Treatment Videos

Treatments We Provide


  • Aneurysms
  • Arterial Venous Malformations
  • Brain Tumors
  • Carpal tunnel
  • Deformities
  • Degenerative Discs
  • Herniated Discs

  • Low Back Pain and Neck Pain
  • Spinal Stenosis
  • Spondylolisthesis
  • Ulnar nerve


Your Spine Deserves Special Care

Your spine is at the center of a delicately balanced system that controls all of your body’s movements. Bones, muscles, ligaments, tendons, joints and nerves all work together to balance the weight of your body. Even minor damage to one component of your back’s structure can upset this fragile balance and result in pain.

It is not surprising then that back pain is second only to headaches as the most common cause of pain, and that 8 out of 10 people will have a problem with back pain at some time. The causes of spine pain, whether in the neck, mid-back or lower back, can be simple or complex. The vast majority of spine problems are treated non-surgically, but in certain cases, surgery may be necessary.

What Causes Back or Neck Pain?

Back or neck pain occurs for many reasons. All the major structures of the spine can cause pain. The most common cause of acute spine pain is muscle and ligament injury. This can occur as a result of minor injuries or more severe injuries, such as whiplash of the cervical spine. Chronic causes of back pain can occur as a result of degenerative or arthritic changes that affect the bones, disks and joints. These issues are typically treated non surgically. Treatment options may include physical therapy, medications, TENS units, and spinal or joint injections.

Sometimes degenerative changes in the spine cause compression of the nerves or spinal cord. This can result in other symptoms such as sciatica, arm pain, numbness or loss of strength function. Nerve compression can occur for many reasons including disk herniations, bone spurs, fractures, tumors or abnormal movement of the spine due to degenerative joints and/or bone.

If you are unable to function at an acceptable level for your lifestyle, or your neurological deficit is becoming progressively worse in spite of conservative treatment, then surgery may be a recommended treatment. In the vast majority of cases, modern spinal surgery is extremely successful in alleviating pain and restoring mobility. While spinal problems are a common cause of neurologic deficits and pain, there are many other causes, and your physician may recommend other treatments or further workup.

When surgery is necessary, there are many different procedures that may be used depending on the location and type of problem. The following is a general description of some of the most commonly performed procedures:

  • Discectomy – the removal of a herniated disk
  • Decompression – the removal of bone spurs, hypertrophied ligament or joints that is causing compression of the nerves or spinal cord
  • Corpectomy – the removal of an entire vertebra
  • Spinal fusion – bone growth and instrumentation is used to maintain stability in the spine after certain types of decompressions, fractures or unstable motion segments

Spinal surgery, as with any major surgery, is not without risks.

Understanding Spinal Anatomy

Your spine is a strong and flexible bony structure, made up of five sections from the neck to the tailbone, consisting of 33 bones or vertebrae. These sections are the:

  1. Cervical spine (neck)
  2. Thoracic spine (upper back)
  3. Lumbar spine (lower back)
  4. Sacrum
  5. Coccyx (tailbone)

In the cervical, thoracic, and lumbar areas, cushion-like discs separate the vertebrae. The discs, along with the facets (joints), give the spine the ability to bend and turn.

There are five vertebrae in the sacrum, but they are fused naturally and do not have discs to separate them. The coccyx has four smaller vertebrae that also are fused.


The cervical spine (neck) consists of seven vertebrae numbered C1 through C7 from top to bottom. Each of the top two vertebrae has a unique design. C1 is ring shaped and articulates with the skull. C2 has a protrusion that acts as a post around which C1 rotates. Together, C1 and C2 are primarily responsible for the motion of the head. Each of the remaining vertebrae in the cervical region is separated by an intervertebral disk and connected by the facet joints allowing for other motions of the neck and head.


The thoracic spine (upper back) consists of 12 vertebrae that are attached to the ribcage. Very little motion occurs in this region due to the strong support of the rib cage, therefore structural problems in the thoracic area are relatively uncommon.


The lumbar spine has five vertebrae. Like the cervical spine, the vertebral bodies in the lumbar spine are separated by intervertebral discs and connected posteriorly by the facet joints. This region endures a lot of stress, especially when you bend, and is a common source of back pain.


The spinal cord runs from the brain through the cervical and thoracic spine and ends in the upper lumbar spine. It relays information from the brain to the peripheral nerves. At each level of vertebrae, a nerve root exits on each side of the spine to the right and the left through a small bony opening called vertebral foramen. Once these nerves exit the spinal canal and neural foramen they are considered peripheral nerves and innervate the limbs and body. This is how signals from the brain reach every part of the body. Each nerve that leaves the spine innervates a specific area of the body referred to as a dermatome. While there is some variation among each person, these dermatomes are quite specific and can be helpful in determining the source of a patient’s pain. Problems can arise anywhere along this pathway from the brain to the nerves.

The Aging Spine

As the spine ages, years of wear and tear can result in a number of conditions. A few of the most common are:

  • Herniated discs – trauma or injury to a disc resulting in the disc protruding from the intervertebral space. A disk protrusion itself may not cause pain, but if the herniated disk material compresses nearby nerves or the spinal cord, this can result in pain and other symptoms.
  • Disc degeneration – wear and tear changes occurring in the discs. Often the disks lose water content and height. This is a universal process that occurs in everyone as they age. Severity is most linked to genetics.
  • Spinal stenosis – the narrowing of the canal that houses the spinal cord and nerve roots due to degenerative changes
  • Spondylolisthesis – when a vertebra slips out of line with an adjacent vertebra often due to congenital weakness of the bone or from significant arthritic changes

To a large extent, these spinal disorders are not problems in themselves. The trouble starts when they put pressure on the nearby nerve roots or spinal cord, causing pain, numbness, or even paralysis in the limbs.

Deciding the right way to treat your pain begins with an accurate diagnosis, which involves a thorough neurologic evaluation and the use of tools such as MRI, selective nerve root blocks (SNRBs) and nerve conduction studies (EMG/NCV).

Back Pain

Back pain is extremely common and can be quite debilitating. Most forms of back pain are best treated with non-operative therapies. The most common cause of acute back pain is muscle and ligament injury. These types of injuries can occur without any significant trauma. Another common source of low back pain includes the arthritis of the facet joints and degenerative changes of the bone and intervertebral disks. Less common but serious causes are fractures, infection and cancer. Back pain from degenerative changes is a diffuse process and often requires multi-modality treatment such as physical therapy and spinal injections.

Neck Pain

Neck pain, like back pain, is most commonly associated with abnormalities in the soft tissues (muscles, ligaments, or nerves) or in the vertebrae or joints of the cervical spine. In some individuals, neck problems may cause pain felt in the upper back area between the shoulder blades and the shoulders. Causes of neck pain are similar to back pain causes.

Spinal Disorders

Description of Disorders

Degenerative Disc Disease

The aging and/or traumatic wearing away of the discs (shock absorbers) that are located between the spinal vertebrae (bones). Degenerative disc disease is not really an actual “disease” but an expected aging process. Degenerative changes of the discs are a normal part of aging. It is usually seen along with other changes in the spine that can contribute to neck or back pain and, in certain cases, nerve pain.

Degenerative Spinal Arthritis

An aging phenomenon that occurs in all individuals. The joints or facets of the spine are often affected by arthritis just like other joints. These changes can be responsible for back pain and are treated with multiple non-operative therapies, including spinal injections. At times, however, the arthritis causes significant bone changes that result in nerve impingement and pain in the extremities. Conservative treatments are usually the first round of treatments but sometimes surgery is necessary to decompress the nerves.


Pain, numbness, tingling or weakness in one or both legs referable to inflammation or compression of one or more branches of the sciatic nerve. The sciatic nerve is formed from the nerves in the lumbar spine area. Symptoms similar to sciatica can also occur with inflammation or compression of the nerves and/or spinal cord in the cervical spine (neck). Nerve pain in the extremities is referred to as radicular pain.

Herniated Disc

Rupture of the intervertebral disc with extrusion of the disk material into the spinal canal or foramen. This can sometimes cause pain, weakness or numbness if the disk herniation compresses the spinal nerves or spinal cord. Disc herniation can also cause discomfort due to inflammation. Many herniated disks do not require surgery and can be treated with a combination of spinal injections and physical therapy.


Narrowing of the spinal canal or intervertebral foramen which may cause compression of the spinal cord or nerves with resultant symptoms


Slippage of one vertebral body on another due to either arthritis or to a fracture acquired during childhood or adolescence Slippage and instability may also cause nerve symptoms.


Curvature of the spine usually due to congenital abnormalities or degenerative changes


Decreased bone density which weakens bone and leaves patients prone to fractures of the spine and other bones. Most commonly occurs in older women after menopause. Osteoporosis is often treated by a primary care physicians with diet and sometimes medical and/or hormonal therapies.


Spinal bones typically fracture due to trauma and falls, although they may occur in osteoporotic patients with minimal trauma.


Tumors may be benign or malignant. Tumors can occur in the nerves, spinal cord, bones or surrounding soft tissues of the spine. Most common spinal tumors are metastatic tumors from other primary sites like the lungs, breast or prostate.


The spinal bones and discs may become infected, usually from bacteria traveling in the blood or urine.

Possible Treatment Options

Degenerative disc disease, spinal arthritis, sciatica, herniated disc, stenosis and spondylolisthesis are usually treated initially with medications, physical therapy and spinal injections. Surgery is reserved for refractory nerve pain or neurologic deficit with corresponding cause found on MRI imaging or other studies. Remember that not all neurologic deficits or pain are caused by problems in the spine, nor is surgery always appropriate.

Children’s and teenage scoliosis are treated with observation, bracing or surgery.

Adult scoliosis is usually treated with medication, physical therapy and spinal injections for pain. Severe or progressive deformities can be treated surgically.

Osteoporosis is treated with medications. Osteoporotic fractures are treated with rest, bracing or surgery.

Tumors are treated with radiation, chemotherapy and sometimes surgery.

Infections are treated with antibiotics and sometimes surgery.

Degenerative Disc Disease

Degenerative Disc Disease (DDD) is an almost a universal finding in patients, and is a natural part of the aging process. Therefore, degenerative disk disease is not really a disease but an aging process often referred to as “arthritis of the back.”

With age, the discs or “shock absorbers” located between the vertebral bodies lose their elasticity and may cause one vertebral body to collapse down onto another. Again this is part of the normal aging process, however, the collapsed disk may contribute to nerve compression causing leg or arm pain.


  • Aching lower back pain
  • Stiffness in back
  • Radiating pain that descends into the legs
  • Pain is usually worse with activity or prolonged sitting or standing


  • Normal changes in disc during the natural aging process
  • Trauma (injury)
  • Repetitive lifting
  • Smoking, obesity and hereditary factors lead to advanced degeneration

Possible Treatment Options

Non Operative Treatment is most common. This includes medications, physical therapy and/or spinal injections


Surgery is not performed for degenerative discs alone. Surgery can sometimes help if the degenerative discs and arthritis cause significant nerve compression and pain. Surgical decompression procedures are aimed at alleviating pressure on the nerves or spinal cord by removing arthritic bone, disk herniations or hypertrophied ligament.

Decompression & Fusion

If decompression of the nerves in the spine requires significant removal of bone, joints or discs sometimes a spinal fusion will be necessary to maintain spinal stability. Fusion surgeries are also commonly used to treat patients with spine tumors, fractures and spondylolisthesis (‘slipped spine’) The goal of fusion is to have new bone form to maintain long term stability of the spine. This is often achieved by using instrumentation such as rods and screws that stabilize the spine while bony fusion occurs. This process of bone formation and fusion can take many months and even year or longer to occur.

Herniated Disc


A herniated disc occurs when a portion of the vertebral disc ruptures. This ruptured portion may push on nerves in the cervical, thoracic or lumbar areas.

This pressure on the nerves can often lead to numbness and pain. Smaller herniations are sometimes called protrusions.

Bulging disks are a normal part of aging and occur in both patient’s with and without back pain.



  • Discomfort in one or both arms
  • Shooting pains in one or both arms
  • Weakness or numbness in one or both arms
  • Burning arm pain


  • Discomfort in leg, ankle, or foot
  • Shooting pain, weakness or numbness in leg
  • Leg pain, particularly when sitting



  • Degeneration due to normal aging process
  • Trauma
  • Episode of heavy lifting


  • Degeneration due to normal aging process
  • Trauma
  • Episode of heavy lifting
  • Sudden twisting

Possible Treatment Options

Non Operative Treatment
Medications and non operative treatments (physical therapy) are sometimes needed. Occasionally epidural injections are indicated for pain relief.

Anterior Cervical Discectomy Fusion Instrumented
The ruptured disc is removed. It is then replaced by a bone graft. An anterior cervical plate is implanted for stability.

Posterior Cervical Laminotomy
The spinous process and lamina are removed to decrease pressure on the spinal cord. Instrumentation may be used to increase post-operative stability.

Lumbar Partial Discectomy
Removal of herniated portion of the disc relieves the pressure on the painful nerve.

Spinal Injuries in Older Children

Children and teens who participate in more competitive and specialized sports are prone to certain types of spinal injuries. Spondylosis is damage to a joint in the spine that can occur in children who regularly hyperextend their backs (bend backwards), as in gymnastics. Spondylolisthesis is a “slipping” of one vertebra on another and is a condition that can progressively worsen through adolescence. Disc injuries and fractured vertebrae frequently result when teens land very hard on their feet or buttocks in “extreme” sports like skateboarding, inline skating, and “vert” biking.

Overuse injuries and back strain from carrying backpacks that are too heavy have also become more prevalent in children and teens. Overloaded backpacks put tremendous stress on the developing spine, especially when slung over one shoulder.



Sciatica is the irritation of the largest nerve in the body, the sciatic nerve. The sciatic nerve begins with several nerves in the lower back and travels down the legs. This irritation can stem from a disc herniation, inflammation, bone spurs or foraminal stenosis. Pain occurs when any or all of these conditions compress the nerve roots or spinal cord.


  • Irritation in one leg
  • Shooting leg pain
  • Weakness or numbness
  • Burning leg pain
  • Pain when sitting


  • Degeneration or rupture of a disc
  • Development of bone spurs or thick ligaments
  • Normal aging process
  • Sudden twisting
  • Episode of heavy lifting
  • Other physical trauma

Possible Treatment Options

Non Operative Treatment
Medications, physical therapy or spinal steroid injections are indicated for pain relief.

This surgical procedure involves removing all or portions of the lamina, removing bone spurs and/or enlarging foramina to relieve pressure or compression on the nerve roots or spinal cord. This pressure is often the cause of the pain.

Decompression & Fusion
Often times, in addition to a decompression, your surgeon will perform an instrumented fusion by inserting a series of screws and rods coupled with the placement of bone graft. This fusion maintains spinal stability.

Posterior Transforaminal Interbody Fusion
This is the same procedure as the ALIF except it is performed from the back. Just as in an ALIF, the disc material is removed and an interbody device is inserted. Spinal stability through the use of pedicle screws and rods is frequently used to aid in fusion.



Spondylolisthesis is defined as a slip of one vertebral body relative to an adjacent vertebral body. This spinal condition most commonly presents as a degenerative disease in adults but may be present in adolescents as a result of deformity or trauma.

Often there is mild to moderate back pain. If the slip is compressing a nerve, leg pain often develops.


  • Lower back pain
  • Leg pain and numbness may develop if there is nerve compression



  • Arthritic changes
  • Disc degeneration
  • Pars defect (congenital or acquired bone defect)


  • Trauma due to athletic activities
  • Congenital deformity
  • Isthmic Spondylolisthesis

Possible Treatment Options

Non Operative Treatment
Medications, physical therapy or spinal steroid injections are indicated for pain relief.


This procedure involves removing all or a portion of the lamina, removing bone spurs and/or enlarging the foramen where the nerves run to relieve pressure on the nerve roots or spinal cord. This pressure is often the source of pain. Usually, in addition to a decompression, your surgeon will also perform an instrumented fusion by inserting a series of rods and screws coupled with the placement of bone graft. Fusion is done to maintain spinal stability.



Stenosis is a narrowing of the spinal canal or the foramen, the opening through which nerve roots pass. Stenosis can develop in any area of the spine but is most common in the lumbar and cervical spine.

Degenerative changes in the spine, a collapsed disc, bone spurs, or cysts can cause the spinal canal to narrow. This narrowing places pressure on the nerve roots and/or spinal cord, often resulting in pain.



  • Stiffness in neck
  • Weakness in arms causing difficulty using the hands
  • Pain and numbness in hands and/or arms


  • Tired, heavy feeling in back, buttocks, and legs while walking or standing
  • Cramping sensation in these areas
  • Decreased walking due to weakness, numbness or pain in legs


  • Arthritic changes like bone spurs
  • Overgrowth of bone or ligament
  • Bone spurs push on nerves and spinal cord
  • Compression can be caused by large disc herniations

Possible Treatment Options

Non Operative Treatment

Medications, physical therapy or spinal steroid injections are indicated for pain relief.

Cervical Laminectomy
Spinous process and lamina are removed to decrease pressure on spinal cord. Instrumentation can be used to ensure stability after removal of bone and/or joints.

Lumbar Decompression
This procedure involves removing all or portions of the lamina, removing bone spurs and/or enlarging foramen to relieve pressure or compression on the nerve roots or spinal cord. This pressure often is the cause of the pain.

Decompression & Fusion
Often times, in addition to a decompression, your surgeon will perform an instrumented posterolateral fusion by inserting a series of screws and rods coupled with the placement of a bone graft. This fusion provides increased spinal stability.

Posterior Transforaminal Interbody Fusion
This is the same procedure as the ALIF, except it is performed from the back. Just as in an ALIF, the disc material is removed and an interbody device is inserted. Compression through the use of pedicle screws is frequently achieved to aid in fusion.


Spinal trauma results from significant physical injury sustained as a result of high energy impacts or falls. Motor vehicle accidents and common falls account for a large portion of spinal trauma. These injuries can lead to compression of one or more vertebrae. Weakened bones can also lead to fracture at a low level of trauma. A traumatic episode can result in the sudden onset of back pain.


  • Back pain after an incident
  • Weakness or numbness
  • Paralysis


  • High energy impact trauma
  • Motor vehicle accident
  • Falls
  • Weakened bones

Possible Treatment Options

Non Operative Treatment
Pain medications, spinal epidural injections and bracing are sometimes needed. Surgery may be considered for those who do not improve.

Lumbar Vertebral Body Replacement
If a vertebral body has been severely fractured in a traumatic event, the entire vertebral body may be replaced with a stabilized metal cage or bone strut. Instrumentation anchored to the surrounding vertebral bodies stabilizes the construct.

This surgical procedure involves removing all or a portion of the lamina, removing bone spurs and/or enlarging the foramen to relieve pressure on the nerve roots or spinal cord.

Posterolateral Fusion
Often times, in addition to a decompression, your surgeon will perform an instrumented posterolateral fusion by inserting a series of rods and screws coupled with the placement of bone graft. This fusion provides increased spinal stability depending on the severity of the injury.

Tumors of the Spine


Tumors of the spine are usually metastatic, meaning they originate from a primary tumor elsewhere in the body and spread to the spine via the lymph nodes or bloodstream. Tumors can grow into the spinal cord causing neurological problems. In addition, tumors may destroy vertebral bodies causing collapse and thus, local or radiating pain.


  • Back pain caused by destroyed bone
  • Radiating leg pain or weakness
  • Neurological problems


  • Growth of a primary tumor in a vertebral body
  • Spread of distant primary organ tumors to the spine
  • Growth of tumors into spinal canal
  • Collapse of vertebral bodies causing nerve pressure

Possible Treatment Options

Non Operative Treatment
Chemotherapy and radiation are sometimes needed. Surgery can be considered for those who do not improve.

Anterior Vertebral Body Replacement
Surgical instruments are used to remove tumor and affected vertebrae. Once the tumor is removed, a metal implant is inserted to provide stability and replace the void caused by the removed tumor.

Laminectomy and Instrumentation
Performed when a tumor has spread to the spine and is pushing on the spinal cord. The laminectomy removes a portion of the bone pushing on the nerves or spinal cord causing pain. Instrumentation is often used to provide additional stability.

Epidural Steroid Injection

An epidural steroid injection is a medical procedure that involves the administration of pain-killing medication into a small space in your back or neck. Epidural steroid treatment usually involves a series of three injections, administered two weeks apart. This treatment has brought relief to many patients who suffer from pain caused by local inflammation, such as bulging discs, arthritis or ligament strain.

How quickly can I expect pain relief?

While relief is not instantaneous, most patients report that initial benefit is felt two to five days after the first injection and maximum relief is reached one or two weeks after the last injection.

How should I prepare for the procedure?

To minimize the chance of complications from the procedure, we ask that you follow a few simple guidelines:

  • If you are allergic to x-ray dye/contrast, iodine, or shellfish please follow the instructions given by the nursing staff. If you were not given specific instructions, please call 501-661-0077.
  • Wash area of injection with Hibiclens for 5-10 minutes every night starting 3 nights prior to your epidural steroid injection. Hibiclens can be purchased at any pharmacy.
  • Do not eat or drink anything four hours prior to the procedure. An exception is always made for routine scheduled medication, which you can take with a sip of water.
  • We require that a responsible adult driver accompany you to and from the hospital. You will be given a small dose of relaxing medication prior to the injection, which could impair your driving ability.
  • If you are having a selective nerve root block or a SI joint injection please bring your MRI, X-ray, and/or CT films.  (For epidural steroid injections you do not have to bring your films.)
  • If you are taking any anti-inflammatory or blood thinning medications, you must STOP taking them prior to each procedure. NSAIDS need to be stopped 3 days prior to your procedure and blood thinners need to be stopped 7 days prior to procedure. More information is available on our injections page.

What happens during the procedure?

You’ll first be given nitric oxide to help you relax and lessen the pain of the injection. We will then begin continuous monitoring of your heart, breathing and blood pressure. You’ll be asked to lie face down on the treatment bed. Sometimes, x-ray guidance aids in appropriate placement of the medication. After cleaning a small patch of your skin, a local anesthetic is injected into the skin to numb the procedure area. The steroid medication is then administered through a small needle. The procedure itself is very brief, usually less than five minutes.

Occasionally, patients describe a recurrence of their normal back pain during administration of the medication. This is viewed as a reassuring sign that the medication is going to the right place, and the sensation usually disappears quickly.

What happens afterwards?

After the epidural steroid medication has been injected, you’ll be monitored for about 20 minutes. If there are no signs of problems, you will be ready to leave.

How do I schedule another injection?

Typically, we schedule patients for three injections. While some patients experience relief from pain after only one, many need two or three to reap the full benefits. To schedule or cancel an injection please call or send us a message today. If you are having a diagnostic nerve root block, please call with results 48 hours after procedure. If you are having a series of epidural injections, you’ll need to contact our office two weeks after your last injection. Please allow one business day for a response.

There are other injections available if the series of epidural injections aren’t successful.

Physical Therapy Following Steroid Injections

Physical Therapy following steroid injections uses a treatment designed to enhance the effectiveness of the epidural steroid shot. A Physical Therapist will also be evaluating and assessing each patient for spinal strength and range of motion. The PT will then design an individualized exercise program to ensure that each patient does not lose any strength or range of motion during and after the series of injections. The Physical Therapist will explain to you in detail your plan of care, as well as the treatment procedures and follow up.

What to expect on your first PT visit: You will get a full evaluation of the range of motion in your neck or back, as well as an evaluation of your arm and leg strength, and muscle flexibility. The therapist will then create a custom exercise plan to target your problem areas. Following the evaluation, you will receive a therapy treatment, usually consisting of electrical stimulation therapy and moist heat near the area of your injection to decrease pain and inflammation in the area as well as promote muscle relaxation.
Estimated time: 45—60 minutes

On your consecutive PT visits you will receive a therapy treatment, usually consisting of electrical stimulation therapy and moist heat near the area of your injection to decrease pain and inflammation in the area as well as promote muscle relaxation. We will also review your Home Exercise Program and exercise progressions it as needed.
Estimated time: 20 minutes

Other Treatment Options for Back and Neck Pain

Your doctor may discuss with you conservative treatments such as traction, anti-inflammatory drugs or physical therapy.

Surgery is usually considered only after all nonsurgical options fail to give you relief from your pain or you are unable to function at an acceptable level for your lifestyle. Another concern arises if you begin to experience numbness in other parts of the body, especially the legs and feet. This typically indicates some kind of nerve damage, which may also be called a neurological deficit. If these symptoms become progressively worse in spite of more conservative treatment, then surgery is often recommended.

The good news is, in the vast majority of cases, modern spinal surgery is extremely successful in alleviating pain and restoring mobility. Of course, spinal surgery, as with any major surgery, is not without risks. You and your doctor should discuss possible complications and how you can help reduce your risks both before and after surgery.

There are a number of different surgical approaches to relieving back and neck pain, including:

  • Discectomy – the removal of all or part of the offending disc
  • Decompression – the removal of bone spurs
  • Corpectomy – the removal of a vertebra
  • Fusion – the joining of discs to prevent motion in the affected area

You and your doctor should discuss which type of procedure is likely to offer you the best results.

 Facet Injections

Facet injections involve a three-step process meant to help patients with localized back or neck pain. The first two steps are diagnostic injections, and determine if the third step, the actual long-lasting relief treatment, is appropriate. The two initial injections determine if the joints in the spine are causing some of the patients pain and pinpoint where the pain is coming from. If it the results from the first two injections indicate joints in the spine are the root cause of the patient’s pain, a third injection which provides more long-term relief will be administered with the purpose of damaging the sensory nerve to numb the painful joint.

In the first injection, numbing medication (bupivacaine) is injected into the joint with a little bit of steroid. If the patient experiences roughly 3-24 hours of temporary relief a second injection is scheduled.
During the second injection, bupivacaine is injected into the nerve that enters into the joint that received the first injection. If the patient gets moderate temporary relief from their back pain he/she is then considered a candidate for the third treatment called a rhizotomy, where a needle is placed onto the nerve of the joint(s) to numb the pain. This procedure often provides long-lasting relief. However, the small sensory nerves the treatment is performed on do have the ability to grow back, which can result in the reoccurrence of pain. If the nerves do grow back, the process usually takes 12-18 months. If needed, the procedure can be done again at that point.
The risks associated with facet injections are very small. However, anytime a needle put into the body near the spine there is risk of infection, bleeding and nerve injury.


Kyphoplasty is a type of minimally invasive spinal surgery used to treat the painful collapse or fracture of a vertebra. The vertebrae are the bones of the spine that encase and protect the spinal cord, provide support for the back, and allow the body to bear weight. The vertebral bones may fracture because of osteoporosis (an age-related weakening of the bones) or by a tumor that has spread to the vertebrae. These conditions cause the spine to weaken and collapse, which results in a sudden onset of intense pain and a resultant deformity of the spine.

During kyphoplasty, a balloon is inserted into the vertebral bones and is expanded, serving to “inflate” the vertebrae to restore height and shape. The vertebra is then strengthened by injecting acrylic bone cement. This procedure is performed under anesthesia.

Kyphoplasty has been shown to provide effective pain relief for a vertebral body collapse and, in most people, provides a return to full functioning. One of the main advantages of kyphoplasty is that there is usually no need to undergo rehabilitation or physical therapy after the procedure. This is because the bone cement hardens within 15 minutes and doesn’t require additional tissue healing. Some people may experience some pain after the procedure because of irritation during the operation; however, this usually diminishes within two weeks. Pain experienced after the operation may in fact be attributed to underlying degenerative changes of the spine. In these cases, nonsteroidal anti-inflammatory medications (NSAIDs) and physical therapy may help.

Although the acrylic cement helps prevent the weakened bone from fracturing again, the surrounding vertebral bones may still be at risk for injury. This risk is greater for people who suffer from osteoporosis, and have bones that are prone to fracture. For this reason, your doctor will continue to manage the cause of the bone weakening or injury through the use of bone-strengthening medications. If surrounding vertebrae are damaged, kyphoplasty can also be used at those levels. Your doctor may also discuss the use of hormonal-replacement therapy if you have osteoporosis.

Minimally Invasive Spine Surgery

Minimally Invasive Spine Surgery (MIS) is a general term used to describe a variety of surgical techniques which involve making smaller incisions and reducing the amount of tissue damage beneath the skin. In spinal surgery, minimally invasive surgery is accomplished with the aid of specially designed instruments which assist in visualization of the surgical field. Typically, this is done with tubular retractors which allows the surgeon to make a small incision but visualize a larger area beneath the small incision. Our surgeons at Legacy who perform minimally invasive spine surgery are fully trained in the correct use of these techniques.

What is the future of Minimally Invasive Spine Surgery?

Newer areas for minimally invasive techniques include the fusion of two vertebrae together and expanding endoscopic procedures (meaning: the surgery is performed through little holes in the skin as opposed to a larger incision). The field of minimally invasive spine surgery is growing rapidly and the overall trend is toward more minimally invasive techniques and new procedures. Our surgeons stay up-to-date on new MIS research and techniques.

What are the potential benefits of Minimally Invasive Spine Surgery?

The potential benefits of minimally invasive spine surgery may include smaller scars following the operation and less damage to the surrounding tissues beneath the skin, meaning less pain and blood loss. The potential outcomes of such operations are the reduction of pain and morbidity associated with standard open surgery.

What is the MIG-LIF Procedure?

Dr. Schlesinger’s MIG LIF Procedure is a new minimally invasive surgical technique developed to treat lumbar stenosis/instability, a very advanced form of back and associated leg pain. This technique utilizes navigation/image guidance and a single midline incision of 15 – 20 mm to achieve direct decompression and instrumentation to relieve this debilitating pain.It allows for marked reduction in post-op pain, quicker recovery time, less blood loss, significantly lower risk of MRSA infections, and lower costs for patients needing lumbar decompression and fusion procedures.

In a retrospective clinical study, 40 patients suffering from degenerative disc disease who tested positive for radicular pain and segmental instability were treated using the Legacy Spinous Process MIG-LIF procedure. All 40 patients were successfully discharged the same day of surgery.

Read the full abstract and study by Dr. Scott Schlesinger here.