Dr Emmanuel
Dr Emmanuel
Orthopaedic Surgeon


Please select a question of your interest or click tab to read the whole section.

Back and Neck

Will neck fusion surgery relieve me of my neck or back pain?

Answer: Herniated discs in the neck cause nerve compression and arm pain or back pain depending where the disc is (cervical/thoracic or lumbar). An anterior cervical discectomy and fusion surgery will remove the degenerated disc, bone spurs or herniated disc. This will in turn relieve the patient from arm pain and neck pain. The surgical outcomes after this type of surgery are excellent! Patients have decreased radicular symptoms such as arm weakness, numbness and tingling. After surgery, physical therapy and neck muscle strengthening play a big role in the postoperative rehabilitation of the patient.

What does it mean when my doctor uses the term “conservative treatment” when referring to my back?

Answer: Conservative treatment is any treatment that does not require surgery and is non-invasive. This means, nothing is inserted into your body and surgery is not performed.
In the case of treating back pain, conservative treatment could mean physiotherapy, pain medications, exercise, heat/cold treatments.

Dr. Emmanuel, in most cases, will recommend one or a few conservative (non-surgical) treatment methods to relieve your back or neck pain before recommending surgery.

What does it mean to have a Multidisciplinary Approach to Treating Back Pain?

Answer: Millions of patients suffer from chronic low back pain everyday. A lot of research has been done to find ways to manage this pain. A multidisciplinary approach involves behavioral modification as well as physical exercises to help the patient manage the pain. Patients are taught to change the way they think about and respond to pain. This is Cognitive and Behavioral therapy. Our goal is to educate our patients. By improving their coping skills, patients are able to increase their function and activity levels even if the pain levels don’t change. For patients who want to return to work, there is also vocational training. Our team of physicians and medical professionals at the Orthopedic & Spine Institute of Los Angeles will work with their patients to educate them about their back pain. Our goal is to increase your functional abilities and help improve your pain.

I am 75 yrs old I have always been active, played golf, and been in good shape. I just found out I have spinal stenosis. How can this happen when I exercise daily and eat healthy foods?

Answer: Spinal stenosis is a degenerative condition of the spine that is caused by natural aging. Spinal Stenosis means there is a narrowing of the spinal canal and openings for the spinal nerves. The narrowing is what causes the back or neck pain to result. Other factors that contribute to spinal stenosis are: soft tissues, changes in bones (osteoporosis), or joint changes as well. When discs in the back get thinner and lose flexibility, the vertebrae and joints start moving closer together and bone spurs are formed. This causes joints to lose their ability to slide and glide. This further adds to the problem when joints no longer fit together and move smoothly.

What is the difference between a bulging disc, a slipped disc, and a herniated disc?

Answer: Of course it can be confusing when you hear these terms but all three mean the same thing.
Other terms used are: compressed, prolapsed and ruptured discs.

For example, if the patient has been in an accident or had a back injury, the result could be that the disc has moved (bulged) and is now pressing on the nerve, which in result causes back pain.

I have had a herniated disc for a long time but didn’t want to have surgery. Now I have developed a foot drop. What should I do?

Answer: Pressure on the spinal nerve can cause a foot drop to occur when the L5 nerve is affected. A herniated (bulging) disc can be one of the causes of it. In many cases, muscle weakness is a result of nerve impairment, especially the L5 nerve. If the L5 nerve is impaired, motor loss can occur along the front of the lower leg. Muscle weakness causes the toes to drag along the floor as the foot and leg move forward.

Surgery is recommended to relieve the pressure from the compressed nerve causing this foot drop. For patients who don’t have surgery soon enough, the foot drop could become permanent depending on the amount of nerve impairment. Your chances of having a full recovery are much better if surgery is done sooner.


What are the most common symptoms of Carpal Tunnel Syndrome?

Answer: Carpal tunnel syndrome is caused by pressure on a nerve (the median nerve) in the wrist. The symptoms include tingling, numbness, weakness, or pain felt in the fingers, thumb, hand, and sometimes into the forearm.

What causes Carpal Tunnel Syndrome?

Answer: Conditions that may contribute to the development of carpal tunnel syndrome include arthritis, obesity, pregnancy, hypothyroidism and diabetes. Improper or prolonged use of the hands or wrist can also put pressure on the median nerve by causing swelling or thickening of tissues close to or within the carpal tunnel. Prior injuries (especially fractures) to the wrist make a person more likely to develop carpal tunnel syndrome.

Both work and recreational activities can cause carpal tunnel syndrome if done repeatedly over a long period of time.

Some of these activities include:

  • Typing, data entry, use of a computer mouse, or bar code scanning.
  • Use of tools, especially those that vibrate (such as sanders).
  • Prolonged knitting or needlework.
  • Prolonged twisting of the wrist.

How Can Carpal Tunnel be treated?

Answer: Carpal tunnel syndrome in most cases can be treated by avoiding repetitive activities that irritate the wrist. Also, applying ice, wearing a night splint, and taking anti-inflammatory medications such as Ibuprofen may provide relief. Strengthening the arms and shoulders may also help. In some cases, surgery may be helpful.

When is Surgery Necessary to Treat Carpal Tunnel Syndrome?

Answer: Most people with Carpal Tunnel Syndrome are treated without surgery. Surgery is considered only when:

  • Symptoms have not improved after a long period of nonsurgical treatment. In general, surgery is not considered until after 3 to 12 months of nonsurgical treatment. Evidence of Nerve damage would make surgery more urgent.
  • Severe symptoms restrict normal daily activities, such as when there is a persistent loss of feeling or coordination in the fingers or hand, no strength in the thumb, or when the patient’s sleep is affected due to the pain.
  • There is damage to the Median Nerve (shown by nerve test results and loss of hand, thumb, or finger function) or a risk of damage to the nerve.

Carpal Tunnel Surgery is used to reduce the pressure on the median nerve in the wrist. This is done by cutting the ligament that forms the top of the carpal tunnel. Cutting this ligament relieves pressure on the median nerve. Any other tissue (such as a tumor) that may be putting pressure on the median nerve can also be removed during surgery. This is a very simple outpatient procedure and the patient is able to go home the same day.

Epidural Steroid Injection

What is an Epidural Steroid Injection?

Answer: Epidural Steroid Injections (ESIs) are the most common treatment options to relieve low back pain and leg pain. Epidural Steroid Injections are have been proven to be effective non-surgical treatment method to alleviate low back pain and radicular pain which is more commonly known as sciatica.

What are the Benefits of an Epidural Steroid Injection?

Answer: One of the benefits of an Epidural Steroid Injection (ESI) is that it can provide relief from back pain and sciatica from one week up to one year. ESI’s are beneficial if the patient has had an acute episode of back or leg pain, and the injection can provide substantial relief of the patient’s symptoms. If the injection is effective, the patient may have up to 3 injections in a one-year period. Another benefit of an Epidural Steroid Injection is that it delivers the medication (corticosteroid) directly to the source of pain. ESI’s also reduce local inflammation in that area which may be causing the pain.

Are Epidurals only used to relieve low back pain?

Answer: While Epidural Steroid Injections are commonly used to treat low back pain, they have also been very effective in relieving pain experienced in the neck (cervical) region and in the mid spine (thoracic) region.

How effective is an Epidural?

Answer: Studies show that more than 80% of patients who have had Epidural Steroid Injections state that they have experienced noticeable relief of the back pain symptoms.

How do Epidural Steroid Injections Reduce Inflammation?

Answer: Epidural Injections are most commonly used to treat radicular pain, better known as sciatica, which is pain that radiates from the back and “shoots” down the leg. Inflammatory chemicals and immunologic mediators in the body can cause pain. The steroids used in the Epidural Injection block the inflammatory response and therefore, relieve the patient from pain

Who is a good candidate for an Epidural Steroid Injection?

Answer: Patients who are symptomatic and have been diagnosed with the following conditions are good candidates for Epidural Injections:

  • Lumbar Disc Hernation
  • Degenerative Disc Disease
  • Lumbar Spinal Stenosis
  • Compression Fracture in the vertebra
  • Cysts in the facet joint or the nerve root
  • Annular tear

Why Get an Epidural Steroid Injection?

Answer: Various conditions can cause spinal passages to become narrow and therefore cause back pain.These conditions include disc herniations, bone spurs, spondylolisthesis (slipped vertebrae) or even joint cyts.

The benefit of an Epidural Steroid Injection (ESI) is that the steroids injected into the epidural space have an anti-inflammatory action that will alleviate back pain.Even though ESI’s don’t change the actual spinal condition, they do break the cycle of pain and inflammation and relieve the patient from pain.

Knee Replacement

What can I expect during recovery and rehabilitation after knee replacement surgery?

Answer: Everypatient’s recovery is different. After surgery, a physical therapist will work with you to gradually increase your knee strength and mobility. It is not uncommon to experience some pain during physical therapy.The important thing to remember is that the pain is temporary and that medications can help you manage this pain.With hard work during the first few weeks of rehab , you will have improved strength and motion, which will help reduce stiffness in your knee.

How much pain will I have after the knee replacement surgery?

Answer: For most patients, the pain after surgery is tolerable and becomes less and less over a few weeks.With various options to manage the pain, patients feel comfortable after surgery.Your physician may suggest one of the following to manage your pain:numbing injections, IV pain medication while you are in the hospital, patient-controlled anesthesia, injections, pain and/or anti-inflammatory medications.

How long will I be in the hospital after I have knee replacement surgery?

Answer: The typical hospital stay is 2 to 6 days.

Will I recover at home or at a rehabilitation facility?

Answer: Many people are able to go home within a few days after surgery. Some patients choose to recover at a rehabilitation center. This decision depends on the availability of family or friends to help you with daily activities after your surgery.Dr. Emmanuel with speak with you and members of your family to help you decide together which course of treatment is best for you.

When can I resume normal activities, such as working or driving?

Answer: Talk with Dr. Emmanuel to determine what’s best for you. Most patients are able to drive again about 4-6 weeks after the surgery as long as they are not taking narcotic medications. If your job is not physically demanding, you may be able to return to work after about a month.

How long will the implant last?

Answer: The success of your knee replacement depends on how satisfied you are with the decrease in knee pain and how much increased mobility you have after the surgery as well as the durability of the implant over time.Knee replacement surgery has a great success rate.About 90 to 95% of patients are satisfied with the outcome of their knee replacement surgery.Studies show that the lifespan of some implants are 10 to 15 years with some designs.

Does my insurance pay for my knee replacement surgery?

Answer: Knee replacement surgery is considered medically necessary and in most cases is covered by both private insurance and Medicare. Your out-of-pocket expenses such as your deductible or copay are determined by your insurance company.Our staff will call your insurance company weeks prior to your surgery to obtain authorization for the surgery and to inquire about out-of-pocket costs.

How can I prepare my family and myself before surgery?

Answer: A few weeks before you undergo knee replacement surgery, Dr. Emmanuel will discuss your recovery with you and your caregiver(s).He will explain the recovery and rehabilitation process with you and the care you will need after the surgery.

What else should I know about knee replacement surgery?

Answer: Many factors affect the way a knee replacement performs:your age, weight, activity level are a few. You should be aware of the potential risks to the surgery and that recovery and rehabilitation takes time.You will be well prepared ahead of time and will know what to expect after the surgery.Dr. Emmanuel and his trained staff are here to help you with the entire process from start to finish.

What you should expect the day of your arthroscopy surgery

Answer: The good thing is that almost all arthroscopic knee procedures are performed in an outpatient setting and the patient is able to go home a few hours after the procedure.Our staff at the Orthopedic Institute of Los Angeles will provide you with all the information you need for your procedure.You will also be contacted by the hospital or surgery center regarding your arrival time.

Arthroscopy can be performed under local, regional, or general anesthesia and your physician will discuss your options with you and pick the one that you are most comfortable with. The procedure normally between 45 minutes up to 1 ½ hours and it is recommended that you have someone take you home afterwards.

The purpose of the arthroscopy procedure is to properly diagnose your knee problem.By inserting the arthroscope (camera), the physician will be able to see the image of your knee on a monitor.

What to expect after your arthroscopic knee surgery?

Answer: After your arthroscopy procedure, you will have some activity restrictions during your recovery period.The arthroscopy findings will affect the outcome of your surgery depending on how much damage or injury was found in your knee.

Physical therapy will also play an important role in the final outcome of the arthroscopy.

Your physician will assess your process and let you know when it is safe to return to intense physical acitivity.

Most patients return to most of their normal physical acitivities within 6-8 weeks after the arthroscopy.Heavy weightbearing is not recommended.

What are the Benefits of Synvisc injections in the knee joint if I have Osteoarthritis?


  • Synvisc-One (Hyalgan G-F20) is the only treatment that can deliver up to 6 months of osteoarthritis (OA) knee pain relief with just one injection.
  • Lubricates and cushions your knee joint
  • Does NOT have any serious side effects
  • It is made from a natural substance similar to healthy joint fuid

Total Disc Replacement

How long has the ProDisc-L Total Disc Replacement been used?

Answer: Since 1999, over 16,000 ProDisc-L Total Disc Replacements have been implanted worldwide. The device was approved by the FDA for use in the United States in August 2006.

Who is a candidate for ProDisc-L Total Disc Replacement surgery?

Answer: If you have been diagnosed with degenerative disc disease (DDD) and your pain has failed to improve after at least six months of conservative (non-surgical) treatment such as physical therapy or medication, you may be a candidate for ProDisc-L total disc replacement surgery. In order to be a candidate to receive the ProDisc-L implant, you must meet the following minimum requirements:

  • Must be suffering from degenerative disc disease (DDD) at only one level between L3 and S1.
    • DDD is defined as a disc that is worn out or has become injured and is causing pain.
    • This determination is made based on history, physical examination and x-rays.
  • Should have had at least six months of conservative treatment without relief of symptoms (e.g., medications, physical therapy, etc.)
  • Vertebrae must be dimensionally large enough to support the device
  • Must not have an active infection, either throughout your body or localized to your spine
  • Must have good bone quality (no osteoporosis or osteopenia)
  • Must not be allergic to cobalt, chromium, molybdenum, polyethylene or titanium
  • Must be old enough that the bones in your body are mature and no longer growing
  • Must not have spinal anatomy that would prevent implantation of the device or cause the device to be unstable in your body, as determined by your doctor

Your occupation or activity level, your weight, the condition of other levels of your spine, whether or not you are pregnant, and any allergies you have may influence whether you should have surgery with the ProDisc-L implant. If any of these factors apply to you or if you think that you have any special health issues, please speak to your doctor.

What are the possible complications of ProDisc-L surgery?

Answer: As with any surgery, there are some possible complications that can occur when you have total disc replacement surgery with the ProDisc-L implant. Complications can occur singly or in combination and may include:

  • Bladder problems
  • Bleeding, which may require a blood transfusion
  • Blood clot (emboli) in the blood stream or lungs
  • Death
  • Difficulty with bowel movement or other problems with your bowels
  • Failure of device/procedure to improve your symptoms and/or ability to function
  • Failure of incision to heal properly or other incision problems
  • Fracture of the vertebrae
  • Fusion
  • Implant failure (e.g., implants that bend, break, loosen or move)
  • Impotence or retrograde ejaculation
  • Infection
  • Injury to internal structures such as your kidney, ureter, bowel, blood vessels, or lymphatic vessels
  • Need for additional surgery which could include removal of the ProDisc-L implant
  • Pain or discomfort
  • Paralysis
  • Phlebitis (swelling of veins)
  • Pneumonia
  • Problems with your blood vessels other than bleeding
  • Seizures
  • Side effects from anesthesia
  • Spinal cord or nerve damage
  • Spinal fluid leakage
  • Spinal instability
  • Tears of the dura (a layer of tissue covering the spinal cord)
  • Wear debris (load bearing implants that allow motion have been shown to potentially generate wear debris over time. Early and/or long-term effects of wear debris in the human spine are not yet known)

Warning: Overloading of the spine by engaging in extreme activities (i.e., heavy weight lifting) may result in failure of the prosthesis.

What should I expect after surgery?

Answer: ProDisc-L total disc replacement surgery is considered major surgery. As with any major surgery, you should expect some discomfort as well as a period of rehabilitation. Your doctor may prescribe medicines to help you manage any pain or nausea you may experience. You should expect to stay in the hospital for at least a few days. The average hospital stay for disc replacement surgery patients in the study for the ProDisc-L was about 3.5 days (range: 1.0 – 8.0 days). Prior to going home, you will be taught how to care for your incision and you and your doctor should discuss a plan to gradually bring you back to normal activity. It is very important that you follow your surgeon’s instructions. Try not to do too much, too soon.

Contact your doctor immediately if you:

  • have a fever
  • notice fluid draining from your incision
  • have trouble swallowing or breathing
  • have trouble urinating
  • have new or increased back or leg pain or numbness or weakness

Is the ProDisc surgery covered by insurance?

Answer: Total disc replacement is a new therapy. While some payors, such as Aetna and Kaiser Permanente have recognized the value of this therapy, many insurance companies are not familiar with total disc replacement and may not have a routine procedure for covering the surgery. Patients should ask their physician to request preauthorization from the insurance company before surgery. Patients can also request preauthorization, but there is often medical information that must be submitted and patients do not always have full access to their medical histories.

If you are a candidate for Artificial Disc Replacement Surgery, our staff at the Orthopedic & Spine Institute of Los Angeles will do all the paperwork involved to get your surgery approved with your insurance company.

Synthes Spine operates a toll free ProDisc hotline (1-800-895-7764) to help patients and physicians through the payment process.

  • North American Spine Society
  • California Medical Association
  • Spine Arthroplasty Society
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