General Pain Management

Do you suffer from joint pain? We have many ways of treating joint pain non-surgically either with steroid injections or using Synvisc or Supartz. Injections can be given under ultrasound guidance for better effect or using a C-arm x-ray device for needle placement.

Many of us have experienced pain in some degree throughout the course of our lives. We may understand what pain can feel like, but it can still be difficult to fully define. A good definition of pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage."

If you are suffering from chronic pain and have not found a therapy that works well, it may be time to see a Pain Management Specialist about Spinal Cord Stimulation (SCS). Pain management specialists focus on treating pain patients with various treatment options tailored to the needs of each individual. A pain specialist can provide more specific pain treatments than General Physicians.

Spinal Cord Stimulation (SCS) is a safe and effective therapy that has been used for more than 40 years to help people take control of their chronic pain. SCS is the most commonly used implantable neurostimulation technology for management of pain syndromes-as many as 50,000 neurostimulators are implanted worldwide every year. SCS is a widely accepted FDA-approved medical treatment for chronic pain of the trunk and limbs (back, legs and arms).

Pain can be very difficult to manage, as the treatment varies from patient to patient. Sometimes the treatment path for a patient can be as simple as resting and aspirin, or as involved as taking medication or having surgery. Usually, physicians will follow a treatment plan that begins with less invasive therapies and progresses to stronger, more invasive solutions depending on the type and severity of pain. Your treatment plan will also depend on how an individual responds to various treatment options. In our experience, injections into the joints have been very successful. Either steroid injections or products such as Supartz and Synvisc had been used.

Endoscopic Discectomy is an outpatient surgical procedure to remove herniated disc material. Using local anesthesia with the help of x-ray flouroscopy and magnified video for guidance, a small specially designed endoscopic probe is inserted through the skin of the back, between the vertebrae and into the herniated disc space. Tiny surgical attachments are the sent down the hollow center of the probe to remove a portion of the offending disc.

The procedure takes about an hour, on average. X-ray exposure is minimal. You normally will feel little, if any pain or discomfort. There are no stitches. Upon completion, the probe is removed and a small Band-Aid is placed over the incision. The amount of nucleus tissue removed varies but the supporting structure of the disc is not affected by the surgery. The access route to the disc consists of only the probe's small puncture site, usually the size of a freckle, in comparison to large incisions required for open surgery.

Endoscopic Discectomy is different from open lumbar disc surgery because there is no traumatic back muscle dissection, no bone removal, or large skin incision. The risk of complications from scarring, blood loss, infection, and anesthesia that may occur with conventional surgery are drastically reduced or eliminated with this procedure. Endoscopic Discectomy was invented to be an effective treatment for herniated discs while avoiding these risks.

Endoscopic spine surgery is the least invasive procedure used to treat herniated, protruded, extruded and disc tears that compress or irritate the spinal nerves causing back or leg pain. Patients suffering from many spinal conditions should consider all less invasive options like pain management and endoscopic procedures before ever considering traditional, open or minimally invasive spine techniques including laminectomy, microdiscectomy or spinal fusion. With proper diagnosis and diagnostic injections the endoscopic physician can pinpoint the cause of the pain and selectively address the painful condition without causing the patient significant post-operative pain or recovery.

Endoscopic Discectomy is an outpatient surgical procedure to remove herniated disc material. Using local anesthesia with the help of x-ray fluoroscopy a needle, then guidewire, then dilator and working cannula are placed in succession of each other to open a small 7mm or ¼ inch portal. Once the working portal is established a specialty designed endoscope and attached HD camera for magnified video are inserted into the cannula. The physician has superior endoscopic visualization of the anatomy and the herniated disc and with tiny surgical instruments can selectively remove a small portion of the disc that is compressing the spinal nerve and eliminate the patients pain.

The procedure takes about an hour, on average. X-ray exposure is minimal. You normally will feel little, if any pain or discomfort. There are no stitches. Upon completion, the endoscope and cannula are removed and a small Band-Aid is placed over the incision. The amount of nucleus tissue removed varies but the supporting structure of the disc is not affected by the surgery. The access route to the disc consists of only the ¼ inch small puncture site, usually the size of a freckle, in comparison to large incisions required for open surgery.

Endoscopic Discectomy is different from open lumbar disc surgery because there is no traumatic back muscle dissection, no bone removal, or large skin incision. The risk of complications from scarring, blood loss, infection, and anesthesia that may occur with conventional surgery are drastically reduced or eliminated with this procedure. Endoscopic Discectomy was invented to be an effective treatment for herniated discs while avoiding these risks.

• Utilizes a HD camera and endoscope which affords the physician a superior view to that of traditional techniques
• ¼ inch - the smallest incision in spine surgery
• No muscle or tissue tearing thus less scar tissue
• Conscious sedation reduces the risk associated with general anesthesia
• Less post-operative pain and need for narcotic medicines
• Less recovery time needed
• Return to work sooner

• Arthritis and Bone Spurs of the Spine
• Bulging Disc
• Discogenic Back Pain
• Herniated Disc
• Failed Back Surgery
• Foraminal Stenosis (Narrowing of the Spinal Canal)
• Sciatica
• Radiculitis or Radiculopathy
• Spondylolisthesis (slipping of the Vertebra)

Transforaminal Endoscopic Discectomy

- treats herniated, bulging, protruded, and extruded discs. Under direct visualization the physician uses the endoscope to decompress the disc to relieve the pressure on the affected spinal nerve.

Endoscopic Foraminalplasty

- treats degenerative disc, foraminal stenosis and facet disease. As the space between the facets diminishes the foramen (natural opening for the spinal and exiting nerves) becomes narrow and begins to compress the nerves. The endoscopic technique uses ronguers, reamers and small motorized burrs to selectively take some bone in order to enlarge the foramen thus decompressing the nerves freeing them up.

Endoscopic Nucleoplasty

- treats patients suffering from severe back pain associated with micro tears in the disc' outer annular wall. When these tears happen the epidural space can be irritated and small nerves begin to innervate the annulus and cause back pain. The endoscopic technique goes inside the disc with a 7mm cannula and uses a HD camera to look for tears and leaks in the disc's annulus. With a radiofrequency probe the physician can ablate the nerve endings and seal the tear, thus providing significant pain relief for the patient.

Endoscopic Rhizotomy

- treats patients suffering from chronic axial back pain. When patients lean forward they are fine but leaning backwards causes significant pain and spasms. Patients who have received some temporary relief from percutaneous medial branch rhizotomy but the pain came back are good candidates for endoscopic rhizotomy. This procedure allows the physician to place a small cannula and endoscope inside the patients back and target visually the medial branch nerve. A radiofrequency probe is used through the endoscope to ablate the medial branch nerve. The results of endoscopic rhizotomy have been significantly better long-term than traditional percutaneous rhizotomy.