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Physician Assistants and Nurse Practitioners are mid-level providers. They are licensed to evaluate patients independently, order diagnostic testing, diagnose, and establish treatment plans under the supervision of a collaborating physician. You may see a PA/NP without seeing the doctor, but the physician always reviews and approves any treatment protocols. PA’s and NP’s have prescriptive authority to prescribe and renew medications.
These are all very important diagnostic tools and can be helpful for the physician to provide an accurate diagnosis and treatment plan.
Look at your child’s spine to see if it curves. Also, check to see if one shoulder is lower than the other. Your doctor can also check by looking at your child’s stance and ordering an X-ray for a definitive diagnosis. In most people, the curve in the spine is so small it causes no problems. In severe cases, the curve may cause back pain and restrict the amount of space available for the lungs and heart to work properly.
In the majority of cases, patients are left with no significant decrease in motion. One and two level neck and back fusions rarely result in any limitation of “functional” motion. Some patients may notice a slight difference in full motion, but this usually does not affect most activities of daily living. Larger fusions involving three or more motion segments may result in a noticeable difference in some activities, but this is usually not debilitating.
This obviously differs with each of the types of surgeries we perform. For lower back fusions, patients typically stay in a stiff/rigid brace for six weeks, then transition into a softer brace for another four weeks thereafter.
For neck fusions, there is usually more variation in how long bracing is used. This ordinarily depends on how many levels are fused and the patient’s bone quality. Most patients wear a stiff/rigid collar anywhere from two to six weeks, then a softer collar for another three to four weeks thereafter.
Patient’s undergoing non-fusion surgery, such as a microdiscectomy, typically wear a soft brace or corset brace for six weeks after surgery.
This varies significantly from patient to patient. We take into account the type of surgery performed, the patient’s line of work, and their post-operative recovery when making this decision. In general, patients who perform sedentary work can return to work as soon as one to two weeks after surgery. Patients who perform heavy-demand work are generally out for a minimum of six weeks. Again, there is no one recommendation; therefore, we suggest you further discuss this during the surgical-planning phase of your care.
Most commonly, pain relief is noticed within 24 to 48 hours. Some patients respond slower and get results within 1 to 2 weeks. Maximum benefit is usually seen by 2 weeks post-procedure.
It is extremely variable from patient to patient. Some patients receive 1 or up to 3 injections with relief lasting from weeks to years.
An ESI is one of the safest procedures performed in medicine today. The overall complication rate is far less than one percent. Nonetheless, there is some expectation of risk with any medical procedure. We take numerous precautions to prevent any problems and strongly recommend that all patients fully review their pre-injection instructions. Most complications arise from patients not following these instructions. The primary procedure risks involve bleeding, infection, spinal fluid leakage, and injury to nerve structures. Secondary risks involve the potential side effects of the medications used during the procedure (from the steroid itself). These include temporary weight gain, increase in blood sugar (mainly in diabetics), water retention, and suppression of the body’s own natural production of similar steroids. Long-term effects of chronic steroid use include thinning of the bones, early cataract formation, and avascular necrosis (a condition involving decreased blood supply to the hip bone).
We advise patients to take it easy for a day or so after the procedure. Afterward, patients are allowed to resume normal activities as tolerated. Most patients have no problem returning to work one or two days after the procedure.
Immediately after the injection, some patients may feel a heaviness or numbness in the legs. This is an expected effect of the numbing agent and usually goes away after several hours. Most patients generally experience a “sore back” for a day or two afterward. The full effect of the steroid medication usually takes 24 to 48 hours to begin working. Some patients have a longer period until they feel relief. It is not uncommon for many patients to feel relief for only a week or so after a first injection; this usually will result in long-term pain relief after a repeated injection.
Minimally invasive procedures typically involve less destruction of normal tissues during surgery. In a traditional open procedure, a wide area of normal tissues (muscles, ligaments and bone structures) are sacrificed during the surgical exposure. These structures typically never return to normal function and will eventually form a large mass of scar that may later cause pain, spasm and dysfunction. During a minimally invasive surgery, special equipment and techniques are employed that allow for the same surgery to be performed with significantly less surgical morbidity. In addition, patients usually have less blood-loss, require shorter hospital stays and encounter less post-operative complications.
Sometimes referred to as ‘laser’ surgery, endoscopic spine surgery is a newer type of minimally invasive spine procedure offered today. During this type of surgery, a small camera is used. This allows for better and more accurate visualization of the areas being targeted. The major advantage of these procedures is that a very small area of normal tissue is disrupted during the surgery. As a result, most patients experience very little pain and have a minimal amount of blood-loss. In addition, this is almost always an outpatient procedure. We offer several different types of endoscopic procedures depending on the patients specific problem.
In the majority of surgeries we perform the only physical therapy needed is for transfers and progressive ambulation. In most cases, this is performed during a patients hospital stay and most people don’t require additional visits with a therapist. Occasionally, some patients may require physical therapy via a home-health agency – the decision for this is made at time of discharge. Following some lumbar procedures, some people benefit greatly from pool-therapy. This is usually evaluated and decided upon during post-operative office visits.
Many patients overlook the role of physical therapy prior to surgery. This often occurs as some people may have had a negative experience with physical therapy in the past. Ideally, pre-operative physical therapy should be targeted to strengthen and condition muscles that support and surround the spine. The stronger these muscles are prior to surgery, the quicker they will rebound afterward. Conversely, weaker muscles will generally require more time and conditioning to return to normal function.
Also known as Lumbar Facet Syndrome, facet pain refers to pain that is generated by the small joints that form the spinal column. These joints fall victim to degenerative changes (arthritis) in all humans. Many people are lucky and only experience minimal or no pain from this natural process. Other people can experience severe symptoms resulting in varying degrees of disability. Most patients note early morning low back pain that improves after they begin moving around. Pain sometimes returns after one has been idle for a while. This pain usually worsens with extension of the lumbar spine - when the spine is stretched and arched backwards (i.e. shoulders back). A Medial Branch Block or Facet Injection is a procedure that helps to diagnose this pain. Many patients with facet pain improve with medications, physical therapy and activity modification. Some patients may require injections and/or surgery depending on their level of disability. The Endoscopic Rhizotomy procedure is extremely effective in providing long-term pain relief from this problem.