected arm.
INTERCOSTAL NERVE BLOCK - an injection of a local anesthetic to the nerve underneath the rib to relieve chest wall pain, broken ribs, lung cancer.
LUMBAR SYMPATHETIC BLOCK - an injection of local anesthetic around a group of nerves in the lower back to relieve pain in the legs.
SPINAL DRUG DELIVERY SYSTEM (PAIN PUMP)- uses a computerized pump to deliver local anesthetics and other pain relief medications continuously into the spine to the block pain signals. It is implanted just under the ski to improve pain relief and avoid external hardware.
BOTOX INJECTION - used for headaches


ELECTRODIAGNOSTIC

We provide scheduled studies that include diagnostic Electromyography (EMG) and Nerve Conduction Study (NCS). The studies help diagnose and evaluate for injury or disease of nerve roots, nerve plexus, peripheral nerves, and muscles diseases. They test the condition of the nerves from the spine, face, and extremities, including the foot and hand. These studies are normally done together and are usually performed as a workup for complaints of pain, weakness, numbness, or tingling.

 
Electromyography

What is an EMG?

Electromyography (EMG) is a diagnostic procedure used to assess the health of muscles and the nerves that control them. Electrical signals travel along the nerve and cause the muscles to contract. An EMG translates these signals into waveforms, sounds and numerical values that a physician will interpret to diagnose conditions that can cause numbness, tingling or weakness.

Who performs the EMG?

A physician who performs EMGs has graduated from medical school and has completed four years of training in a residency program such as physical medicine and rehabilitation (PMR), or neurology. Medical training helps the doctor decide which tests to perform based on your symptoms. In our practice, a board-certified PMR physician performs the EMG.

Why am I having an EMG performed?

You have been referred to have an EMG performed because you have numbness, tingling, pain, weakness, or muscle cramping.  Some of the tests that the doctor may use to diagnose your symptoms are nerve conduction studies, needle EMGs and evoked potentials. Valley's PMR physician will examine you to determine which tests to perform.

What is a nerve conduction study?

This study tests how well signals travel along a nerve and can help find the cause of abnormal nerve function. Surface electrodes are placed on the hands or feet. To test the nerve a small electrical pulse is given to the skin and a measurement is taken. The small electric pulse causes a short, mild tingling feeling. This is repeated at 2 or three points along the arm or leg. This is to measure the speed and strength of signals traveling between two or more points.

What is a needle EMG?

An EMG can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.  A fine needle or pin is inserted into a muscle. Recordings are taken with the muscle relaxed (at rest) and when the muscle is tense (contracted).  This takes a few minutes for each muscle. The doctor will interpret the waveforms and sounds transmitted to assess for any abnormalities. The needles are discarded after use to prevent transmission of infection. You may experience some temporary, minor bruising where the needle electrode was inserted into your muscle. This bruising should fade within several days. If it persists, contact your primary care doctor.

How should I prepare for the test?

Please wear comfortable, loose clothing on the day of the examination. You may be asked to change into a hospital gown for the procedure to properly assess the area of concern. Avoid applying lotion, cream, or oils to the skin the day of the procedure.  Please take all medications as prescribed by your referring physician. Please notify us and the referring physician if you are taking aspirin, any blood thinners (Coumadin, Plavix), have a pacemaker or have hemophilia the day the appointment is made.

What should I expect during the procedure?

During the nerve conduction study, you may experience a twinge or spasm as the physician is stimulating a particular nerve. During the needle EMG, the needle electrode may cause discomfort or pain that usually ends shortly after the needle is removed. The needle EMG tests the muscle during relaxation and during a slight contraction. The physician will give you instructions on relaxing and contracting the muscle.  If you're concerned about discomfort or pain, you may want to talk to the physician about taking a short break during the exam.

How long will the test take?

The test on average takes about 20 to 60 minutes. The length of time of the testing depends on where you are experiencing your symptoms (one or two extremities).

When will I receive the results?

The physical medicine and rehabilitation physician will interpret the results of your exam and prepare a report within 1-2 days of the testing. Your primary care physician, or the provider who ordered the EMG, will discuss the report with you at a follow-up appointment.



DISCOGRAM

What is it?

A discogram is a diagnostic injection performed into a spinal disc (cushion-like structure between the vertebrae).  Using x-ray guidance, dye is injected into one or more discs.  After the dye is injected, the physician can view the internal structure of each injected disc to determine the source of back pain.

What are the expected results?

This is a diagnostic procedure which helps the physician determine where your back pain is coming from.  This may help the physician determine what treatments will best control your pain.  You may be sore for a few days after the procedure.

How long will it take?

The procedure itself only takes 30-60 minutes to perform.  You will be observed in the recovery room for 30-60 minutes after the procedure.

After the procedure:

Most often you can go home in about 30-60 minutes.  Written instructions will be sent home with you.  You will need someone to drive you home and care for you for the first few hours after the procedure.  It is recommended that you take it easy for the rest of the day.

What to expect the day of your procedure?

You are expected to arrive at the surgery center at least one hour before your procedure is scheduled. Bring a responsible adult driver with you because you may be receiving medications which could impair your ability to drive. Unless you are certain you will not be receiving sedation, do not eat anything for 6 hours prior to your procedure; you may have modest amounts of clear liquids (liquids you can see through) up to 4 hours beforehand.  Please take your regularly scheduled blood pressure, heart, asthma, long-acting narcotic and nerve pain medications with sips of water as you normally would. If you have diabetes, take half of your normal dosage and bring your insulin with you.  Be sure to discontinue aspirin products and any other blood thinners as instructed.

After you arrive, you will be asked to sign-in and complete any paperwork as needed. You will then be taken to the preoperative area. At this time, a nurse will ask you some medical questions and have you sign your consent forms. It is imperative that you, the patient, inform the assistant of any changes in your history and/or physical, such as a recent flu or any health problems that might affect your procedure. Inform the staff of any allergies, especially to Betadine or Iodine.

 
MILD PROCEDURE
(Minimally Invasive Lumbar Decompression)

What is it?

The MILD procedure is a minimally invasive procedure that is effective for some causes of spinal stenosis, or narrowing of the spinal canal.  A very small incision is made.  Small amounts of tissue and bone are removed in order to relieve the pressure caused by spinal stenosis and provide pain relief.

What are the expected results?

Pain relief is typically noted within two hours after the procedure.  As inflammation from the procedure occurs, pain may return for a few days; pain relief recurs as the inflammation subsides (only a few days).

How long will it take?

It takes 20-30 minutes for each spinal level that is done.  Patient’s are typically kept in the hospital overnight and discharged the next day.   

What happens after the procedure?

You will be monitored overnight; most patients are discharged the next day.  Written instructions will be sent home with you.  There is no restriction in regards to when you can return to work or normal activities. 

What to expect the day of your procedure

You are expected to arrive at the surgery center at least one hour before your procedure is scheduled. Bring a responsible adult driver with you because you may be receiving medications which could impair your ability to drive.  Unless you are certain you will not be receiving sedation, do not eat anything for 6 hours prior to your procedure; you may have modest amounts of clear liquids (liquids you can see through) up to 4 hours beforehand.  Please take your regularly scheduled blood pressure, heart, asthma, long-acting narcotic and nerve pain medications with sips of water as you normally would. If you have diabetes, take half of your normal dosage and bring your insulin with you.  Be sure to discontinue aspirin products and any other blood thinners as instructed.

After you arrive, you will be asked to sign-in and complete any paperwork as needed. You will then be taken to the preoperative area. At this time, a nurse will ask you some medical questions and have you sign your consent forms. It is imperative that you, the patient, inform the assistant of any changes in your history and/or physical, such as a recent flu or any health problems that might affect your procedure. Inform the staff of any allergies, especially to Betadine or Iodine.

You may be asked to change into a gown.  An assistant will take your vital signs and an IV may be started in order to provide pain relief and relaxation.

The physician and nurse will talk to you before your procedure.  In certain cases an anesthesiologist may also be utilized.  You will then be positioned and the injection sites will be prepped.  Your pain management physician will perform the procedure. Medications may be administered before and during your procedure to help you relax and provide pain relief. You may doze off during this time.  Afterwards, Band-Aids will be applied as needed.

You will be transported to the recovery room area where you will be monitored anywhere from 30 minutes to an hour. You will be offered beverages and some crackers. After this, someone will take out your IV and help you get dressed if needed. Lastly, your caregiver will be given discharge instructions for your care at home.



ADHESIONLYSIS - RACZ  

What is it?

RACZ procedure is used to dissolve some of the scar tissue from around entrapped nerves in the epidural space so that medications can reach the affected areas.  To numb and break down the adhesions, a local anesthetic (numbing medication) is administered.  This procedure is also used to deliver medication to a specific site with the aid of the catheter.  A special needle and catheter are inserted into the affected area. A specialized x-ray (fluoroscopy) is used to confirm placement. Medication is then used.

What are the expected results?

The major goal of the procedure is pain relief.  You may be sore for a day or so.  As the steroid used in the injection is a time-release medication, it may take 3-10 days for you to notice pain relief.

How long will it take?

The procedure itself only takes 15-30 minutes to perform.  You will be observed in the recovery room for 30-60 minutes after the procedure.

What happens after the procedure?

Most often you can go home in about 30-60 minutes.  Written instructions will be sent home with you.  You will need someone to drive you home and care for you for the first few hours after the procedure.  It is recommended that you take it easy for the rest of the day.

What to expect the day of your procedure.

You are expected to arrive at the surgery center at least one hour before your procedure is scheduled. Bring a responsible adult driver with you because you may be receiving medications which could impair your ability to drive.  Unless you are certain you will not be receiving sedation, do not eat anything for 6 hours prior to your procedure; you may have modest amounts of clear liquids (liquids you can see through) up to 4 hours beforehand.  Please take your regularly scheduled blood pressure, heart, asthma, long-acting narcotic and nerve pain medications with sips of water as you normally would. If you have diabetes, take half of your normal dosage and bring your insulin with you.  Be sure to discontinue aspirin products and any other blood thinners as instructed.

After you arrive, you will be asked to sign-in and complete any paperwork as needed. You will then be taken to the preoperative area. At this time, a nurse will ask you some medical questions and have you sign your consent forms. It is imperative that you, the patient, inform the assistant of any changes in your history and/or physical, such as a recent flu or any health problems that might affect your procedure. Inform the staff of any allergies, especially to Betadine or Iodine.

You may be asked to change into a gown.  An assistant will take your vital signs and an IV may be started in order to provide pain relief and relaxation.

The physician and nurse will talk to you before your procedure.  In certain cases an anesthesiologist may also be utilized.  You will then be positioned and the injection sites will be prepped.  Your pain management physician will perform the procedure. Medications may be administered before and during your procedure to help you relax and provide pain relief. You may doze off during this time.  Afterwards, Band-Aids will be applied as needed.

You will be transported to the recovery room area where you will be monitored anywhere from 30 minutes to an hour. You will be offered beverages and some crackers. After this, someone will take out your IV and help you get dressed if needed. Lastly, your caregiver will be given discharge instructions for your care at home.


KYPHOPLASTY

What is it?

Kyphoplasty is a minimally invasive procedure used for compression fractures in the vertebrae (the small bones that make up the spinal column), usually caused by osteoporosis. Using x-ray guidance, a balloon-like device is inserted into the vertebra to help restore the height and shape of the spine and a cement-like substance is injected to repair and stabilize it.

What are the expected results?

Pain relief may be immediate for some patients. In others, pain is eliminated or reduced within two days.

How long will it take?

The procedure itself takes approximately 60 minutes, but you may be observed for 30-60 minutes after the procedure.

After the procedure:

Most often you can go home in about 30-60 minutes.  Written instructions will be sent home with you.  You will need someone to drive you home and care for you for the first 24 hours after the procedure, as bed rest is recommended during this time.

What to expect the day of your procedure?

You are expected to arrive at the surgery center at least one hour before your procedure is scheduled. Bring a responsible adult driver with you because you may be receiving medications which could impair your ability to drive. Unless you are certain you will not be receiving sedation, do not eat anything for 6 hours prior to your procedure; you may have modest amounts of clear liquids (liquids you can see through) up to 4 hours beforehand. Please take your regularly scheduled blood pressure and heart medications with a sip of water as you normally would. If you have diabetes, take half of your normal dosage and bring your insulin with you.



RADIOFREQUENCY LESIONING

What is it?

Radiofrequency (RF) lesioning is a procedure using a specialized machine that disrupts nerve conduction along nerves transmitting pain impulses by applying heat lesions.  Sedation and a local anesthetic is given. Special needles are then inserted into the affected areas. The physician will use fluoroscopy (a specialized x-ray) to guide the needles. Electrical stimulation is performed before any lesioning. This may produce a buzzing or tingling sensation. You may also feel your muscles jump. You will be allowed to awaken during this time in order to pinpoint the areas to be lesioned. Electrical current is then used to disrupt the affected nerves.

The procedure is specifically for pain emanating from facet joints. These joints are located along the entire spine on each side of the midline. Unfortunately, most other types of pain cannot be successfully treated with this form of therapy.  A variant of radiofrequency lesioning called “Pulsed RF” has been utilized to treat some other types of pain. Instead of a heat lesion, it applies an electromagnetic impulse to adjacent nerves. However, Pulsed RF is considered experimental and therefore not covered under most insurance plans, including Medicare. The reported pain relief is typically less dramatic and lasts for only 2-3 months.

What are the expected results?

Pain relief from this procedure lasts until the nerves regenerate, which is typically 9 months but can range from six months to two years.  Patients are typically sore for a few days after the procedure, although responses can vary.  Pain relief is typically experienced within 1-2 weeks after the procedure.

How long will it take?

The procedure itself typically takes 30-60 minutes to perform.  You will be observed in the recovery room for 30-60 minutes after the procedure.

What happens after the procedure?

Most often you can go home in about 30-60 minutes.  Written instructions will be sent home with you.  You will need someone to drive you home and care for you for the first few hours after the procedure.  You will need to take is easy for the rest of the day.

What to expect the day of your procedure.

You are expected to arrive at the surgery center at least one hour before your procedure is scheduled. Bring a responsible adult driver with you because you will be receiving medications which could impair your ability to drive. Unless you are certain you will not be receiving sedation, do not eat anything for 6 hours prior to your procedure; you may have modest amounts of clear liquids (liquids you can see through) up to 4 hours beforehand.  Please take your regularly scheduled blood pressure, heart, asthma, long-acting narcotic and nerve pain medications with sips of water as you normally would. If you have diabetes, take half of your normal dosage and bring your insulin with you.  Be sure to discontinue aspirin products and any other blood thinners as instructed.

After you arrive, you will be asked to sign-in and complete any paperwork as needed. You will then be taken to the preoperative area. At this time, a nurse will ask you some medical questions and have you sign your consent forms. It is imperative that you, the patient, inform the assistant of any changes in your history and/or physical, such as a recent flu or any health problems that might affect your procedure. Inform the staff of any allergies, especially to Betadine or Iodine.

You may be asked to change into a gown.  An assistant will take your vital signs and an IV may be started in order to provide pain relief and relaxation.Type your paragraph here.

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