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SPECIALTIES

CERVICAL EPIDURAL STEROID INJECTION (CESI)

The dura is a protective covering of the spinal cord and its nerves.  The area surrounding the dura s the epidural space.  It contains fat and small vessels, and medications can easily spread when injected into this space.

The cervical area of the spine has seven bones, called vertebrae.  Soft discs found between these vertebrae cushion them and control motion.  If a disc tears or ruptures, chemicals inside may leak out.  This can inflame the nerve roots or the dura, and cause neck pain radiating down the arm.  The discs may also push outward towards the nerves or spinal cord, compressing the roots or the spinal cord, thereby causing pain, numbness or weakness.  This is called disc bulge or herniation.  Bone spurs, called osteophytes, can also press against nerve roots and cause pain radiating into the arm.

A cervical epidural steroid injection is a simple procedure for treating neck, upper back, shoulder, and arm pain, commonly due to disc bulges and arthritis.

A local anesthetic will be used to numb your skin.  The doctor will then insert a thin needle directly into the epidural space.  Fluoroscopy, a type of x-ray, will be used to ensure proper needle placement.  A dye will also be injected to make sure the needle is in the correct spot.  Once your physician is sure the needle is correctly placed, the medicine, a mixture of local anesthetic and steroid will be injected.

You may want to check for pain by moving your neck in ways that hurt before the injection but do not overdo it.  You may feel immediate pain relief and numbness in your neck and arm for up to six hours after the injection.  This means the medication had reached the right spot.  Your pain may return after this short pain-free period or may even be a little worse for a day or two.  This is normal.  It may be caused by needle irritation of by the steroid itself.  Steroids usually take two to three days to start working but can take as long as a week.  Depending on the amount of inflammation, an injection could offer several months of pain relief before further treatment is needed.

CERVICAL MEDIAL BRANCH BLOCK (CMBB)

Facet joints connect the vertebrae, the bones of the spine.  They help guide your spine when you move.  The neck area of the spine is called the cervical region.  It contains seven vertebrae.  Facet joints are found on both sides of the spine.  Each is about the size of a thumbnail.  Cervical facet joints are named for the vertebrae they connect and the side of the spine where they are found.  Medical branch nerves are found near facet joints.  They communicate pain from the facet joints.  They tell the brain when a facet joint has been injured.

You may feel pain if a cervical facet joint is injured.  Sometimes it feels like simple muscle tension.  Other times it can be severe pain.  The cartilage inside the joint may be injured.  Other times only connecting ligaments surrounding the joints are injured.  Facet pain also depends on which joint is affected.  Cervical facet joint pain can occur in an area from your head down to your shoulder blade.

A cervical medial branch block is a simple procedure for diagnosing and treating headaches, neck, shoulder, and upper back pain.  This type of pain is most commonly seen with arthritis, degenerative joint disease, and injuries.

In a cervical medial branch block, an anesthetic is injected near the medial branch nerve.  This stops the transmission of pain signals from the facet joint.  If this reduces your pain and helps you move your back like normal, it may tell the doctor which facet joint is causing the pain.

A local anesthetic will be used to numb your skin.  Fluoroscopy, a type of x-ray, will be used to ensure the safe and proper position of the needle.  The doctor will insert a thin needle near the medial branch nerve.  Once the doctor is sure the needle is correctly placed, the medicine will be injected.

You may feel sore for one to four days.  This is normal and may be caused by muscle and nerve irritation.  It may help to move your neck in ways that hurt before the injection, to see if the pain is still there, but do not overdo it.  Take it easy for the rest of the day.

You may feel immediate pain relief and numbness in your neck for a short period of time after the injection.  This tells you that the medication has reached the right spot.  If your pain goes away for a short time, but then returns, you may be a candidate for radio-frequency ablation (RFA) of the medial branch nerve.

CERVICAL RADIO-FREQUENCY ABLATION (RFA)

A cervical radio-frequency ablation (RFA) is a procedure for treating neck, shoulder, and upper back pain.  It is also called cervical facet thermal coagulation or rhizotomy.  RFA uses radio-frequency energy to disrupt nerve function.  Then this is done to a cervical medial branch nerve, the nerve can no longer transmit pain from an injured facet joint.

A local anesthetic will be used to numb your skin.  Fluoroscopy, a type of x-ray, will be used to insure the safe and proper position of the needle.  The doctor will then check that the needle is in the proper position by stimulating the nerve.  This may cause muscle twitching and provoke some of your pain.  With the needle in the correct position, the area will be numbed.  Your provider will then use radio-frequency energy, this is commonly called “burning” of the nerve, to disrupt the medical branch nerve.  This is often repeated at more than one level of the spine.

You may feel sore for one to four days.  This is normal and may be caused by muscle and nerve irritation.  Your neck, mid back, or lower back may feel numb, weak or itchy for a couple of weeks.  Be patient, as full pain relief normally takes two to three weeks.  While it varies from patient to patient, nerves can take up to 18 months to regenerate after a RFA.  Your pain may or may not return when the nerves regenerate.  If it does, another RFA can be performed.

OCCIPITAL NERVE PULSED RADIO-FREQUENCY NEUROLYSIS

An occipital nerve radio-frequency neurolysis is an outpatient procedure for treating headaches.  The greater occipital nerve (GON) and/or the lesser occipital nerve (LON) can be involved.  This procedure is performed on patients who get temporary pain relief from an occipital nerve block.  This is likely to provide longer-term pain relief.

A local anesthetic will be used to numb your skin.  Fluoroscopy, a type of x-ray, will be used to ensurethe safe and proper position of the needle.  The doctor will then check that the needle is in the proper position by stimulating the nerve.

This may cause muscle twitching and provoke some of your pain.  With the needle in the correct position, the area will be numbed.  Your provider will then use radio-frequency energy, this is commonly called “burning” of the nerve, to disrupt the occipital nerves.

You may feel immediate pain relief and numbness in the back of your head for up to six hours after the injection.  Your pain may be a little worse for a day or two.  This is normal.  It may be caused by needle irritation.

While it varies from patient to patient, nerves can take up to 18 months to regenerate after an RFA.  Your pain may or may not return when the nerves regenerate.  If it does, another RFA can be done.

OCCIPITAL NERVE BLOCK (ONB)

The greater and lesser occipital nerves are located in the back of your head.  They produce tenderness and headaches at the base of your head.  These nerves can be irritated from trauma or chronic upper neck pain.

You may feel a headache if the greater or lesser occipital nerves are irritated.  Sometimes it feels like muscle tension in the head.  But at other times the pain may be severe and feel like a migraine.  Unlike a migraine, occipital nerve pain does not
respond to migraine medications.  However, it does decrease with an occipital nerve block.

An occipital nerve block is an outpatient procedure for treating headaches.  The greater occipital nerve (GON) and/or the lesser occipital nerve (LON) can be involved.  In an occipital nerve block, a local anesthetic and steroid are injected near the GON and LON.  The anesthetic helps to temporarily numb pain, and the steroid helps reduce inflammation.  This injection can be used to diagnose or treat your pain.

The doctor will insert a small needle near the GON and LON into the scalp at the base of the skull.  When the doctor is sure the needle is at the correct place, the medication will be injected.

You may feel immediate pain relief and numbness in the back of your head for up to six hours after the injection.  This tells you the medication has reached the right spot.  Your pain may return after this short pain-free period or may even be a little worse for a day or two.  This is normal.  It may be caused by the needle irritated or by the steroid itself.  Steroids usually take two to three days to start working but can take as long as a week.  If our pain goes away for a short time, but then returns, you may be a candidate for a pulsed radio-frequency ablation (RFA) of the occipital nerves.

THORACIC EPIDURAL STEROID INJECTION (TESI)

The thoracic epidural steroid injection is a simple procedure for treating upper and middle back pain.  The medication from the injection travels through the epidural space calming the painful nerves.

A local anesthetic will be used to numb your skin.  The doctor will then insert a thin needle directly into the epidural space.  Fluoroscopy, a type of x-ray, will be used to insure proper needle placement.  A dye will also be injected to make sure the needle is in the correct spot.  Once your physician is sure that the needle is correctly placed, the medicine, a mixture of local anesthetic and steroid, will be injected.

You may want to check for pain by moving your neck back in ways that hurt before the injection, but do not overdo it.  You may feel immediate pain relief and numbness in your back and legs for up to six hours after the injection.  This means the medication has reached the right spot.  Your pain may return after this short pain-free period or may even be a little worse for a day or two.  This is normal.  It may be caused by needle irritation or the steroid itself.  Steroids usually take two to three days to start working but can take as long as a week.  Depending on the amount of inflammation, an injection could offer several months of pain relief before further treatment is needed.

THORACIC MEDIAL BRANCH BLOCK (TMBB)

A thoracic medial branch block is an outpatient procedure for diagnosing and treating upper and middle back pain.  In a thoracic medial branch block, an anesthetic is injected near the medial branch nerve.  This stops the transmission of pain signals from the facet joint.  If this reduced your pain and helps you move your back like normal, it may tell the doctor which facet joint is causing the pain.

A local anesthetic will be used to numb your skin.  Fluoroscopy, a type of x-ray, will be used to ensure the safe and proper position of the needle.  The doctor will insert a thin needle near the medial branch nerve.  Once the doctor is sure the needle is correctly placed, the medicine is injected.

You may feel sore for one to four days.  This is normal and may be caused by muscle and nerve irritation.  It may help to move your upper and mid back in ways that hurt before the injection to see if the pain is still there, but do not overdo it.  Take it easy for the rest of the day.  You may feel immediate pain relief and numbness in your upper and mid back for a limited period of time after the injection.  This tells you that the medication has reached the right spot.  If your pain goes away for a short time, but then returns, you may be a candidate for radio-frequency ablation (RFA) of the medial branch nerve.

THORACIC RADIO-FREQUENCY ABLATION (RFA)

WHAT IS A THORACIC RFA?

A thoracic radio-frequency ablation (RFA) is an outpatient procedure for treating upper and middle back pain.  It is also called thoracic facet thermal coagulation or rhizotomy.  RFA uses radio-frequency energy to disrupt nerve function.  When this is done to a lumbar medial branch nerve, the nerve can no longer transmit pain from an injured or facet joint.

WHAT TO EXPECT DURING THE PROCEDURE

A local anesthetic will be used to numb your skin.  Fluoroscopy, a type of x-ray, will be used to ensure the safe and proper position of the needle.  The doctor will then check that the needle is in the proper position by stimulating the nerve.  This may cause muscle twitching and provoke some of your pain.  With the needle in the correct position, the area will be numbed.  Your provider will then use radio-frequency energy, this is commonly called “burning” of the nerve, to disrupt the medial branch nerve.  This is often repeated at more than one level of the spine.

WHAT HAPPENS AFTER THE PROCEDURE?

You may feel sore for one to four days.  This is normal and may be caused by muscle and nerve irritation.  Your neck, mid back, or lower back may feel numb, weak or itchy for a couple of weeks.  Be patient, as full pain relief normally takes two to three weeks.  While it varies from patient to patient, nerves can take up to 18 months to regenerate after a RFA.  Your pain may or may not return when the nerves regenerate.  If it does, another RFA can be done.

LUMBAR EPIDURAL STEROID INJECTION (LESI)

The lumbar area of the spine has five bones, called vertebrae.  Soft discs between the two vertebrae act as cushions, offering support and helping to control motion.  If a disc tears, chemicals inside may leak out, causing inflammation of nerve roots or the dura, and pain.  A large tear may cause a disc to bulge, resulting in inflammation and pain.  Bone spurs, called osteophytes, can also press against nerve roots and cause pain.

A lumbar epidural steroid injection is a minimally invasive procedure to help treat pain caused by inflamed spinal nerves.  The medication from the injection travels through the epidural space calming the painful nerves.

A local anesthetic will be used to numb your skin.  The doctor will then insert a thin needle directly into the epidural space.  Fluoroscopy, a type of x-ray, will be used to ensure proper needle placement.  A dye will also be injected to make sure the needle is in the correct spot.  Once your physician is sure the needle is correctly placed, the medicine, a mixture of local anesthetic and steroid, will be injected.

You may want to check for pain by moving your back in ways that hurt before the injection, but do not overdo it.  You may feel immediate pain relief and numbness in your back and legs for up to six hours after the injection. This means the medication has reached the right spot.  Your pain may return after this short pain-free period or may even be a little worse for a day or two.  This is normal.  It may be caused by needle irritation or by the steroid itself.  Steroids usually take two to three days to start working but can take as long as a week.  Depending on the amount of inflammation, an injection could offer several months of pain relief before further treatment is needed.

LUMBAR MEDIAL BRANCH BLOCK (LMBB)

WHAT ARE LUMBAR FACET JOINTS?

You may feel pain if a lumbar facet joint is injured or arthritic.  The pain can range from mild to severe and sometimes radiates into the buttocks and legs.  It is typically worse with activity.  Other common symptoms include stiffness and limited range of motion.  Facet pain also depends on which joint is affected.  Lumbar facet joint pain can occur in an area from your low back down to your buttocks.

WHAT IS A LUMBAR MEDIAL BRANCH BLOCK?

A lumbar medial branch block is an outpatient procedure for diagnosing and treating low back, buttock, hip and groin pain.  In a lumbar medial branch block, an anesthetic is injected near the medial branch nerve.  This stops the transmission of pain signals from the facet joint.  If this reduces your pain and helps you move your back like normal, it may tell the doctor which facet joint is causing the pain.

WHAT TO EXPECT DURING THE PROCEDURE

A local anesthetic will be used to numb your skin.  Fluoroscopy, a type of x-ray, will be used to ensure the safe and proper position of the needle.  The doctor will insert a thin needle near the medial branch nerve.  Once the doctor is sure the needle is correctly placed, the medicine will be injected.

You may feel sore for one to four days.  This is normal and may be caused by muscle and nerve irritation.  It may help to move your back in ways that hurt before the injection to see if the pain is still there, but do not overdo it.  Take it easy for the rest of the day.  You may feel immediate pain relief and numbness in your back for a limited period of time after the injection.  This tells you that the medication has reached the right spot.  If your pain goes away for a short time, but then returns, you may be a candidate for radio-frequency ablation (RFA) of the medial branch nerve.

LUMBAR RADIO-FREQUENCY ABLATION (RFA)

WHAT ARE LUMBAR FACET JOINTS?

A lumbar radio-frequency neurolysis is a procedure for treating arthritic low back pain, buttock, hip and groin pain.  It is also called lumbar nerve ablation or rhizotomy.  RFA uses radio-frequency energy to disrupt nerve function.  When this is done to a lumbar medial branch nerve, the nerve can no longer transmit pain from an injured or arthritic facet joint.

WHAT TO EXPECT DURING THE PROCEDURE

A local anesthetic will be used to numb your skin.  Fluoroscopy, a type of x-ray, will be used to ensure the safe and proper position of the needle.  The doctor will then check that the needle is in the proper position by stimulating the nerve.  This may cause muscle twitching and provoke some of your pain.  With the needle in the correct position, the area will be numbed.  Your provider will then use radio-frequency energy, this is commonly called “burning” of the nerve, to disrupt the medial branch nerve.  This is often repeated at more than one level of the spine.

WHAT HAPPENS AFTER THE PROCEDURE?

You may feel sore for one to four days.  This is normal and may be caused by muscle and nerve irritation.  Your neck, mid back, or lower back may feel numb, weak or itchy for a couple of weeks.  Be patient, as full pain relief normally takes two to three weeks.  While it varies from patient to patient, nerves can take up to 18 months to regenerate after a RFA.  Your pain may or may not return when the nerves regenerate.  If it does, another RFA can be done.

AMNIOTIC MEMBRANE INJECTION

The amniotic membrane injection uses a dehydrated form of human amniotic membrane.  Human amniotic membrane is derived of the same nutrients and growth factors that facilitate fetal growth.

Amniotic membrane application is recommended for patients suffering from debilitating musculoskeletal pain where conservative management options such as activity restriction, medications, physical therapy, chiropractic treatment and steroid injections have failed.

​Amniotic membrane, which is rich in stem cells, can help repair the worn out, damaged tissues in pathological joint conditions, osteoarthritis, tendinopathies, and other inflammatory disease.  The naturally present cells in amniotic fluid have anti-inflammatory and regenerative properties to provide a non-steroidal approach to long lasting pain relief.  The regenerative effect of stem cell rich tissue can reduce further degeneration proving a longer lasting relief without the side effects of steroid injections.