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There are many alternative treatments to spine surgery. Use our interactive module below to learn more about some of the non-surgical medical treatments Dr. Friedman uses to treat his patients.

 

Our multi-disciplinary, integrated approach

Our team diagnoses and treats chronic pain conditions of the spine; peripheral joint, muscle and nerve conditions; as well as provides anti-aging solutions (functional and regenerative medicine.) From initial consultation to final follow-up care, you will experience a unique patient-centric philosophy:

Because I've worked side by side with surgeons, orthopedic specialists, rehabilitation specialists and alternative physicians at world-renowned medical universities like Johns Hopkins, as well as in my own patient practice over the years, I can offer you a broad clinical perspective.

Partnering with different medical disciplines throughout my career has shown me first-hand how lasting, successful outcomes can stem from a combination of methods. My goal is always the same: to explore all viable options with an open mind, to

  1. Provide you with the strongest likelihood of achieving long-lasting pain relief
  2. Provide you with the best possibility of functional restoration

Learn More About These Non-Surgical Solutions for Pain

  • Caudal Epidural Steroid Injection +

    Overview
    This outpatient procedure is an injection of a steroid-anesthetic medication through an opening in the sacrum. The medication can reduce swelling and inflammation of irritated spinal nerves. The injection takes only a few minutes to complete.

    Preparation
    In preparation for the procedure, the patient lies face down. A cushion is placed under the abdomen to elevate the sacrum.

    Anesthetic Injected
    The physician administers a local anesthetic to numb the skin and the tissue above the small opening at the base of the sacrum. This opening is called the sacral hiatus.

    Needle Inserted
    When the area is numb, the physician guides a needle through the sacral hiatus and into the caudal epidural space. This is the open space in the sacrum where the irritated nerve rootsare located.

    Contrast Solution Injected
    The physician injects contrast solution through the needle. The physician uses a fluoroscope (a type of x-ray device) to confirm that the tip of the needle is positioned correctly within the epidural space.

  • Cervical Epidural Steroid Injection +

    Overview
    This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine.
    Conditions such as herniated discs and spinal stenosis can compress nerves, causing inflammation and pain. The medication injected helps decrease the swelling of nerves.

    Patient Sedated
    The procedure is performed with the patient lying down. Intravenous sedation may be administered, and a region of skin and tissue of the neck is numbed with a local anesthetic delivered through a small needle.

    Needle Inserted
    Using x-ray guidance (also called fluoroscopy), the physician guides a larger needle to the painful area of the neck. The needle is inserted into the epidural space, which is the region through which spinal nerves travel.

    Contrast Dye Injected
    Contrast dye is injected into the space to make sure the needle is properly positioned near the irritated nerve or nerves.

    Steroid Injected
    A combination of an anesthetic and cortisone steroid solution is injected into the epidural space. The steroid is an anti-inflammatory medication. It is absorbed by the inflamed nerves to decrease swelling and relieve pressure. The needle is removed and a small bandage is applied.

    End of Procedure
    The patient goes to a recovery room and is given food and drink and discharged with post treatment instructions. Some patients may need only one injection, but it may take two or three injections (administered weeks apart) to provide significant pain relief.

  • Cervical Facet Radiofrequency Neurotomy +

    Overview
    This minimally-invasive procedure, also called radiofrequency (or RF) rhizotomy, reduces or eliminates the pain of damaged facet joints by disrupting the medial branch nerves that carry the pain signals. This procedure is performed with local anesthetic.

    Preparation
    The neck and shoulder are cleaned and sterilized. Local anesthesia is administered to numb the tissue at the injection site down to the spinal column.

    Inserting the Cannula
    The physician uses an x-ray device called a fluoroscope to carefully guide a needle-like tube called a cannula to the irritated medial branch nerves.

    Injecting the Radiofrequency Electrode
    A radiofrequency electrode is inserted through the cannula. The physician tests the electrode's position by administering a weak electric current. If the stimulation recreates the pain without any other muscular effects, the electrode is positioned correctly.

    Heating the Nerve
    The physician uses the electrode to heat and cauterize the nerve. This disrupts its ability to communicate with the brain, blocking the pain signals. Multiple nerves may require treatment.

    End of Procedure
    The electrode and cannula are removed, and the injection site is covered with a small bandage. Although pain may increase for the first week after the procedure, the patient usually has full relief from pain within a month. Successful RF neurotomies can last longer than steroid block injections.

  • Cervical Selective Nerve Root Block +

    Overview
    This injection relieves pain in the neck, shoulders, and arms caused by a pinched nerve (or nerves) in the cervical spine. It can be used to treat conditions such as herniated discs, spinal stenosis, and radiculopathy.

    Preparation
    The procedure is performed with the patient lying face down or face up to expose the neck. The patient may be sedated but awake during the procedure. A region of skin and tissue of the neck is numbed with a local anesthetic delivered through a small needle.

    Inserting the Needle
    The physician uses an x-ray device called a fluoroscope to guide a needle to the painful area of the neck. The needle is inserted into the neural foramen space, which is the region through which spinal nerves travel.

    Confirming the Needle Placement
    Contrast dye is injected into the space to make sure the needle is properly positioned near the irritated nerve or nerves.

    Injecting the Medication
    An anesthetic solution is injected into the foramen space, bathing the irritated nerve.

    End of Procedure and After Care
    The needle is removed and a small bandage is applied. Some patients may need only one injection, but two or three injections may be needed to provide significant pain relief.

  • Cervical Transforaminal Epidural Steroid Injection +

    Overview
    This injection procedure is performed to relieve neck, shoulder and arm pain related to compression of a nerve root in the cervical spine. Conditions such as herniated discs and spinal stenosis can compress nerves, causing inflammation and pain. The medication injected helps decrease the swelling of nerves.

    Vertebra and Nerve Root Located
    The physician uses a fluoroscope to locate the appropriate cervical vertebra and nerve root. A local anesthetic is applied to numb the skin.

    Tissue Anesthetized
    All the tissue down to the surface of the vertebral transverse process is anesthetized.

    Needle Inserted
    The physician slides a thin needle with a slightly curved tip through the anesthetized track.

    Foraminal Space Accessed
    With the aid of the fluoroscope, the physician carefully guides the needle into the foraminal space near the nerve root.

    Contrast Dye Injected
    The physician injects a contrast solution and uses the fluoroscope to confirm the correct position of the needle tip.

    Steroids Injected
    A steroid-anesthetics mix is injected into the foraminal epidural space, bathing the painful nerve root with soothing medication.

    End of Procedure
    The needle is removed, and a small bandage is applied. In most cases, the patient will be able to return home the same day.

  • Dekompressor Discectomy +

    Overview
    This minimally-invasive procedure uses a small needle and probe device to reduce a herniated disc, quickly relieving pain in most patients. The procedure may be performed on an outpatient basis using a gentle, relaxing medicine and local anesthetic.

    Cannula Inserted
    After some anesthetic is injected to numb the area, a thin needle called a cannula is inserted through the back and into the herniated disc. The surgeon uses x-ray images to guide the placement of the cannula.

    Disc Nucleus Treated
    The small probe is carefully inserted through the cannula and into the disc. When the probe is turned on, its rotating tip removes small portions of the disc nucleus. Because only enough of the disc is removed to reduce pressure inside the disc, the spine remains stable.

    Herniation Relieved
    The empty space created by the probe allows the disc to reabsorb the herniation.

    End of Procedure and After Care
    The probe and needle are removed, and the insertion area in the skin is covered with a small bandage. Because no muscles or bone are cut during the procedure, recovery is fast and scarring is minimized. The patient may need a day of bed rest after the procedure, as well as physical therapy. Most may return to normal activity within one to six weeks.

  • Discography +

    Overview
    This diagnostic procedure, also called discogram, is used to determine whether back pain is caused by one or more spinal discs. The procedure involves pressurizing suspect discs with an injection of sterile liquid to induce pain. Discography helps the specialist plan a course of treatment.

    IV Inserted
    In preparation for the procedure, the patient lies on the side or stomach on a table equipped with a type of x-ray unit called a fluoroscope. Medication is administered through an intravenous (IV) line to relax the patient. It is important for the patient to be awake enough to tell the physician what he or she is feeling. A local anesthetic is used to numb the skin and all the tissue down to the disc area.

    Guide Needles Inserted
    A guide needle is inserted through the anesthetized track to the outer edge of the disc. The physician uses the fluoroscope to identify the target disc. A smaller needle is inserted through the guide needle into the center of the disc. This may be repeated for several discs.

    Discs Tested
    Once all the needles are placed, the discs are pressurized one at a time with injections of contrast dye. With each injection, the patient may feel either pressure or pain. If the patient feels pain, the physician will ask the patient to compare it to the pain the patient has been experiencing. If the pain is the same, this may indicate a diseased disc. After each disc is tested, images are taken with the fluoroscopic unit.

    Needles Removed
    The needles are removed. The patient may be taken for a CT scan to obtain additional images of the inside of the discs.

    End of Procedure
    Discography usually takes less than an hour to perform. The procedure may cause soreness for a few days. The patient is usually advised to take acetaminophen or ibuprofen and to ice the affected area for several minutes each day until the soreness subsides.
    www.viewmedica.com © 2013 Swarm Interactive. Unauthorized duplication is strictly forbidden.

  • Facet Joint Injections +

    Overview
    The facet joints, found on both sides of the back of the spine, can become painfully irritated or inflamed. A facet joint injection may help diagnose the source of a patient's pain. It can also relieve pain and inflammation.

    Skin Numbed
    In preparation for the procedure, the physician numbs the skin and tissue above the facet joint with an injection of local anesthetic.

    Placement Confirmed
    With the aid of an x-ray device called a fluoroscope, the physician guides a needle through the numbed tissue and into the facet joint. Contrast dye is injected into the joint to confirm the needle's placement.

    Medication Injected
    Once the needle is positioned properly, the physician injects a soothing mixture of numbing anesthetic and anti-inflammatory steroid medication. One or more facet joints may be treated. If this causes the pain to subside, it suggests that the facet joint (or joints) injected were the cause of pain.

    End of Procedure
    Back or neck pain may disappear immediately after a successful injection because of the anesthetic that is administered. As this anesthetic wears off, pain may return. The steroid will begin to take effect in the days after the injection. The steroid will reduce inflammation and pain. The injection can provide relief for a span ranging from several days to several months. Up to three injections may be given per year.

  • Flouroscopic Guided Hip Injection +

    Overview
    This non-operative, outpatient procedure is designed to provide relief for patients with arthritis of the hip joint. The technique allows the physician to inject numbing and anti-inflammatory medications with maximum accuracy.

    Preparation
    The physician swabs the front of the hip and injects a numbing medication. A special X-ray device called a fluoroscope is positioned over the hip.

    Injecting the Dye
    To make sure the medicine injection is in the hip joint, the physician first uses an injection of dye. The dye shows up on the fluoroscope image. If the dye pools in the soft tissue at the front of the hip joint, the physician adjusts the needle placement.

    Finding the Target Area
    When the dye reaches the target area - the space inside the joint - the physician is ready to inject the medication.

    Injecting the Medication
    The syringe is removed from the needle and a syringe filled with medication is attached. The physician injects the medication into the joint.

    End of Procedure
    The needle is removed and a small bandage is applied. The numbing medication will provide short-term pain relief, while the
    anti-inflammatory medication will aid in long-term relief.

  • Flouroscopic Guided Piriformis Injection +

    Overview
    This injection procedure is performed to diagnose and relieve the pain of piriformis syndrome, an irritation of the sciatic nerve caused by a contraction of the piriformis muscle in the buttocks.

    Preparation and Approach
    In preparation for the procedure, the patient lies on the stomach, and the skin at the injection site is numbed. Then, the physician uses a fluoroscope to carefully guide a needle into the piriformis muscle. A small amount of contrast dye is injected to confirm that the needle is positioned properly.

    Injection
    When the needle is correctly positioned, an anesthetic and steroid mediation is injected into the muscle. The medication will reduce the inflammation, relieving pain.

    End of Procedure
    Once the injection is complete, the patient is taken to a recovery area. If the injection is used for diagnostic purposes, the physician will wait to see if muscle pain temporarily subsides after the injection, which would confirm that the piriformis muscle is the source of the pain.

  • Fluroscopic Guided Steroid Injection for Knee Pain +

    Overview
    This non-operative, outpatient procedure is designed to provide relief for patients with arthritis of the knee. The technique allows the physician to inject an inflammation-reducing steroid with maximum accuracy.

    Preparation
    The physician swabs the knee, injects a numbing medication and positions a special X-ray device called a fluoroscope.

    Injecting the Dye
    To make sure the medicine injection gets to the space inside the joint, the physician first uses an injection of dye. The dye shows up on the fluoroscope image. If the dye pools in the soft tissue at the front of the knee, the physician adjusts the needle placement.

    Finding the Target Area
    When the dye reaches the target area - the space inside the joint - the physician is ready to inject the medication.

    Injecting the Medication
    The rear of the syringe is removed from the needle and a syringe filled with a local anesthetic and steroid is attached. The physician injects the medication into the joint.

    End of Procedure
    The local anesthetic and steroid solution in the knee joint will reduce inflammation and pain. The injection can be repeated if necessary.

  • HYALGAN® Injection for Knee Pain +

    Overview
    During this non-operative, outpatient procedure, the physician injects a pain relief medication called HYALGAN@ into the knee joint. The HYALGAN will help the knee move smoothly, reducing or relieving the pain of osteoarthritis.

    Preparation
    In preparation for the injection, the physician swabs the knee and administers a local anesthetic. The physician positions a device called a fluoroscope over the knee. The fluoroscope will display a moving x-ray image of the inside of the knee. This will ensure that the HYALGAN is injected into the joint space.

    Injecting the Dye
    The physician carefully guides a needle into the knee joint. The physician confirms the needle's placement with an injection of dye. The dye is clearly visible on the fluoroscope. If the dye pools in the soft tissue at the front of the knee, the physician adjusts the placement of the needle. When the dye successfully reaches the space inside the joint, the physician is ready to inject the HYALGAN.

    Injecting the Medication
    While leaving the needle in position, the physician removes the dye syringe and replaces it with a HYALGAN syringe. The physician injects the HYALGAN into the space within the knee joint. The HYALGAN will bond with the synovial fluid inside the joint. It will help cushion and lubricate the joint.

    End of Procedure
    When the injection is complete, the physician removes the needle and bandages the knee. HYALGAN is administered in a series of three to five injections given one week apart. Patients typically begin to feel pain relief after the third injection, and pain relief can last for up to six months. Physical therapy will enhance the effects of the medication.
    HYALGAN® is a registered trademark of Fidia Farmaceutici S.p.A., which is not responsible for this content.

  • Lumbar Epidural Steroid Injection +

    Overview
    This injection procedure is performed to relieve low back and radiating leg pain. Steroid medication can reduce the swelling and inflammation caused by spinal conditions.

    Patient Positioning
    The patient lies face down. A cushion under the stomach area provides comfort and flexes the back. In this position, the spine opens and allows for easier access to the epidural space.

    Tissue Anesthetized
    A local anesthetic is used to numb the skin. All the tissue down to the surface of the lamina portion of the lumbar vertebra bone is anesthetized. The physician slides a thicker needle through the anesthetized track.

    Fluoroscopic Guidance
    Using a fluoroscope for guidance, the physician slides the needle toward the epidural space between the L-4 and L-5 vertebra. A contrast solution is injected. The physician uses the fluoroscope to confirm the correct location of the needle tip.

    Steroids Injected
    A steroid-anesthetics mix is injected into the epidural space, bathing the painful nerve root with soothing medication.

    End of Procedure
    The needle is removed, and a small bandage is applied to cover the tiny needle surface wound. In some cases it may be necessary to repeat the procedure as many as three times to get the full benefit of the medication. Many patients get significant relief from only one or two injections.

  • Lumbar Radiofrequency Neurotomy +

    Overview
    This minimally-invasive procedure, also called radiofrequency (RF) rhizotomy, reduces or eliminates the pain of damaged facet joints by disrupting the medial branch nerves that carry the pain signals. This procedure is performed with local anesthetic.

    Cannula Inserted
    A needle-like tube called a cannula is inserted and positioned near the irritated medial branch nerves. An X-ray or fluoroscope is used to help position the cannula properly.

    Electrode Inserted
    A radiofrequency electrode is inserted through the cannula. The surgeon tests the electrode's position by administering a weak electric jolt. If the stimulation recreates the pain without any other muscular effects, the electrode is positioned correctly.

    Nerve Treated
    The surgeon uses the electrode to heat and cauterize the nerve. This disrupts its ability to communicate with the brain, blocking the pain signals. The surgeon may treat multiple nerves if needed.

    End of Procedure
    After the procedure, the electrode and cannula are removed. Although pain may increase for the first week after the procedure, the patient usually has relief from pain within a month. Successful RF neurotomies can last longer than steroid block injections.

  • Lumbar Transforaminal Epidural Steroid Injection +

    Overview
    This outpatient procedure is an injection of a steroid-anesthetic medication. The medication can reduce swelling and inflammation of irritated spinal nerves. This procedure is performed to relieve pain in the lower back and pain that radiates from the back to the legs. The injection takes only a few minutes to complete.

    Preparation
    In preparation for the procedure, the patient lies face down. A cushion is placed under the abdomen, which causes the spine to bend in a way that opens the spaces on the sides of the spine. These spaces are called the foramina.

    Anesthetic Injected
    A local anesthetic is administered to numb the skin and the tissue that covers the spine.

    Needle Inserted
    When the area is numb, the physician carefully guides a needle into the foraminal space that surrounds the irritated nerve root.
    Contrast Solution Injected
    A contrast solution is injected through the needle. The physician uses a fluoroscope (a type of x-ray device) to confirm that the tip of the needle is positioned correctly.

    Medication Injected
    After the needle's position has been confirmed, the physician injects a steroid-anesthetic medication. This medication bathes the irritated nerve roots. It will help alleviate the patient's pain.

    End of Procedure
    When the procedure is complete, the physician removes the needle and bandages the insertion site. The patient may feel significant relief after one injection. Some patients may need multiple injections before they feel the full benefit of the medication.
    www.viewmedica.com © 2013 Swarm Interactive. Unauthorized duplication is strictly forbidden.

  • Medial Branch Block +

    Overview
    This diagnostic procedure is performed to identify a painful facet joint. The facet joints are the joints between the vertebrae in the spine. They allow the spine to bend, flex and twist.

    Preparation
    In preparation for the procedure, the patient is positioned on his stomach. The physician injects a local anesthetic. This numbs the skin and tissue around the facet joint that is suspected of causing the patient's pain.

    Contrast Dye Injected
    Once this tissue is numb, the physician inserts a needle into the skin. The needle is carefully guided down to the facet joint. The physician injects a contrast solution through this needle. The contrast solution helps the physician see the area on a camera called a fluoroscope. The fluoroscope provides live x-ray images. The physician uses the fluoroscope to confirm the location of the needle's tip.

    Anesthetic Injected
    Once the physician has confirmed that the needle is positioned correctly, the physician attaches a syringe containing an anesthetic medication. This medication is injected around small nerves called the medial branch nerves. These carry signals to and from the facet joints. The anesthetic will temporarily block sensation in these nerves.

    End of Procedure
    If the temporary injection relieves the patient's pain, the physician may inject a more
    long-lasting anesthetic. If the temporary injection does not relieve the pain, the physician may test nearby facet joints to identify the correct one.

  • Percutaneous Disc Nucleoplasty +

    Overview
    This minimally-invasive procedure uses a small needle and advanced radiofrequency technology to reduce a herniated disc, quickly relieving pain in most patients. The procedure may be performed on an outpatient basis using a gentle, relaxing medicine and local anesthetic.

    Cannula Inserted
    After some anesthetic is injected to numb the area, a thin needle called a cannula is inserted through the back and into the herniated disc. The surgeon uses x-ray images to guide the placement of the cannula.

    Disc Nucleus Treated
    A small radiofrequency probe is carefully inserted through the cannula and into the disc. The device sends pulses of radio waves to dissolve small portions of the disc nucleus. Because only enough of the disc is removed to reduce pressure inside the disc, the spine remains stable.

    Herniation Relieved
    The empty space created by the probe allows the disc to reabsorb the herniation.

    End of Procedure and After Care
    The probe and needle are removed, and the insertion area in the skin is covered with a small bandage. Because no muscles or bone are cut during the procedure, recovery is fast and scarring is minimized. The patient may need a day of bed rest after the procedure, as well as physical therapy. Most may return to normal activity within one to six weeks.

  • Prolotherapy Treatment for Chronic Knee Pain +

    Overview
    This non-surgical procedure relieves chronic knee pain with an injection that promotes the natural healing of damaged joints and soft tissues.

    Causes of Knee Pain
    Problems of the knee, the most commonly injured joint in the body, often involve degeneration of the cartilage surface and sprains of the meniscus, ligaments and tendons. The limited blood supply and poor healing properties of these soft tissues make treatment necessary after injury.

    Preparation
    The knee is cleansed and sterilized. A local anesthetic is applied to numb the injection site.

    Administering the Injection
    A mixture of concentrated dextrose, composed of natural compounds and anesthetic, is injected into the damaged tissues. The physician may need to administer additional injections to other injured structures of the knee.

    The Body Reacts
    The injected solution promotes mild inflammation of the injured tissue. This tricks the body into responding as if a new injury has occurred. The body releases proteins called growth factors that promote a natural healing process.

    Healing Begins
    Once the inflammation resolves, cells called fibroblasts move in. The fibroblasts create collagen and use it to strengthen and rebuild any damaged ligaments and tendons. The strengthening and repair of these tissues results in improved joint stability and reduced pain.

    Long-term Outcome
    The patient will be able to go home the same day, and should avoid taking any anti-inflammatory pain medications (aspirin, ibuprofen and naproxen). Full recovery from inflammation usually occurs within one week of the procedure. Additional treatments may be required to ensure complete healing of the injured tissues.

  • Prolotherapy Treatment for Chronic Lower Back Pain +

    Overview
    This non-surgical procedure relieves chronic lower back pain with an injection that promotes the natural healing of damaged joints and soft tissues of the spine.

    Causes of Lower Back Pain
    Problems in the lower spine are often associated with the damage or degeneration of tendons, ligaments and joint capsules. The limited blood supply and poor healing properties of these soft tissues make treatment necessary after injury.

    Preparation
    The back is cleansed and sterilized. A local anesthetic is used to numb the injection site.

    Administering the Injection
    A mixture of concentrated dextrose, composed of natural compounds and anesthetic, is injected into the damaged tissues. The physician may need to administer additional injections to other injured structures of the spine.

    The Body Reacts
    The injected solution promotes mild inflammation of the injured tissue. This tricks the body into responding as if a new injury has occurred. The body releases proteins called growth factors that promote a natural healing process.

    Healing Begins
    Once the inflammation resolves, cells called fibroblasts move in. The fibroblasts create collagen and use it to strengthen and rebuild the damaged ligaments and joint capsules. The strengthening and repair of these tissues results in improved joint stability and reduced pain.

    End of Procedure and Aftercare
    The patient will be able to go home the same day, and should avoid taking any anti-inflammatory pain medications (aspirin, ibuprofen and naproxen). Full recovery from inflammation usually occurs within one week of the procedure. Additional treatments may be required to ensure complete healing of the injured tissues.

  • PRP Injection for Chronic Back Pain +

    Overview
    This non-surgical procedure relieves chronic back pain with an injection of the patient's own blood platelets. The concentrated platelets promote the natural healing of damaged joints and soft tissues of the spine.

    Causes of Lower Back Pain
    Problems in the lower spine are often associated with the damage or degeneration of tendons, ligaments and joint capsules. The limited blood supply and poor healing properties of these soft tissues make treatment necessary after injury.

    Collecting the Platelets
    The PRP process begins when a sample of blood is taken from the patient and is separated into its components - platelets and white blood cells, plasma, and red blood cells. A portion of the plasma is removed. The patient's concentrated platelets are mixed with the remaining plasma to form a concentrated solution. A syringe is filled with the solution.

    Preparation
    The back is cleansed and sterilized. A local anesthetic may be used to numb the injection site.

    Administering the Injection
    The needle is directed into the back and then guided to the target area. The platelet rich plasma is injected into and around the damaged tissues. The physician may need to administer additional injections to other injured structures of the spine. This will help to ensure complete tissue healing and maximize joint stability.

  • PRP Injection for Chronic Knee Pain +

    Overview
    This non-surgical procedure relieves chronic knee pain with an injection of the patient’s own blood platelets. The concentrated platelets promote the natural healing of damaged ligaments, cartilage and tendons.

    Causes of Knee Pain
    Injuries of the knee, the most commonly injured joint in the body, often involve the surrounding soft tissues, ligaments, tendons and cartilage. Causes of knee pain include degeneration of the cartilage surface, and sprains or tears of the ligaments or tendons.

    Collecting the Platelets
    The PRP process begins when a sample of blood is taken from the patient and is separated into its components – platelets and white blood cells, plasma, and red blood cells. A portion of the plasma is removed. The patient’s concentrated platelets are mixed with the remaining plasma to form a concentrated solution. A syringe is filled with the solution.

    Preparing the Knee
    The knee is cleansed and sterilized. A local anesthetic may be applied to reduce pain at the injection site.

    Administering the Injection
    The needle is directed into the knee and then guided to the target area. The platelet rich plasma is injected into and around the damaged tissues. The physician may need to administer additional injections to other injured structures of the knee. This will help to ensure complete tissue healing and maximize joint stability.

    The Body Reacts
    The concentrated platelets release many growth factors that promote a natural immune response, mobilizing stem cells to the injured tissues. Macrophages – specialized white blood cells – rush in to remove damaged cells and prepare the tissue for healing.

    The Healing Begins
    Stem cells and other cells multiply, repair and rebuild the damaged tissue. This accelerated healing response reduces pain, promotes increased strength, and improves joint function.

    Follow-up
    The entire PRP treatment process takes about an hour – the patient will be able to go home the same day. Full recovery from the injection usually occurs within one week of the procedure. Many patients require three to four treatments before the injured tissues are completely healed and they return to a normal active lifestyle.

  • PRP Injection for Knee Arthritis +

    Overview
    This non-surgical procedure relieves the pain of knee arthritis with an injection of the patient's own blood platelets. The concentrated platelets promote natural healing.

    Collecting the Platelets
    The PRP process begins when a sample of blood is taken from the patient and placed into a centrifuge, where it is spun rapidly. The spinning process separates it into its components: plasma, platelets and white blood cells, and red blood cells. The red blood cells are drained away, and then the patient's concentrated platelets, along with a portion of the plasma, are drawn into a syringe.

    Preparing the Knee
    The knee is cleansed and sterilized. A local anesthetic may be applied to reduce pain at the injection site.

    Administering the Injection
    The needle with the platelet rich plasma is directed into the knee and then guided to the target area. The platelet rich plasma is injected into and around the damaged tissues. Additional injections to other injured structures of the knee may be needed to ensure complete tissue healing and maximize joint stability.

    The Body Reacts
    The concentrated platelets release many growth factors that promote a natural immune response, mobilizing stem cells to the injured tissues. Macrophages - specialized white blood cells - rush in to remove damaged cells and prepare the tissue for healing.

    The Healing Begins
    Stem cells and other cells multiply, repair and rebuild the damaged tissue. This accelerated healing response reduces pain, promotes increased strength, and improves joint function.

    Follow-up
    The entire PRP treatment process takes about an hour - the patient will be able to go home the same day. Full recovery from the injection usually occurs within one week of the procedure. Many patients require three to four treatments before the injured tissues are completely healed and they return to a normal active lifestyle.

  • PRP Injection for Rotator Cuff Injury +

    Overview
    This non-surgical procedure treats rotator cuff injury with an injection of the patient's own blood platelets. The concentrated platelets promote the natural healing of damaged ligaments, cartilage and tendons.

    Collecting the Platelets
    The PRP process begins when a sample of blood is taken from the patient and placed into a centrifuge, where it is spun rapidly. The spinning process separates it into its components: plasma, platelets and white blood cells, and red blood cells. The red blood cells are drained away, and then the patient's concentrated platelets, along with a portion of the plasma, are drawn into a syringe.

    Preparing the Shoulder
    The shoulder is cleansed and sterilized. A local anesthetic may be applied to reduce pain at the injection site.

    Administering the Injection
    The needle with the platelet rich plasma is directed into the shoulder and then guided to the target area. The platelet rich plasma is injected into and around the damaged tissues. Additional injections to other injured structures of the shoulder may be needed to ensure complete tissue healing and maximize joint stability.

    The Body Reacts
    The concentrated platelets release many growth factors that promote a natural immune response, mobilizing stem cells to the injured tissues. Macrophages - specialized white blood cells - rush in to remove damaged cells and prepare the tissue for healing.

    The Healing Begins
    Stem cells and other cells multiply, repair and rebuild the damaged tissue. This accelerated healing response reduces pain, promotes increased strength, and improves joint function.

    Follow-up
    The entire PRP treatment process takes about an hour - the patient will be able to go home the same day. Full recovery from the injection usually occurs within one week of the procedure. Many patients require three to four treatments before the injured tissues are completely healed and they return to a normal active lifestyle.

  • PRP Injection for Whiplash +

    Overview
    This non-surgical procedure treats whiplash injury with an injection of the patient's own blood platelets. The concentrated platelets promote the natural healing of damaged ligaments, cartilage and tendons.

    Collecting the Platelets
    The PRP process begins when a sample of blood is taken from the patient and placed into a centrifuge, where it is spun rapidly. The spinning process separates it into its components: plasma, platelets and white blood cells, and red blood cells. The red blood cells are drained away, and then the patient's concentrated platelets, along with a portion of the plasma, are drawn into a syringe.

    Preparing the Neck
    The neck is cleansed and sterilized. A local anesthetic may be applied to reduce pain at the injection site.

    Administering the Injection
    The needle containing the platelet rich plasma is directed into the neck and precisely guided to the target area with the help of fluoroscopic x-ray visualization. The platelet rich plasma is injected into and around the damaged tissues. Additional injections to other injured structures of the neck may be needed to ensure complete tissue healing.

  • RACZ Caudal Neurolysis +

    Overview
    This injection, generally performed as an outpatient procedure under local anesthesia, relieves low back and leg pain most often caused by scarring from a prior back surgery. The procedure is performed with the patient lying face down with a cushion placed under the stomach.

    Anesthetic Injected
    The physician locates the small opening at the base of the sacrum (called the sacral hiatus) and injects a local anesthetic that numbs the skin and all the tissue down to the surface of the sacral hiatus.

    Needle Inserted
    The physician then guides the needle through the anesthetized track and into the epidural space.

    Contrast Solution Injected
    A contrast solution is injected, allowing the physician to see the scarred and painful areas on an X-ray device called a fluoroscope.

    Catheter Inserted
    A small, flexible catheter is fed through the needle and positioned at the location of scarring.

    Medication Injected
    A steroid-anesthetics mix is injected through the catheter and around the scarring, bathing the painful area in medication and dissolving the scar tissue.

    End of Procedure
    The needle and catheter are removed. In some cases, it may be necessary to keep the catheter in place to allow for more injections over the next few days. It also may be necessary to repeat the procedure a few months later to reduce scar tissue further.

  • Sacroiliac Joint Steroid Injection +

    Overview
    This injection procedure is performed to relieve pain caused by arthritis in the sacroiliac joint where the spine and hip bone meet. The steroid medication can reduce swelling and inflammation in the joint.

    Sacroiliac Joint Located
    The patient lies face down. A cushion is placed under the stomach for comfort and to arch the back. The physician uses touch and a fluoroscope to find the sacroiliac joint.

    Anesthetic Injected
    A local anesthetic numbs the skin and all the tissue down to the surface of the sacroiliac joint.

    Needle Inserted
    The physician advances a needle through the anesthetized track and into the sacroiliac joint.

    Steroids Injected
    A steroid-anesthetics mix is injected into the sacroiliac joint, bathing the painful area in medication.

    End of Procedure
    The needle is removed, and a small bandage is used to cover the tiny surface wound.

  • Sciatic Nerve Block +

    Overview
    This procedure is an injection of anesthesia (or an anesthetic/steroid mixture) around the sciatic nerve. It can be used to block the pain of surgery on the knee, leg ankle or foot, or it can be used to manage the pain of chronic issues in the lower extremity.

    Preparation
    In preparation for the procedure, the patient is positioned to expose the buttock. The physician uses an ultrasound probe to determine the precise entry point for the needle. The tissue at the entry point is numbed with an injection of local anesthesia.

    Needle Placement
    The physician inserts a needle into the numbed tissue and carefully advances it down to the sciatic nerve. The physician uses the ultrasound to confirm the correct placement of the needle.

    Injection
    The physician injects the anesthetic (or anesthetic/steroid mixture) through the needle. The medication bathes the main trunk of the sciatic nerve, temporarily blocking sensation in the leg or relieving chronic pain and inflammation.

    End of Procedure
    When the injection is complete, the needle is carefully removed and a small bandage is placed over the injection site. The duration of the injection varies depending on the type of medication administered and the goal of the procedure.

  • Shoulder Joint Injection (therapeutic) +

    Overview
    This outpatient injection procedure relieves pain in the shoulder and arm caused by arthritis, injury or disorder.

    Preparation
    In preparation for the procedure, the shoulder is cleansed and sanitized. Local anesthetic is administered to numb the tissue at the injection site. The physician may choose from multiple needle approaches, depending on which part of the shoulder requires treatment.

    Needle Insertion
    The physician carefully guides a needle into the shoulder joint. The physician may guide the needle with the help of an x-ray device called a fluoroscope. If so, the physician may inject contrast dye to confirm the needle's placement.

    Pain Relief Injection
    When the needle is in position, the physician injects a mixture of anesthetic and steroid medication. The medication will help reduce inflammation and relieve pain.

    End of Procedure
    When the injection is complete, the needle is slowly withdrawn. The injection site may be covered with a small bandage. For many patients, extended pain relief begins within two to three days of the injection. In some cases it may be necessary to repeat the procedure one or more times to receive the full benefit of the treatment.

  • Spinal Cord Stimulation +

    Overview
    Spinal cord stimulation (also called SCS) uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. SCS candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed.

    Trial Implantation
    The injection site is anesthetized. One or more insulated wire leads are inserted through an epidural needle or through a small incision into the space surrounding the spinal cord, called the epidural space.

    Find the Right Location
    Electrodes at the end of the lead produce electrical pulses that stimulate the nerves, blocking pain signals. The patient gives feedback to help the physician determine where to place the stimulators to best block the patient's pain. The leads are connected to an external trial stimulator, which will be used for approximately one week to determine if SCS will help the patient.

    Determine Effectiveness
    If the patient and physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the leads are removed.

    Permanent Implantation
    The permanent implantation may be performed while the patient is under sedation or general anesthesia. First, one or more permanent leads are inserted through an epidural needle or a small incision into the predetermined location in the epidural space.

    Generator Implantation
    Next, a small incision is created, and the implantable pulse generator (IPG) battery is positioned beneath the skin. It is most often implanted in the buttocks or the abdomen. The leads are then connected to the IPG battery.

    End of Procedure
    The implant’s electrical pulses are programmed with an external wireless programmer. The patient can use the programmer to turn the system on or off, adjust the stimulation power level and switch between different programs.

  • Spinal Cord Stimulator Implant Trial Procedure +

    Overview
    Spinal cord stimulation (also called SCS) uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. SCS candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed.

    Trial Implantation
    The injection site is anesthetized. One or more insulated wire leads are inserted through an epidural needle or through a small incision into the space surrounding the spinal cord, called the epidural space.

    Find the Right Location
    Electrodes at the end of the lead produce electrical pulses that stimulate the nerves, blocking pain signals. The patient gives feedback to help the physician determine where to place the stimulators to best block the patient’s pain. The leads are connected to an external trial stimulator, which will be used for approximately one week to determine if SCS will help the patient.

    Determine Effectiveness
    If the patient and physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the leads are removed.

  • Spinal Epidural for Hip and Lower Extremity +

    Overview
    This procedure uses an injection of anesthesia to numb the hips and lower extremities in preparation for a medical procedure. The patient remains awake and alert, and still has the ability to offer feedback to the operating physician.

    Preparation
    The skin of the lower back is cleaned and sterilized, and the patient is positioned to expose the lower back. A small needle injects a local anesthetic, creating a numb pathway down to the spine.

    Positioning the Needle
    A larger needle is carefully inserted through the numb tissue and guided to the epidural space. The needle is not pushed through the dura, the sac that surrounds the nerve roots, but stops just outside this sac. If a catheter is needed, it is fed through the needle.

    Injecting the Anesthesia
    The anesthetic mixture is slowly injected, bathing the area. The pain-numbing sensation typically takes affect within 20 minutes.

    End of Procedure
    The needle is carefully removed. The affect will typically last for a few hours after the injection. If a catheter is used, it will remain in place in the spinal canal so that more anesthetic can be injected as needed. The catheter will be removed when the patient no longer requires anesthesia, and the injection site will be covered with a small bandage.

  • Subacromial Injection +

    Overview
    During this procedure, a mixture of anesthesia and anti-inflammatory medication is injected into the space between the acromion and the head of the humerus. This injection can be used to treat a variety of painful conditions, including adhesive capsulitis, rotator cuff tendinosis, and impingement syndrome. The physician may choose an injection site on the front, side or rear of the shoulder.

    Preparation
    The patient is placed in a seated position, and the skin on the shoulder is cleaned and anesthetized.

    The Injection
    The physician carefully inserts a needle into the joint space and injects the medicated solution. The mixture bathes the joint space to reduce pain and inflammation in the joint.

    End of Procedure and Aftercare
    The needle is removed, and a small bandage is placed on the shoulder. The patient may be advised to avoid strenuous activity for the next few days.

  • Thoracic Epidural Steroid Injection +

    Overview
    This outpatient procedure is an injection performed to relieve pain in the upper back.

    Preparation
    The patient sits or lies down to expose the back. The back is cleaned and sterilized, and a local anesthetic is administered to numb the tissue of the injection site down to the spinal column.

    Inserting the Needle
    The physician uses an x-ray device called a fluoroscope to guide a needle down to the vertebra that is causing the pain. The needle is carefully pushed into the epidural space, which is the area surrounding the spinal cord. A contrast solution is injected to confirm the needle's position.

    Inserting the Medication
    The physician injects a steroid-anesthetic mix into the epidural space, bathing the painful areas with soothing medication. The mixture will help reduce inflammation and reduce pain.

    End of Procedure
    The needle is removed, and the injection site may be covered with a small bandage. Extended pain relief usually begins within three to five days of the injection. In some cases it may be necessary to repeat the procedure as many as three times to get the full benefit of the medication. However, many patients get significant relief from only one or two injections.

  • Thoracic Transforaminal Epidural Steroid Injection +

    Overview
    This injection procedure relieves pain in the upper back, ribs, and abdomen caused by a pinched nerve (or nerves) in the thoracic spine.

    Preparation
    The procedure is performed with the patient lying on the stomach. A region of skin and tissue of the back is numbed with an injection of local anesthetic.

    Inserting the Needle
    The physician uses an x-ray device called a fluoroscope to guide a needle to the painful area of the spine. The needle is inserted into the neural foramen space, the region through which spinal nerves travel.

    Confirming the Needle Placement
    Contrast dye is injected into the space to make sure the needle is properly positioned near the irritated nerve or nerves.

    Injecting the Medication
    A combination of an anesthetic and cortisone steroid solution is injected into the foramen space. The steroid is an anti-inflammatory medication that is absorbed by the inflamed nerves to decrease swelling and relieve pressure.

    End of Procedure and After Care
    The needle is removed and a small bandage is applied. Extended pain relief usually begins within two to three days of the injection. Some patients may need only one injection, but two or three injections may be needed to provide significant pain relief.

  • Trigger Point Injections +

    Overview
    This outpatient procedure is designed to reduce or relieve the pain of trigger points. These small, tender knots can form in muscles or in the fascia (the soft, stretchy connective tissue that surrounds muscles and organs). The trigger point injection procedure takes only a few minutes to complete.

    Preparation
    In preparation for the procedure, the patient is positioned comfortably. The physician presses and pinches the skin to locate the trigger point. Once it has been identified, the physician cleanses the overlying skin. A topical anesthetic may be used to temporarily numb the skin.

    Medication Injected
    The physician carefully inserts a needle through the skin and into the trigger point. The physician injects an anesthetic mixture into the trigger point. This causes the trigger point to relax. If the trigger point does not relax completely after the first injection, the physician may adjust the needle's position and give additional injections.

    End of Procedure
    When the injection is complete, the physician removes the needle. A small bandage may be placed over the injection site. The patient may be encouraged to stretch and move the muscle after the injection.

  • Ultrasound-guided Injection for Knee Pain +

    Overview
    This non-operative, outpatient procedure is designed to provide relief for patients with arthritis of the knee. The technique allows the physician to inject an inflammation-reducing steroid with maximum accuracy.

    Preparation
    In preparation for the procedure, the physician swabs the knee, injects a numbing medication and positions a hand-held ultrasound probe that will allow the physician to visualize the anatomy of the knee and accurately inject the medication.

    Injecting the Medication
    The physician inserts a needle into the knee and guides it to the problem area using ultrasound imagery. The medication is then injected into the joint.

    End of Procedure
    When the injection is complete, the needle is removed. The local anesthetic and steroid solution in the knee joint will reduce inflammation and pain. The injection can be repeated if necessary.

  • Ultrasound-guided Injection for Shoulder Pain +

    Overview
    This non-operative, outpatient procedure is designed to provide relief for patients with pain in the shoulder from conditions such as osteoarthritis, rheumatoid arthritis and adhesive capsulitis. The technique allows the physician to inject an inflammation-reducing steroid with maximum accuracy.

    Preparation
    In preparation for the procedure, the physician swabs the shoulder, injects a numbing medication and positions a hand-held ultrasound probe that will allow the physician to visualize the anatomy of the shoulder and accurately inject the medication.

    Injecting the Medication
    The physician inserts a needle into the joint space and guides it to the problem area using ultrasound imagery. The medication is then injected into the joint.

    End of Procedure
    When the injection is complete, the needle is removed. The local anesthetic and steroid solution in the shoulder joint will reduce inflammation and pain. The injection can be repeated if necessary.

  • Vertebral Augmentation +

    Overview
    This minimally-invasive, outpatient procedure is used to treat a compression fracture of the vertebra, an injury that commonly results from osteoporosis. This technique can restore the height of the vertebra and stabilize the fracture, providing rapid pain relief.

    Preparation
    After the patient has been positioned and anesthesia administered, the surgeon inserts a guide wire or needle through the skin of the back. Using fluoroscopic guidance, the surgeon pushes the wire down to the target vertebra. A dilator is pushed over the wire to create a working channel to the vertebra.

    Stabilization
    The surgeon pushes an instrument through the working channel and into the collapsed vertebra. The instrument is used to create a cavity in the body of the vertebra. The cavity is filled with bone cement which rapidly cures and thus stabilizes the bone.

    End of Procedure
    The instruments are removed, and the patient is monitored in a recovery room. In many cases, pain relief is immediate, and the patient can return home within a few hours of the procedure.

  • Vertebroplasty +

    Overview
    This minimally-invasive treatment is used to repair spine fractures caused by osteoporosis or cancer. It stabilizes the spine, providing rapid back pain relief and helping prevent further weakening of the spine.

    Bone Biopsied
    After an area on the back is numbed, a tube is inserted through a small incision and positioned under x-ray guidance. One or two needles are inserted into the collapsed vertebra and used to collect diseased bone tissue for study.

    Fracture Stabilized
    The weakened area in the vertebra is filled with bone cement to stabilize the fracture. Once filled, the tube is removed. In some cases, the cement may be injected in both the left and right sides of the vertebra.

    End of Procedure
    An "internal cast" is now in place. The cast stabilizes the vertebral body and provides rapid mobility and pain relief.

  • Visco-supplementation for Arthritis of the Knee +

    Overview
    This nonsurgical procedure is an injection of a gel-like medication into the knee joint to supplement or replace the thick synovial fluid that cushions the joint. This treatment can help reduce the pain of arthritis.

    Preparation
    In preparation for the procedure, the physician numbs the knee with an injection of local anesthetic.

    The Injection
    The physician carefully guides a needle through the numbed tissue and into the space within the knee joint. The physician may confirm the position of the needle with a fluoroscope, a special type of x-ray that shows moving images. Once the tip of the needle is positioned correctly, the physician injects the medication. This fluid will cushion and lubricate the knee joint.

    End of Procedure and Aftercare
    When the injection is complete, the physician removes the needle. The injection site is bandaged. The patient may not feel relief for a few weeks, and may need to return for additional injections.

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