Non-Surgical and Diagnostic Procedures

What is a Epidural steroid injection (ESI)?

An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves. ESI may be performed to relieve pain caused by spinal stenosis, spondylolysis, or disc herniation. Medicines are delivered to the spinal nerve through the epidural space, the area between the protective covering of the spinal nerves and bony vertebrae.

Epidural steroid injection image

Reasons for the procedure

Patients with pain in the neck, arm, low back, or leg (sciatica) may benefit from ESI. Specifically, those with the following conditions:

  • Spinal stenosis: A narrowing of the spinal canal and nerve root canal can cause back and leg pain, especially when walking.
  • Spondylolysis: A weakness or fracture between the upper and lower facets of a vertebra. If the vertebra slips forward (spondylolisthesis), it can compress the nerve roots causing pain.
  • Herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve.
  • Degenerative disc: A breakdown or aging of the intervertebral disc causing collapse of the disc space, tears in the annulus, and growth of bone spurs.
  • Sciatica: Pain that courses along the sciatic nerve in the buttocks and down the legs. It is usually caused by compression of the 5th lumbar or 1st sacral spinal nerve.

ESI should NOT be performed on people who have an infection or have bleeding problems. The injection may slightly elevate the blood sugar levels in patients with diabetes. It may also temporarily elevate blood pressure and eye pressure for patients with glaucoma. You should discuss this with your doctor.


 

What is Facet thermal ablation?

Facet joints are the joints in your spine that make your back flexible, and enable you to bend and twist. Facet Thermal Ablation uses a laser to deaden sensory nerves that are irritating the facet joins, causing pain.

During the facet thermal ablation procedure, surgeons vaporize irritated and painful nerves around the facets of the vertebrae, removing pain-inducing tissue in nerve branches above and below the affected facet joints on the spine.

facet thermal ablation image

 

Reasons for the procedure

The most common symptoms of this spine condition include:

  • Acute pain — Facet arthritis may cause localized pain in the neck or lower back where the joints are affected. The pain can be random and intermittent, ranging from almost constant to just a few times a month.
  • Persistent tenderness or pain — One of the most common symptoms of facet arthritis is a continual tenderness at the site of the arthritis.
  • Limited movement and flexibility — Often arthritis in the facet joints will cause limited movement and stiffness in the spine. You might experience more pain bending backward than forward.
  • Radiating pain — You may experience pain in your buttock and leg if your facet arthritis is in your lower spine. Likewise, if the facet arthritis is in your cervical (neck) spine, you may experience radiating pain in your shoulder and arm.

 

What is Pain Mapping?

Pain mapping uses the most advanced techniques and technology to pinpoint the precise source of your neck and/or back pain. Doctors will perform a series of precisely targeted injections to determine exactly where your pain originates. This allows us to provide temporary relief while establishing the root cause of the pain.

There are several different pain mapping procedures that can be performed, including:

  • Selective Nerve Root Blocks
  • Piriformis Injections
  • Occipital Nerve Blocks
  • Sciatic (Peripheral) Nerve Blocks
  • Sacroiliac Joint Injections/Blocks
  • Cervical/Thoracic/Lumbar Medial Branch Blocks
  • Discography
  • And Many More

 

Reasons for the procedure

The spine is a complex network of nerves, bones and discs, so nerve roots can sometimes be prone to compression or stenosis from herniated or bulging discs. Nerves in our upper and lower extremities originate from large spinal nerves that separate from the spinal cord in various places. They can be compressed by the bones of the spine themselves, such as with cases of degenerative disc disease. This often results in pain in the neck and lower back region that can radiate into the upper and lower extremities.

Our pain mapping techniques are performed in order to expertly pinpoint and isolate the nerve(s) that causes the pain. With this knowledge, we are able to create a more efficient plan of action to treat the pain.


 

What is Physical Therapy

Physical therapy, also known as physiotherapy, is a physical rehabilitation specialty that, by using mechanical force and movements, remedies impairments and promotes mobility, function, and quality of life.

Therapists examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, they work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

 

Reasons for the procedure

Physical therapy attempts to address the illnesses, or injuries that limit a person's abilities to move and perform functional activities in their daily lives. Functional movement is central to what it means to be healthy.

Physical Therapy img

 

What is a Sacroiliac joint injection?

The Sacroiliac Joint injection is performed under fluoroscopy for accuracy. Once the needle has entered the sacroiliac joint, a special contrasting chemical is injected into the joint to ensure proper needle placement and proper spread of medication.

Also called a sacroiliac joint block, it is primarily used either to diagnose or treat low back pain and/or sciatica symptoms associated with sacroiliac joint dysfunction.

Reasons for the procedure

The sacroiliac joints lie next to the spine and connect the sacrum with the hip on both sides. There are two sacroiliac joints, one on the right and one on the left. Joint inflammation and/or dysfunction in this area can cause pain. The purpose of a sacroiliac joint injection is two-fold: to diagnose the source of a patient's pain, and to provide therapeutic pain relief.

 

Sacroiliac Joint image


 

Spinal Cord Stimulation for Chronic Back and Neck Pain

A spinal cord stimulator (SCS) device is surgically placed under your skin and sends a mild electric current to your spinal cord.

Unlike most surgical procedures, spinal cord stimulation therapy is reversible. If a person decides at any time to discontinue the therapy, the electrical contacts, wires, and generator can all be removed and there are no permanent changes to the spine.

 

Reasons for the procedure

Spinal cord stimulation is a therapy that masks pain signals before they reach the brain. A small device, similar to a pacemaker, is implanted in the body to deliver electrical pulses to the spinal cord. It helps patients better manage their chronic pain symptoms and decrease the use of opioid medications.

This stimulation does not eliminate the source of pain, it simply interferes with the signal to the brain, and so the amount of pain relief varies for each person. The goal for SCS is a 50 to 70% reduction in pain. Stimulation does not work for everyone. Some patients may find the sensation unpleasant. In other cases it may not cover the entire pain area.


 

What is Adult Stem Cell Therapy?

Stem cells are cells that are located within the body that have not yet transformed to perform a certain function. Stem cells are the body’s natural healers. Unlike other cells, they have the unique ability to transform into the other types of cells the body need for repairing damage joints in the back. As we age, the number of stem cells and their potency decline.

With stem cell therapy for back pain, we revitalize a patient’s stem cells and inject a concentrated dosage of them and PRP directly to the damaged area of the spine.

 

Reasons for the procedure

Once injected, the stem cells will begin restoring and rebuilding the diseased discs in the spine. The PRP, which contains a tremendous amount of growth factors, will stimulate the stem cells to maximize their effectiveness. The entire procedure only takes a few hours to complete, and patients will be able to leave the clinic and go back home immediately.

For most patients, a single stem cell injection is all that is needed to eliminate their back pain, and the pain relief can last for the rest of their life. For patients with a severe degenerative disease, additional stem cell injections may be needed.


 

About Us

The first in Texas to perform micro-endoscopic laser spine surgery with an incision as small as 3 mm, Dr. Won advises multiple international spine technology companies and has helped design many groundbreaking tools for the minimally invasive spine surgery industry.

Dr. Won also innovated the Pain Mapping procedures, this diagnostic study helps to pin point the pain generator so that we can provide the least invasive spine procedures, LuMINI.

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