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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.
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.
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.
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.
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.
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.
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.
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:
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.
Answer: Most people with Carpal Tunnel Syndrome are treated without surgery. Surgery is considered only when:
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.
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.
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.
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.
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.
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
Answer: Patients who are symptomatic and have been diagnosed with the following conditions are good candidates for Epidural Injections:
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.
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.
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.
Answer: The typical hospital stay is 2 to 6 days.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
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:
Warning: Overloading of the spine by engaging in extreme activities (i.e., heavy weight lifting) may result in failure of the prosthesis.
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:
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.