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Spine & Sports Medical Group

Procedures



Epidural Injection

What is an epidural and why is it helpful?

An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the back or legs. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.


What is the epidural space?

EpiduralThe membrane that covers the spinal cord and nerve roots in the spine is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the back and into the legs (or to the neck and into the arms). Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contract in some way with the bony structure of the spine.


What happens during the procedure?

An IV is started so that relaxation medication can be given. If you do not wish to receive sedation, the IV is optional. However, as a safety precaution in case of an allergic reaction to the injected solution, an IV is highly recommended for the first injection. You are placed on your stomach on the x-ray table. For cervical injection, you will be placed on your back or your side. The skin on the back is painted with an aseptic solution Betadine. Next, the physician numbs a small area of skin with an anesthetic (numbing medicine). This medicine stings for several seconds.

After the anesthetic has been given time to be effective, the physician directs a small needle, using x-ray guidance into epidural space. A small amount of contrast (dye) is injected to insure proper needle position in the epidural space as well as to rule out any evidence of adhesion, bony narrowing, nerve root constriction, or possible nerve root inflammation. A mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected. For two level epidural, the above procedure is repeated for the second level. The procedure usually takes about 10-15 minutes.


What happens after the procedure?

You are then returned to the recovery area where they are monitored for 15-30 minutes. A follow-up appointment will be made for a repeat block if indicated. These injections are usually done in a series of three (3), about two (2) weeks apart. If you do not have any improvement with the first injection, please see your doctor prior to the second injection as it may not be necessary to perform the second injection. Approximately 10% of patients may experience slight increase of pain one (1) to three (3) days after the injection. The back or legs (or neck and arms in case of cervical injections) may feel weak or numb for a few hours. You will be given additional warning signs to look for on the day of the procedure.


Risks and Complications

Epidural injections performed under X ray guidance by an experienced physician are extremely safe. Potential complications including infections, bleeding, nerve injury, headache, paralysis could happen but they are highly unlikely to occur. Dr. Tran has performed over 3000 epidurals without any complications. Cortisone that is used, Depomedrol/Celestone/Kenalog, is the similar cortisone produced by your body, and it is not the illicit version used on the “street”. There are no known long term side effects with a series of three epidurals per year. If you are a diabetic, your blood sugar level may rise for 1-2 days after the injection.


General Pre/Post Instructions

If you choose to have IV sedation, you must not eat or drink within 6 hours of the procedure. Otherwise, you can eat a light meal within one-two hours before the procedure. You may take your routine medications with sips of water (i.e. high blood pressure and diabetic medications). You have to be hurting prior to this procedure. They may not take medications that may give pain relief or lessen their usual pain. Please inform your physician if you are taking Aspirin or blood thinner medications (Coumadine). These medications must be stopped (per the approval of your private physician) at least 7 days prior to the procedure.

You are generally asked to be at the surgery center one hour prior to the procedure and can expect to be at that facility approximately 2-3 hours. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure if you receive sedation. You may drive if you do not receive sedation, though, this is not recommended. Icing of the area is recommended for the first day. You may return to your normal activities the day after the procedure, including returning to work.


How does the scheduling process work?

The office will call your insurance carrier to obtain authorization for the procedure. This process may take from a few days to a month depending on your insurance. You may call this office in two weeks to check on the authorization status. You may also call the insurance directly to make inquiry. Once authorization is given, our scheduler will call you to set up the appointment. Injections are done on Thursday only at Los Gatos Spinal Diagnostics Surgery Center and occasionally at Forest Surgery Center. A map and letter of confirmation will be mailed to you.


If You Still Have Questions

Please call the clinic where you were seen and make an appointment with Dr. Tran so that your questions can be answered. It would be best that your questions are answered in person rather than over the phone.
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Extra-corporeal shock wave treatment (ESWT)

What is Extracorporeal Shockwave Treatment?

ESWTExtracorporeal Shockwave Treatment (ESWT) is a non-invasive (no incisions) treatment that involves the delivery of acoustical energy, or sound waves, to affected areas of the body to trigger the body’s own natural repair mechanisms and stimulate healing.

Extracorporeal Shockwave Treatment (‘extracorporeal’ meaning ‘outside the body’) is a safe and effective treatment option. The recovery period is shorter than traditional invasive surgery and the procedure eliminates many of the risks associated with traditional surgery.

Extracorporeal Shockwave Treatment has been used effectively for many years around the world. It was approved in the United States by the FDA for treatment of Plantar Fasciitis in 2000 and for Lateral Epicondylitis in 2003.


What is it Used For?

Millions of people suffer from pain caused by inflammation of tendons and other soft tissues attached to bones. ESWT has been used effectively worldwide to treat these conditions:
  • Heel Pain (Plantar Fasciitis)
  • Tennis Elbow (Lateral Epicondylitis)
  • Golfers Elbow (Medial Epicondylitis)
  • Shoulder Calcifications (Calcific Tendonitis)
  • Achilles Tendonitis
  • Knees (Patellar Tendonitis)

ESWT has also been used to treat bone pathologies such as Delayed-Union and Non¬Union Fractures - conditions where broken bones do not properly heal back together.


How Does it Work?

The widely accepted theory is that ESWT causes microtrauma and controlled injury at the affected area, thereby leading to the formation of blood vessels (revascularization) which triggers the body’s natural healing process and repair mechanisms. Studies have shown an 80% and higher success rate in significantly reducing or eliminating pain.


What are Alternative Treatments?

We will first pursue conservative treatment options to reduce or eliminate pain. Conservative treatment may include such measures as rest, non-steroidal anti-inflammatory medications (NSAIDs), steroid injections, over-the-counter pain relievers, physical therapy, and shoe inserts (for heel pain). When pain has been persistent for 6 months or longer and conservative treatment has failed, ESWT is increasingly being used to avoid traditional invasive surgery.


Is This Treatment Right for Everyone?

This must be determined on a case-by-case basis. Regardless, ESWT is not recommended for use on pregnant women, children, anyone with a pacemaker, or anyone on anti-coagulant therapy or who has a history of bleeding problems.


What Happens Before, During and After Treatment?

BEFORE: Patients will be instructed to discontinue medication containing aspirin or non-steroidal anti-inflammatory medications (e.g. Motrin) for several days before treatment (and most likely for up to 30 days following treatment) unless otherwise instructed by the treating doctor. Patients will be asked to stop eating and drinking a number of hours prior to treatment due to the use of anesthesia.

DURING: Treatment typically lasts 20 to 30 minutes and is performed on an outpatient basis in a surgical center. To avoid discomfort during treatment, most doctors administer a local anesthetic at the point of pain and perform the procedure with the patient under intravenous (conscious) sedation.

AFTER: Patients may experience discomfort in the treated area after the effects of anesthesia have subsided. Some bruising, swelling, and temporary numbness is normal and expected. In the immediate days following treatment, many doctors will recommend RICE — Rest, Ice, Compression, Elevation. For 1 to 2 weeks following treatment, patients may continue to have the same type of pain experienced prior to treatment.

For 4 weeks following treatment, patients are advised not to participate in stressful activities (e.g. jogging, heavy housework, yard work, participating in sports) involving the affected area. Patients can then typically resume normal activity. Heel pain patients are typically instructed to avoid flat shoes such as sandals and slippers; continued use of orthotics may be encouraged.

Healing is generally complete at about 12 weeks, although patients may continue to experience additional reduction in pain thereafter.

Download the color brochure on Extracorporeal Shockwave Treatment (requires Acrobat reader).
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EMG/NCS

What is an EMG/NCS and why is it helpful?

EMG stands for Electromyograghy and NCS stands for Nerve Conduction Study. These two studies are done together; but on occasions, the EMG portion is skipped depending on the diagnosis and the result of the NCS portion. These two tests examine the integrity and function of your nerves to make sure there is no injury to the nerves from a compression in the arms or legs (carpal tunnel, cubital tunnel, pronator teres syndrome, tarsal tunnel, nerve laceration). These tests are also very useful to determine whether you may have a nerve injury from nerve compression in your neck or back from a slipped disc or from bony overgrowth.


How does the scheduling process work?

The office will call your insurance carrier to obtain authorization for the test. This process may take from a few days to a month depending on your insurance. You may call this office in two weeks to check on the authorization status. You may also call the insurance directly to make inquiry. Once authorization is given, we will call you to come to the office to have the test performed. Please make sure to keep your appointment and be on time as the next available appointment may be in a few weeks.


What happens during the procedure?

The test is performed in the sitting or lying position. Your leg or arm will be attached with electrodes to a portable machine. For the NCS portion, small electrical stimulation similar to the TENS unit will be discharged to measure the nerve function. For the EMG portion, a small, Teflon coated, sterile needle will be inserted in the muscles. This will feel very much like acupuncture. The EMG portion is not always performed. The procedure takes between 15-30 minutes. Pain is quite minimal and it is much less than a blood drawn. Most patients describe the pain as a discomfort.


What happens after the procedure?

Local discomfort may last a few minutes to about half an hour. You may return to work on the same day.


Risks and complications

There are no known risks with the EMG/NCS. Local discomfort is very brief and transient.


General Pre/Post instructions

Please do not apply any lotion, perfume, or cream to your skins prior to the procedure. There are no precautions after the procedure.


If you still have questions

Please call the clinic where you were seen and make an appointment with Dr. Tran so that your questions can be answered. It would be best that your questions are answered in person rather than over the phone. You may also visit our sister site www.spinalmedicine.com for additional information and links to other useful sites.
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