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Patients will typically experience pain along the neck, corresponding to the level of where the pain is being generated from. Neck pain may be felt in the shoulders, upper back or may even sometimes cause headache. Neck arthritis may result in compression of the nerves of the neck. With involvement of nerves, radiating pain may be present in the shoulder, arm or fingers.
Neck pain is usually caused by degenerative conditions of the spine, most commonly arthritis. This arthritis involves the disc, which serves as a cushion between the vertebrae. Arthritis can also involve the neck joints, called facets. Neck pain can also be caused by an injury, such as a fall or car accident. An injury can cause pain by hurting the joints, the disc or the ligaments.
The first step in the evaluation of neck pain is a careful history and physical examination. Often, a history will give many clues as to what part of the neck is causing the pain, the joints or the disc. When conservative care with medications and therapy fails to bring relief an MRI gives doctors a look inside the neck.
The first step is treatment with therapy and neck exercises. Medications can relieve pain and inflammation. In patients that don’t respond a spinal pain management evaluation can be performed. In this highly specialized evaluation, we determine which of the structures in the neck the pain is emanating from. Spinal injections can bring relief and confirm the source of pain. Minimally invasive surgery is reserved only for cases that do not improve with spinal injections.
The following spinal injections may be used to treat neck pain:
The following minimally invasive surgical procedures may be used to treat neck pain:
A whiplash injury is a non-medical term to describe a range of neck injuries that occur with a sudden distortion of the neck. A whiplash injury is commonly the result of a motor vehicle accident. The most common scenario is that the victim is seated in a vehicle that is rear ended or hit from the rear quarter. A whiplash injury can occur at speeds less than 15 miles per hour.
Patients will typically experience pain along the neck, corresponding to the level of where the pain is being generated from. Neck pain due to whiplash injury can be immediate or can progress over several weeks. Neck pain may be referred to the shoulders, upper back or may even sometimes cause headache. A whiplash injury may result in stretching or pinching of the spinal nerves. With involvement of the nerves, radiating pain may be present to the shoulder, arm or fingers.
The biomechanics of whiplash injury are well studied. At impact there is a violent and complex multi- stage movement of the neck. First, the lower spine extends while the rest of the spine flexes, resulting in an S shaped configuration of the spine. Then, the upper spine starts to extend, as the lower spine already has. This causes an extreme rotational torque at the lower spine. This torque causes the joints of the lower spine to impact on one another, injuring the spinal joints, called facet joints. Spinal ligaments and discs can also be injured due to whiplash. Neck pain can become chronic in 10% to 40% of sufferers.
The diagnosis of a whiplash injury can be made by a careful history. The mechanism of injury and pain symptoms are the leading clues. MRI will often fail to show acute injury to the facets joints, although MRI is effective in detecting disc herniation or ligament injury due to whiplash. In chronic injury, x-rays and MRI can show neck joint degeneration.
Medications and therapy are the first line in the treatment of a whiplash injury. In patients that don’t respond a spinal pain management evaluation can be performed. In this highly specialized evaluation, we determine which of the structures in the neck the pain is emanating from. Spinal injections can bring relief and confirm the source of pain. Minimally invasive surgery is reserved only for cases that do not improve with spinal injections.
Patients with headache after a whiplash injury will typically experience pain in the back of the head where the head meets the neck. This pain may radiate to the temples, the top of the head, the front of the head or down the neck. The pain may be intermittent or constant. Pain may be worse with moving the neck, reading, using a computer monitor or texting. These headaches may be associated with dizziness or a sensation that the room is spinning. The medical term for these headaches is cervicogenic headaches.
Early after a whiplash injury headaches may be caused by overstretching of the ligaments and tendons of the upper neck. This is called a sprain or a strain. Typically, symptoms from sprain or strain will resolve within 6–8 weeks. When symptoms continue it is a sign of a more severe injury. Approximately 80% of the time chronic headaches following a whiplash are due to an upper joint injury in the neck. These joints are called the facet joints. Approximately 20% of the time a chronic headache may be due to a disc injury in the upper neck.
In the initial evaluation of a whiplash headache the most important thing is time. If the headache is predominantly caused by a sprain or a strain the headache will resolve by 6–8 weeks. When pain persists additional investigation is warranted. A physical examination will show a typical pain pattern. An MRI is obtained to determine if a disc herniation is present. If there is no disc herniation, additional diagnostic testing is required to evaluate for a facet injury. This is because a facet injury is typically not seen on MRI. This additional testing usually consists of performing a diagnostic injection at the facet joint. This injection is called a medial branch block. A medial branch block will anesthetize the joint for approximately 5 hours. If pain is relieved during that period one can confidently determine that the headaches are caused by a whiplash facet injury.
The first step in treatment of whiplash headache is therapy and neck exercises. While a sprain or strain will resolve on its own, therapy and exercises will hasten improvement. Nonsteroidal anti-inflammatory medications, ibuprofen, and muscle relaxants can also help. When pain is persistent additional testing will often reveal either a facet joint injury or a disc injury. When facet joint injuries or disc injuries persistently cause pain and disability additional treatment will be required. This may take the form of injections or minimally invasive procedures.
Patients will typically experience pain across the back, sometimes radiating to the hip or buttocks. Specific symptoms depend on what structures or combination of structures in the spine is causing the back pain. Degeneration of the facet joints can result in pain with sitting or standing. Degeneration of the lumbar disc may result in herniation. Pain occurring from the disc can be felt as constant pain across the back. When disc is herniated back pain may radiate to the leg. Pain from sacroiliac joint is felt at the low back, buttocks or hip. Pain can be worse sitting, standing or climbing stairs.
Back pain is usually caused by degenerative conditions of the spine, or wear and tear. The most common causes of back pain vary with age. The usual sources are the back joints, called facets, the intervertebral disc or the sacroiliac joint. The facet joints are the joints that hold the back of the spine together. The disc is a cushion between the vertebrae. The sacroiliac joint is the joint between the spine and the pelvis.
The first step in the evaluation of back pain is a careful history and physical examination. Often, a history will give many clues as to what part of the back is causing the pain; the joints or the disc. When conservative care with medications and therapy fails to bring relief, an MRI gives doctors a look inside the back.
Medications and therapy are the first line in the treatment of back pain. In patients that don’t respond a spinal pain management evaluation can be performed. In this highly specialized evaluation, we determine which of the structures in the back the pain is emanating from. Spinal injections can bring relief and confirm the source of pain. Minimally invasive surgery is reserved only for cases that do not improve with spinal injections.
Between the bones, or vertebrae, of the spine are the intervertebral discs, or just discs for short. The discs have an important function in stabilizing the spine. The discs absorb much of the load that the spine is subjected to when sitting or standing. When undue stress is placed on a disc, especially a degenerated disc, the material from the inside of the disc can exit the disc through a tear. The tear itself is usually caused by a combination of degeneration and stress. The resultant exited material is called a herniated disc.
When the herniated disc pushes or irritates the passing nerves of the spine there is nerve pain. This causes pain radiating down the leg, arm or shoulder. When a nerve travelling to the leg is involved it’s called sciatica. Sometimes the herniated disc will cause pain in and of itself. This is felt as pain across the neck or back. If nerve compression is severe it can affect muscle function. If weakness in the arm or leg occurs one should seek medical attention urgently. If bowel or bladder incontinence occurs it is a medical emergency.
Commonly, there is an event resulting in severe pain that patients will recall. Most likely that event resulted in a painful tear of the disc. In the back, it usually results from a flexion and rotation motion while the back is under stress, such as carrying a heavy load. In the neck it can result from the violent flexion associated with a car accident, among other things. After the initial injury, there is weakening of the disc lining. This can cause a progressive herniation over time, or can cause repeated herniations. Sometimes the injury is not as well delineated. In these cases, a herniation is likely the result of chronic use and degeneration of the disc lining, causing a gradual tear.
The first step in the evaluation of a painful herniated is a careful history and physical examination. It’s important to note that not every herniated disc is painful. In fact, most adults over the age of 40 have multiple, non-painful herniated discs. A careful evaluation is important in determining which disc, if any, or causing spinal pain. In patients who continue to have symptoms despite therapy and medications an MRI of the spine is often helpful.
The first line in treatment of a painful disc herniation is medication and therapy. In patients that don’t respond a spinal pain management evaluation can be performed. In this highly specialized evaluation, we determine which disc the pain is eminating from. Spinal injections can bring relief and confirm the source of pain. Minimally invasive surgery is reserved only for cases that do not improve with spinal injections.
Sciatica is a term that describes pain radiating down the leg caused by irritation or compression of one or more spinal nerves that make up the sciatic nerve. The sciatic nerve is the major nerve of the leg, responsible for sensation of the entire leg and function of all leg muscles. The sciatic nerve is made up of spinal nerves L4 to S3. Irritation of any of those spinal nerves can be felt as pain running down the leg, or course of the sciatic nerve. This pain is referred to as sciatica.
Patients will usually sense intense pain radiating from the buttocks to the back of the thigh or calf. Sometimes the pain will radiate to the foot. The pain may be constant, may increase with activity or may diminish with sitting or resting. If nerve compression is severe it can affect muscle function. If weakness in the leg or foot occurs, such as a foot drop or dragging foot, one should seek medical attention urgently. If bowel or bladder incontinence occurs it is a medical emergency.
Anything that can cause irritation or compression of the spinal nerves making up the sciatic nerve can cause sciatica. Commonly, sciatica is caused by a herniated disc. The herniated disc material can directly compress the spinal nerve. Sometimes, arthritis of the vertebral joints, the facets, can cause enlargement of the joint, compressing the nerve. Often times it’s a combination of the two.
The first step in the evaluation of sciatica is a careful history and physical. An MRI will usually identify the region of the spine where the nerve compression or irritation causing the sciatica is. An MRI is indicated in patients who do not improve with conservative means or patients with severe symptoms.
Medications and therapy are the first line in the treatment of back pain. In patients that don’t respond a spinal pain management evaluation can be performed. In this highly specialized evaluation, we determine which spinal nerve is involved and what the cause is. Spinal injections can bring relief and confirm the source of pain. Often, a spinal injection will bring relief long enough for the nerve to heal on its own. Minimally invasive surgery is reserved only for cases that do not improve with spinal injections.
Lumbar facet joint syndrome is caused by pain arising from the lumbar facet joints. The facet joint joins the vertebra above and below and lies behind the disc. Lumbar facet pain is usually experienced as pain across the back. The pain may radiate to the buttocks, hips and thighs. The pain may even travel down the leg, mimicking sciatica. Pain will be greater standing and laying down and may be improved with sitting or bending.
Lumbar facet joint syndrome is usually a degenerative condition of the facet joint. Facet degeneration may occur after extensive degeneration of the disc, usually after a disc injury. The disc cushions the vertebra above and below. The facet joint is located behind the disc and joins the vertebra above and below. When the disc degenerates it may shrink or flatten. This places undue stress on the facet joint behind the disc. This type of disc degeneration may occur after an injury and can be seen after surgery for an injured disc.
Lumbar facet joint syndrome can also occur after a fall or a car accident. In these instances, a tear or bruising of the joint components can occur. In some cases this can lead to chronic pain, or pain lasting more than 8-12 weeks.
Any significant back pain that persists beyond 4-6 weeks merits a careful evaluation. Since disc injuries are more common, especially in younger age groups, an MRI can be obtained to rule out a disorder of the lumbar disc. Physical examination may also suggest a lumbar facet joint syndrome. Maneuvers that stress the facet joint, such as pain with bending backwards and to the side, will suggest the diagnosis. Once the diagnosis is suggested a lumbar medial branch injection can be done to see if there is temporary abatement of pain. If the pain goes away after a medial branch injection the diagnosis of lumbar facet joint syndrome can confidently be made. Medial branch injections are diagnostic, not therapeutic injections. That means that they are designed to diagnose a condition and not to bring long lasting relief. In some cases it’s appropriate to proceed straight to treatment without a diagnostic injection.
The first step in the treatment of lumbar facet joint syndrome is therapy and exercises. Nonsteroidal anti-inflammatory medications and muscle relaxants can also help. When pain is persistent and the diagnosis is strongly suspected, a lumbar facet injection can be performed to relieve pain. If more long-lasting relief is sought and medial branch injections are positive then rhizotomy can provide 3-6 month of relief while endoscopic median branch avulsion is considered a permanent treatment.
Spinal stenosis is a unique cause of back pain caused by narrowing of the spinal canal. The narrowing can be congenital, meaning that one was born with it. Commonly the narrowing is due to arthritis, or degeneration. Degeneration causes disc herniation and joint enlargement, both of which narrow the spinal canal.
Patients suffering from spinal stenosis complain of pain radiating to one or both legs while walking or standing upright. The pain usually improves after sitting or leaning forward. Leaning back may make the pain worse. The reason for this fluctuation is that an upright posture, such as standing or walking, narrows an already narrowed spine. Leaning forward or taking a flexed posture, such as sitting, makes the degenerated spinal canal bigger, bringing relief.
Narrowing of the spinal canal is usually caused by degeneration of the spine. This degeneration is the result of bulging of the disc joints, bony growth of the facet joints or overgrowth of the ligaments of the spine.
The first step in the evaluation of spinal stenosis is a careful history and physical examination. In patients who continue to have symptoms despite therapy and medications an MRI of the lumbar spine is often helpful, identifying the region of the spine where the stenosis resulting in painful activities lies.
Medications and therapy are the first line in the treatment of back pain. In patients that don’t respond a spinal pain management evaluation can be performed. In this highly specialized evaluation, we determine which spinal nerve is compressed by the stenosis and what the cause is. Spinal injections can bring relief and confirm the source of pain. Minimally invasive surgery is reserved only for cases that do not improve with spinal injections.
The sacroiliac joint is the joint that joins the pelvis with the lower portion of the spine. The joint can be palpated, several inches from the midline, over the upper buttocks.
The patient with sacroiliac joint pain experiences low back, buttock or hip pain, on one or both sides. Often, pain is worse with activities like getting out of a chair to stand, going from standing to sitting position and walking up stairs.
The sacroiliac joint is under considerable stress from every day activities like standing, walking and sitting. Sometimes, back pain due other spine conditions can lead patients to alter their posture, leading to more stress on the sacroiliac joint and accelerating degeneration of the joint. Prior spinal fusion can also increase the stress on the sacroiliac joint.
The diagnosis of sacroiliac joint pain is made based on a careful history and physical examination. There is considerable overlap between sacroiliac joint pain and other causes of back pain. Special physical examination maneuvers will strongly suggest the diagnosis. X-rays and MRI can rule out other sources of pain, but usually will not suggest a diagnosis of sacroiliac joint pain. Often, the most reliable method of diagnosis is to see if the pain is relieved with an anesthetic injection of the joint.
The first line in treatment of sacroiliac joint pain is medication and therapy. In patients that don’t respond a spinal pain management evaluation can be performed. In this highly specialized evaluation, we determine what the cause of pain is. Sacroiliac joint pain is often difficult to diagnose and may not have been suspected prior. Spinal injections can bring relief and confirm the source of pain. Minimally invasive surgery is reserved for cases that do not improve with spinal injections.
When a patient continues to experience severe back and/or leg pain after spine surgery it is referred to as failed back syndrome. Therefore, failed back syndrome is not a cause of pain in and of itself, it’s a term used to describe persistent symptoms after surgery.
A patient with failed back syndrome will, by definition, have very similar symptoms after as before surgery. This may be back pain, sciatica or symptoms of spinal stenosis.
There may be a number of reasons why patients are left in pain after prior surgery. Some patients may have had the right procedure, only to see it fail; spine surgery has a well described failure rate. In other patients, it may be that there spinal condition has progressed to involve an area of the spine not previously operated on. In yet others, it may be that pain is being caused by an area not addressed by surgery. Though the cause may be progression of disease or an area not addressed by surgery, patients and physicians alike may wrongly label the patient as having had “failed back” surgery.
The first step in the evaluation of persistent pain after surgery is a careful history and physical examination. Often, a history will give many clues as to whether or not the pain is coming from a condition addressed at surgery, or is a new condition. Often, repeating x-rays and MRI’s is useful in determining whether the condition is a progression or new condition, as opposed to a persistent one. Failed back syndrome is a frustrating condition to patients and doctors alike, and great patience on the part of both are required.
In patients who have pain after surgery a spinal pain management evaluation can be performed. In this highly specialized evaluation, we try to determine if the pain is persistent after surgery, is transient post-surgical pain, is due to a progressive condition or is new. In many cases, spinal injections or minimally invasive surgery can bring relief if used appropriately and targeted precisely to the cause of pain. As a last resort, spinal cord stimulators have a track record of providing relief in carefully selected patients.
A vertebral compression fracture is a fracture of the body of the vertebrae, the bony spine. Unlike other fractures, this fracture is more a compression, or flattening of the vertebral body. Vertebral compression fractures are fractures that commonly occur spontaneously, without undue stress on the back.
Patients will usually complain of severe pain along the middle of the back. In some cases the pain is so severe as to render the patient bed or wheelchair bound.
The vertebrae are usually weakened from a condition called osteoporosis, or thinning of the bone. This is seen in the elderly and in postmenopausal women. In non-elderly males, the bone thinning leading to a fracture can be caused by a lack of testosterone. The weakened bone cannot sustain daily stress and bending forward may cause a collapse of the body of the vertebrae.
The diagnosis is made by a careful history and physical examination. X rays will show collapsed or compressed vertebrae, but will not show fractured vertebrae that have not compressed. Often there are multiple fractured vertebrae. An MRI can distinguish between fractures that have healed and those that have not.
The first line of treatment in bone pain due to vertebral compression fractures is conservative management, consisting of back rest, bracing and pain medications. Patients should undergo at least two to four weeks of conservative managements. In many cases the fracture will heal itself with rest. If rest and medication have failed to relieve pain then a minimally invasive procedure can be performed to stabilize the fracture. Importantly, the underlying cause of the fracture should be addressed. In osteoporosis this would consist of medications designed to harden or strengthen bone.
An epidural steroid injection is used to treat pain arising from irritation of spinal nerves and discs. Steroid medications, designed to reduce inflammation, are injected into the epidural space. The epidural space is a space in the spine superficial to the spinal cord where spinal nerves travel.
In 2012 there was an outbreak of meningitis caused by contaminated steroids. All cases came from facilities that used medications that were mixed in an unclean environment. The Los Angeles Minimally invasive Spine Institute only uses medications that are mixed in the operating room under clean and sterile conditions at the time of injection.
The physician places a small needle through the skin of the lower neck and through a natural opening in the bones of the spine. The needle then is directed into the epidural space where spinal nerves travel. A small amount of x-ray dye shows the doctor that the needle is in the correct location. The injection consists of medications that reduce inflammation and pain.
Allow yourself an hour to be prepared for the procedure. The actual procedure will take about 15 to 30 minutes. After the procedure you will recover for 30 minutes to an hour before going home.
You can generally return to your normal activities by the next day. You can shower the same day as the procedure.
A cervical medial branch injection (sometimes referred to as a block) is a procedure used to diagnose pain arising from the joints in the back of the neck (cervical spine). These joints are called the cervicalfacet joints. Cervical facet pain is seen with degenerative conditions and is more common with older age groups. Cervical facet pain can also occur after a fall or after a motor vehicle injury. A forceful flexion and extension of the neck may occur, called a whiplash. When there is chronic neck pain (pain lasting more than 8-12 weeks) after a whiplash injury, cervical facet injury is the culprit most of the time.
To perform a cervical medial branch injection, the doctor places a small needle through the skin of the side of the neck and navigates the needle via x-ray guidance to the site of the cervical medial branch nerve, along the bony spine. A cervical medial branch block works by anesthetizing the nerve that transmits pain impulses from the facet joint, providing relief until the anesthetic wears off. This allows the physician to examine the neck and see if it is now pain free. It’s important to note that a cervical medial branch block is a diagnostic test, resulting in temporary pain relief that lasts long enough for your doctor to diagnose your condition. In order to minimize false negative results the procedure is usually repeated. This is called a confirmatory medial branch block. If the initial and confirmatory injection results in substantial pain relief it will be followed by a procedure that brings long lasting relief.
Allow yourself an hour to be prepared for the procedure. The actual procedure will take about 15 to 30 minutes. After the procedure you will recover for 30 minutes to an hour before going home.
You can generally return to normal activities by the next day. you can shower the same day as the procedure.
An epidural steroid injection is used to treat pain arising from irritation of spinal nerves and discs. Steroid medications, designed to reduce inflammation, are injected into the epidural space. The epidural space is a space in the spine superficial to the spinal cord where spinal nerves travel.
In 2012 there was an outbreak of meningitis caused by contaminated steroids. All cases came from facilities that used medications that were mixed in an unclean environment. The Los Angeles Minimally invasive Spine Institute only uses medications that are mixed in the operating room under clean and sterile conditions at the time of injection.
The physician places a small needle through the skin of the lower back and through a natural opening in the bones of the spine. The needle then is directed into the epidural space where spinal nerves travel. A small amount of x-ray dye shows the doctor that the needle is in the correct location. The injection includes a mixture of medications that reduce inflammation and medications that reduce pain. Epidural injections can be performed in the neck, upper back or low back. They can be placed in the middle of the spine, between the back of the vertebrae. This is an interlaminar injection. Epidural injections can also be performed at the exit point where the nerves leave the spine, the foramina. This is a foraminal injection.
Allow yourself an hour to be prepared for the procedure. The actual procedure will take about 15 to 30 minutes. After the procedure you will recover for 30 minutes to an hour before going home.
You can generally return to your normal activities by the next day. You can shower the same day as the procedure.
A lumbar medial branch injection (sometimes referred to as block) is a procedure used to diagnose pain arising from the joints in the back of the lower (lumbar) spine. These joints are called the lumbar facet joints. Lumbar facet pain is seen with degenerative conditions and is more common with older age groups. Lumbar facet pain may occur with degeneration of an injured disc. The decreasing cushion from a degenerative disc places stress on the lumbar facet joints. Lumbar facet pain can also occur after falls and motor vehicle accidents.
To perform a lumbar medial branch injection, the doctor places a small needle through the skin and navigates the needle via x-ray guidance to the site of the lumbar medial branch nerve, along the bony lower spine. A lumbar medial branch injection works by anesthetizing the nerve that transmits pain impulses from the facet joint, providing relief until the anesthetic wears off. This allows the physician to examine the lower back and see if it is now pain free. It’s important to note that a lumbar medial branch injection is a diagnostic test, resulting in temporary pain relief that lasts long enough for your doctor to diagnose your condition. In order to minimize false negative results the procedure is usually repeated. This is called a confirmatory medial branch block. If the initial and confirmatory injection results in substantial pain relief it will be followed by a procedure that brings long lasting relief.
Allow yourself an hour to be prepared for the procedure. The actual procedure will take about 15 to 30 minutes. After the procedure you will recover for 30 minutes to an hour before going home.
You can generally return to normal activities by the next day. you can shower the same day as the procedure.
A lumbar facet jointinjection is a procedure used to treat pain arising from the joints in the back of the lower (lumbar) spine. These joints are called the lumbar facet joints and sit behind the disc. Lumbar facet pain is seen with degenerative conditions and is more common with older age groups. Lumbar facet pain may occur with degeneration of an injured disc. The disc normally cushions the vertebra. The decreasing cushion from a degenerative disc places more stress on the lumbar facet joints. Lumbar facet pain can also occur after falls and motor vehicle accidents.
To perform a lumbar facet joint injection the doctor places a small needle through the skin and navigates the needle via x-ray guidance to the site of the lumbar facet joint, along the bony lower spine. A combination of an anesthetic (pain killer) and a steroid (anti-inflammation drug) is injected into the joint. The anesthetic provides immediate pain relief. The steroid reduces inflammation inside the joint for up to 2-3 months. The goal of the procedure is to reduce pain long enough for the painful joint to improve on its own.
Allow yourself an hour to be prepared for the procedure. The actual procedure will take about 15 to 30 minutes. After the procedure you will recover for 30 minutes to an hour before going home.
You can generally return to normal activities by the next day. you can shower the same day as the procedure.
The joint where the pelvis and spine join is called the sacroiliac joint. A sacroiliac joint injection is used to alleviate pain arising from the joint. The sacroiliac joint is very superficial and can be easily felt in most people.
To perform a sacroiliac joint block, the doctor places a small needle through the skin and into the joint, injecting medication. The injection includes a combination of a steroid and an anesthetic that reduce inflammation and pain.
Allow yourself an hour to be prepared for the procedure. The actual procedure will take about 15 to 30 minutes. After the procedure you will recover for 30 minutes to an hour before going home.
You can generally return to your normal activities by the next day. You can shower the same day as the procedure.
Rhizotomy is a term that describes the interruption of a spinal nerve, usually to treat pain. Rhizotomy is a minimally invasive procedure to treat neck and back pain resulting from arthritis of the joints of the spine, the facet joints. A rhizotomy is performed after previous injection procedures have confirmed that the facet joint is the cause of pain.
A needle is directed to the nerve that carries nerve signals from the inflamed facet joint. The needle has an electrode at its tip. Energy, in the form of a radiofrequency, is applied to the electrode. This causes heating of the nerve, shutting off painful signals coming from the facet joint. Pain relief lasts 3 to 6 months.
The procedure takes 30 minutes to an hour to perform. After the procedure you will recover for about 30 minutes before going home.
You will walk out the door and go home the same day with pain medications. We advise no strenuous physical activity or heavy lifting for 2 to 3 days. After that, you can resume work and usual activities. Physical therapy and chiropractic care can be resumed immediately.
Percutaneous means surgery is performed through a needle puncture, instead of a large skin incision. The use of a needle allows the surgeon to access the disc through a tiny opening in the skin and through natural openings in the spine. Once the needle is in place it is exchanged for a small tube that allows an endoscope to pass through it. Endoscopic means that the surgeon performs the procedure through a channel in the endoscope, while watching with the endoscope camera.
Percutaneous cervical discectomy is a minimally invasive procedure for the treatment of neck pain or cervical nerve pain due to a herniated disk. To start the procedure, a tiny skin nick is made on the skin at the front of the neck. A needle is placed through the skin nick and into the disc. A small wire is then placed into the disc, through the needle. The needle is exchanged for a series of small tubes. Using specialized instruments surgery is performed through these tubes. The procedure is guided by an endoscope, placed through the tube, and x-rays.
Because a needle is used to access the disc from the skin a skin incision is not made, only a skin nick. Since the needle arrives to the disc via natural spinal openings healthy tissues are not disrupted. For example, unlike traditional minimally invasive surgery, muscles are not stripped from bone to access the spine, healthy bone is not removed to access the spinal openings and important spinal ligaments are not cut to access the disc. Performing surgery through a tiny skin nick and leaving healthy tissues intact means a same day procedure with a quicker recovery.
When arthritis of the spine has led to instability, or abnormal motion resulting in pain, a minimally invasive spinal fusion may be required. In a fusion procedure, the diseased lumbar disc is removed. In its place bone growth material is placed. The material allows new bone to grow over time. It takes about a year for the new bone to heal completely. Implanted devices, such as screws, support the spine while fusion, or bony healing, occurs.
Percutaneous lumbar fusion is a minimally invasive procedure for the treatment of lower back pain due to a herniated disk. The patient is face down or lies on his/her side. A tiny skin nick is made on the skin of the back, near the flank. A needle is then placed through the skin nick and into the disc, via a natural opening in the spine, the intervertebral foramen. A small wire is then placed into the disc, through the needle. The needle is exchanged for a series of small tubes. Using specialized instruments the diseased disc is removed and bone growth material is placed. An implant is placed in the operated space to support the vertebrae while bony healing takes place. Screws are also placed on the back of the spine, through tiny incisions, to further support bony healing. The procedure is guided by an endoscope and x-rays.
Fusion procedures are by nature more invasive than discectomy procedures. When a fusion is required though, it’s our philosophy to make it as minimally invasive as possible. Conventional fusion procedures access the disc by cutting through normal muscle, ligaments and bone. The transforaminal approach allows the discectomy and fusion procedure to be done through a natural opening in the spine, the intervertebral foramen. This allows a fusion without disrupting normal structures, making recovery faster and easier.
Endoscopic posterior foraminotomy/discectomy is performed through a small tube placed through a small skin incision at the back of the neck. The small tube allows the surgeon to place an endoscope through the tube and to use tools through the endoscope to remove disc (discectomy) or to free the nerve from compression (foraminotomy). Endoscopic means that the surgeon performs the procedure through a channel in the endoscope, while watching with the endoscope camera.
Endoscopic posterior foraminotomy/discectomy is a minimally invasive procedure for the treatment of pain arising from compression of the nerve as it travels through the natural passage ways of the spine. To start the procedure, a tiny skin nick is made on the skin at the back of the neck. A small tube is placed through the skin and, using x-ray guidance, the tube is advanced to the facet or neck joint. The facet joint is a joint in the neck that not only connects vertebra to one another but also forms the back of a passage way for nerves to travel out of the neck. Using specialized instruments surgery is performed through the small tube and a small hole (foraminotomy) is made along part of the joint. This small opening frees up the nerve and allows the surgeon to remove some forms of herniated discs (discectomy). The procedure is guided by an endoscope, placed through the tube, and x-rays.
This procedure allows the surgeon to free up compressed nerve in the neck or remove some types of disc herniation through a tiny opening. The tiny opening means that there is minimal disruption to the facet joints or the muscles and ligaments of the neck. Performing surgery through a tiny skin nick and leaving healthy tissues intact means a same day procedure with a quicker recovery.
The procedure typically takes an hour to an hour and a half, depending on how many levels are operated on. After the procedure you will recover for two to four hours before going home.
Percutaneous means surgery is performed through a needle puncture, instead of a large skin incision. The use of a needle allows the surgeon to access the disc through a tiny opening in the skin and through natural openings in the spine. Once the needle is in place it is exchanged for a small tube that allows an endoscope to pass through it. Endoscopic means that the surgeon performs the procedure through a channel in the endoscope, while watching with the endoscope camera.
Endoscopic Transforaminal Lumbar Disectomy is a minimally invasive procedure for the treatment of lower back pain due to a herniated disk. The patient is face down or lies on their side. A tiny skin nick is made on the skin of the back, near the flank. A needle is then placed through the skin nick and into the disc. A small wire is then placed into the disc, through the needle. The needle is exchanged for a series of small tubes. Using specialized instruments surgery is performed through these tubes. The procedure is guided by an endoscope, placed through the tube, and X-rays.
Because a needle is used to access the disc from the skin a skin incision is not made, only a skin nick. Since the needle arrives to the disc via natural spinal openings healthy tissues are not disrupted. Unlike traditional minimally invasive surgery, muscles are not stripped from bone to access the spine, healthy bone is not removed to access the spinal openings and important spinal ligaments are not cut to access the disc. Performing surgery through a tiny skin nick and leaving healthy tissues intact means a same day procedure with a quicker recovery.
The procedure typically takes an hour to an hour and a half, depending on how many levels are operated on. After the procedure you will recover for about two hours before going home.
Intralaminar lumbar endoscopic discectomy is performed through a small tube placed through a small skin incision in the lower back. The small tube allows the surgeon to place an endoscope through the tube and to use tools through the endoscope to remove disc (discectomy) or to free the nerve from compression. Endoscopic means that the surgeon performs the procedure through a channel in the endoscope, while watching with the endoscope camera.
Intralaminar lumbar endoscopic discectomy is a minimally invasive procedure for the treatment of pain arising from a disc herniation compressing or irritating the nerves of the spine. To start the procedure, a tiny skin nick is made on the skin of the lower back. A small tube is placed through the skin and, using the endoscopic camera and x-ray guidance, the tube is advanced to a natural opening of the spine, the intralaminar space. This effaces normally covered by a ligament. A tiny opening is made in the ligament, allowing the tube and endoscopic camera to be carefully placed in the spinal canal. The spinal canal is the opening in the back of the spine which runs from top to bottom. All of the spine nerves travel to the canal. Using the endoscopic camera for guidance, we nerves are carefully moved to side to expose the injured disc. The injured portion of the disc is then carefully removed.
This procedure allows the identical type of surgery as a traditional discectomy but to a much smaller opening. The tube used for this surgery is 8 mm, as opposed to over 20 mm in a traditional microdiscectomy. The use of a smaller tube means a incision and a smaller opening into the spinal canal. The smaller opening results in less damage to healthy tissues and an easier recovery.
The procedure typically takes an hour to an hour and a half, depending on how many levels are operated on. After the procedure you will recover for two to four hours before going home.
Back pain that keeps you from doing your regular everyday activities may warrant a surgical procedure for treatment. A back surgery laminectomy is a surgical procedure in which a surgeon takes out all or a portion of the lamina or vertebral bone. This relieves pressure on the spine or nerve roots induced by injuries, herniated disks, tumors, or, canal constriction/spinal stenosis. A laminectomy is performed only after all other medical interventions do not work.
If you are experiencing neck and back pain that has been caused by a strain or an injury to your tendons and muscles, you can contact the LAMIS Institute in Los Angeles. We provide a broad spectrum of treatments to help you manage severe as well as chronic spinal issues. We will assist you in determining the best course of action for your specific condition and offer you the best possible care for a fast recovery.
Minimally invasive spine surgery is a type of surgery done on the bones and structures in your spine. This procedure uses smaller incisions compared to traditional surgery. Minimally invasive spine surgery has become a standard gold technique for treating spinal complications like herniated discs, degenerative disc disease, and other spinal deformities.
The technical development, which is based on light amplification stimulated by the emission of radiation, is common in minimally invasive spine surgery. As an alternative to traditional open spine surgery, minimally invasive spine surgery offers a variety of benefits, including decreased blood loss, reduced pain, less scarring and damage to surrounding tissues, and shorter hospital stays, among others.
Although MISS is a relatively safe procedure, the outcome may be unpredictable when the doctor’s skills and experience perming the procedure are questioned. If you want to explore this procedure to treat your spine complications, you will need the services of a skilled laser spine surgeon in Los Angeles, CA. At LAMIS Institute, we offer expert guidance and treatment for all our patients for the outcome of the MISS procedures.
Percutaneous means surgery is performed through a needle puncture, instead of a large skin incision. The use of a needle allows the surgeon to access the nerve without a large incision through skin and important back muscles. Once the needle is in place it is exchanged for a small tube that allows an endoscope to pass through it. Endoscopic means that the surgeon performs the procedure through a channel in the endoscope, while watching with the endoscope camera. The median branch is a nerve that carries painful signals from the spine joints. The avulsion procedure is a minimally invasive way to relieve spine joint pain by cutting the median branch nerve.
A median nerve avulsion is a minimally invasive procedure for back pain resulting from arthritis of the joints of the spine, known as the facet joints. The procedure is performed after previous injection procedures have confirmed that the facet joint is the cause of pain. A needle is directed to the nerve that carries nerve signals from the inflamed facet joint. The needle is exchanged for a small tube. Using specialized instruments through the tube the nerve transmitting painful signals is cut.
Because a needle is used to access the nerve from the skin a skin incision is not made, only a skin nick. The lack of an incision means healthy muscle is not disrupted. Performing surgery through a tiny skin nick and leaving healthy tissues intact means a same day procedure with a quicker recovery. A percutaneous median branch avulsion has several distinct advantages compared to other procedures to treat back pain:
An interspinous spacer is a device that is inserted into the back of the spine, between the spinous processes. The device is used to treat spinal stenosis. Spinal stenosis occurs when the passageways of the spine are narrow and compress the nerves of the spine. The spinous processes are the part of the vertebra that stick out and form small bumps in the middle of your back. The spacer is placed between the spinous processes and gently opened. By opening the spacer, it functions similar to a car jack. It separates the spinous processes and thereby opens up compressed passageways in the vertebra. This frees up the nerves of the spine from compression.
A small skin incision is made in the middle of the back at the level to be treated. A series of small tubes is placed through the incision and a 10 mm tube is placed through a smaller tube to a final position between the spinous processes of the vertebra. The spacer is then inserted through this small tube and by twisting the handle of a delivery apparatus attached to the spacer the lobes of the spacer are opened. The skin incision is closed with one or 2 sutures.
In a recently concluded trial, percutaneous interspinous spacers present effective in treating the symptoms of lumbar spinal stenosis as a spacer placed through a larger skin incision and requiring a larger surgery.
The procedure takes approximately one and a half to two hours to perform depending on the number of levels operated on.
A vertebral body augmentation is a procedure used to treat painful compression fractures of the vertebrae. The procedure results in an augmentation of the weakened vertebrae by “casting” the broken bone from the inside, with special cement.
The patient lies face down and a small skin nick is made on the back, near the middle, overlying the fractured vertebrae. Using X-ray guidance the surgeon carefully guides a small metal tube into the vertebrae to the area of the fracture. Specialized attachments inside the metal tube allow passage through bone. Once at the fractured portion of the vertebral body a cavity is created with specially designed instruments. The cavity is then filled with special cement that hardens within minutes.
A vertebral body augmentation takes about an hour, depending on the number of vertebrae treated. After surgery, you will recover for one to two hours before returning home.
You will walk out the door and go home the same day with pain medications. You will be asked to wear a back brace for four weeks after surgery whenever sitting upright, standing or walking. In the first week exercise is limited to short walks. Avoid heavy lifting (greater than 10 to 15 pounds), bending or twisting for the first several months. You can return to work at 4 weeks, unless work requires strenuous activity. At 4 weeks a progressive physical therapy program should be begun. If your fracture was caused by osteoporosis, or thinning of the bones, it will be important to start a medical treatment regimen to avoid another fracture. Individual factors will dictate recovery time.
Laser spine surgery is a minimally invasive procedure that serves as a treatment option for sciatica, radiculopathy, and degenerative disc. The procedure focuses on a heat source or laser technology to reduce the disc material which compresses the spinal cord or the nerves. The traditional and open back surgeries required the surgery to make incisions through the muscle, increasing the risks of tissue damage. But under laser spine surgery, the surgeon makes small incisions. An endoscope or a small metal tube is placed through the incision to allow the surgeon to perform the surgery through the small surface. The procedure has many benefits, including a quick recovery and less pain.
Are you in Los Angeles and want to undergo laser spine surgery? You want to look for a well-experienced surgeon for the best surgical process. At LAMIS Institute, our surgeons have performed numerous surgeries, including laser spine surgery. Our charges are affordable, and our experts are available around the clock. We start by examining whether you are eligible for the procedure. After the procedure, we plan appointments to help monitor your process.
If you have an aching back that will not go away, it could be that you need spinal surgery. Back pain is the most common chronic pain in the country today. If you live with severe pain and have tried other treatments like physical therapy and medication management without much success, your doctor could recommend spinal surgery. However, the recommendation will come after an in-depth diagnosis of the cause of your pain. If you need to undergo an operation, it is advisable to consider working with the best spine surgeon in Los Angeles. Talk to LAMIS Institute for proper diagnosis and treatment options that best fit your needs. We work with the best spine surgeons in Los Angeles for quality and timely treatment for your back and neck pain.
Back pain is why many people requiring spinal surgery seek medical help. Conservative treatments like physical therapy and medication management are sometimes recommended to provide temporary or permanent relief. However, more serious back issues like trauma, spinal infections, and spine tumors require more significant intervention. You will not achieve complete relief from pain from conservative treatments if you have a more serious issue. That is where spinal surgery comes in.
If you experience back pain, your doctor will first recommend other alternative treatments to surgery, like heat, ice, spinal injections, anti-inflammatory medications, and physical therapy. Sometimes even regular exercises could relieve back pain and keep it from returning. But if you have been experiencing excruciating back pain that you cannot easily manage by alternative treatments, it could indicate a more serious issue that could require spinal surgery.
Surgeons recommend spinal surgery as a last resort after all other treatment options have failed. If your back pain persists after several visits to and treatments by your doctor, your doctor will recommend an imaging test to identify the exact problem and make a proper diagnosis. They will then recommend a treatment option to rectify the underlying problem to keep the pain from returning.
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