Whether we are your first stop or second opinion, we are your pain management solution.
At Montvale Health Sport + Spine we take a comprehensive approach to pain management. We provide various treatment options for patients and combine different disciplines for the best possible outcomes.
Medial Nerve Injection (Non-Surgical)
This procedure is used to relieve pain associated with damaged branch nerves that originate in the facet joint.
When these nerves become damaged they often swell, causing the pain.
Conditions treated:
- Arthritis
- Traumatic injury
Caudal Steroid Injection (Non-Surgical)
Steroid injections help reduce pain and inflammation in targeted areas.
A caudal steroid injection reduces irritation on the nerve roots around the tailbone. A florescent dye is first injected into the area to allow the physician to see contrast and determine the exact location of the painful area.
Conditions treated:
- Spinal stenosis
- Foraminal stenosis
- Cervical radiculopathy (Pinched Nerve)
- Lumbar radiculopathy (Sciatica)
- Herniated disc
- Bulging disc
- Torn disc
- Facet Joint Syndrome
- Arthritis
Cervical Epidural Nerve Block (Non-Surgical)
The cervical area of the spine includes the vertebrae in the neck.
A cervical epidural steroid injection is used to alleviate pain associated with certain conditions due to swollen, damaged nerves in the cervical epidural space.
During the procedure, an intravenous (IV) will be placed, so Aspirin and other blood-thinning medication must be stopped prior to this procedure (includes most anti-inflammatory medication). Our protocol is 10 days for aspirin and Plavix, 3 to 5 days SAIDS (Motrin, Aleve, Advil, Feldene, Mobic, and others), Coumadin 7 to 10 days with blood levels checked prior to procedure. Your prescribing physician will need to approve withholding this medication.
Most often performed with local anesthesia so you may drive home after, this procedure is usually completed in a series of three treatments, two-three weeks apart using fluoroscopy (low-dose X-ray) guidance. However, if sedation is used, you must fast 8 hours prior to the procedure and must have a ride home. You will be required to maintain light activities for 48 hours.
Relief can be immediate, but also may not be noted for a week following the procedure. Pain may be exacerbated (worsened) for the first 48 hours.
This procedure is very safe and complications are very rare but include: skin infection, bruising, hematoma, or spinal headache. Our expert physicians at Montvale Health Associates can treat all these side effects if necessary.
Epidural Adhesiolysis (Non-Surgical)
Epidural adhesiolysis is used to remove scar tissue on nerves within the epidural space, the space that contains the spinal cord.
These nerves can become inflamed by rubbing against other tissues and cause pain. The procedure reduces pain by injecting anti-inflammatory steroids to the area.
Conditions treated:
- Arthritis
- Traumatic injury
- Lumber spine surgery
Facet Joint Injection (Non-Surgical)
Facet joints, located on both sides of each vertebra, allow for flexibility and movement of the spine and thusly allowing us to bend.
A facet joint injection is used to alleviate pain associated with swelling and inflammation of these facet joints.
Conditions treated:
- Arthritis
- Traumatic injury
Lumbar Discography (Non-Surgical)
Lumbar Discography is indicated as a diagnostic maneuver in a selected set of patients suffering from back and lumbar radicular pain.
Patients who may benefit from discography include (1) those patients with persistent back and/or lumbar radicular pain in whom traditional diagnostic modalities (i.e. MRI, CT) have failed to delineate a cause of the pain; (2) those patients that are confirmed to have a bulging disc, to determine whether such abnormalities are responsible for the pain; and (3) pre-surgical screening where a fusion may be performed but more information is needed.
You are to remain nothing by mouth 8 hours prior to the procedure. Medications may be taken with only a sip of water up to three hours before your procedure. During the procedure, an anesthesiologist will provide conscious sedation so you will be able to answer questions at a suitable juncture. A needle will be placed into the discs. You will indicate varying degrees of discomfort associated with injections into the discs. The disk in question will be assessed, as well as a “control” disc. This will allow the physician to correlate specific information to determine a diagnosis.
You will receive an IV (intravenous) antibiotic, and antibiotics will be given directly into the disc. This will assist in prevention of infection. A local anesthetic and “x-ray contrast” will also be utilized. To increase the success rate and to limit complications, we use the CT scan or fluoroscopy (special types of x-rays) for guidance.
Increased pain is a likely side effect of this procedure. Complications related to needle placement will be discussed by your physician prior to informed consent.
You will need an escort to drive you home. Recovery time varies, a few days of light activity is suggested. You may be required to take additional days off from work.
Lumbar Transforaminal Epidural Nerve Block (Non-Surgical)
A lumbar epidural Nerve Block is used to reduce pain in the lower back caused by inflammation and swelling of nerves that run in and out of the epidural space, or the outer most layer of the spinal canal.
Most often performed with local anesthesia so you may drive home after, this procedure is usually completed in a series of three treatments, two-three weeks apart using fluoroscopy (low-dose X-ray) guidance. However, if sedation is used, you must fast 8 hours prior to the procedure and must have a ride home. You will be required to maintain light activities for 48 hours.
Relief can be immediate, but also may not be noted for a week following the procedure. Pain may be exacerbated (worsened) for the first 48 hours.
This procedure is very safe and complications are very rare but include: skin infection, bruising, hematoma, or spinal headache. Our expert physicians at Montvale Health Associates can treat all these side effects if necessary.
Aspirin and other blood-thinning medication must be stopped prior to this procedure (includes most anti-inflammatory medication).
Lumbar Sympathetic Ganglion Block (Non-Surgical)
Our experts at Montvale Health Associates use a lumbar sympathetic ganglion block in evaluating and managing pain in the lower extremities, including reflex sympathetic dystrophy, causalgia, and a variety of other peripheral neuropathies.
This procedure may be completed singularly or in a series. If the temporary or diagnostic procedure(s) result in significant pain relief, a long-term procedure can be performed. The long-term procedure can produce pain relief noted for three months or more.
During the procedure, a local anesthetic is injected into the sympathetic nerves to determine their response; this will block the nerves that are acting via the sympathetic system.
In most cases, sedation will be given through your IV once monitoring equipment is in place. Monitoring includes blood pressure, heart rate, oxygen saturation, and ECG tracing (Electrocardiography). The area will be located using fluoroscopy (low-dose X-ray), so the physician can visualize the precise area. Often, pain relief is noted immediately and relief may increase in intensity and duration with each subsequent block.
Side effects of this procedure are soreness at the injection site and in the lower lumbar area. Complications such as infection, bruising, or hematoma (blood leaking under the skin) may occur on rare occasions.
Sacroiliac Joint Block (Non-Surgical)
The sacroiliac joint is a large joint located in the lower back.
Inflammation in this joint can cause pain, particularly when sitting. A sacroiliac joint steroid injection is used to treat the pain by reducing the inflammation in the tissue surrounding the joint.
This procedure will be completed under fluoro (low-dose X-ray) guidance. This will allow the physician to visualize the precise areas. The physician will instill a local anesthetic, and once the areas are numb a small needle will be placed, through which medications are injected. This will block the pain pathways and relieve your pain. The effects are rarely immediate and may take up to a week before relief is noted.
A side effect of this procedure is soreness at the injection sites. You may have an increase in pain for a few days. Complications are: infection, bruising, or hematoma (blood leaking under the skin). The procedure time is approximately 10 minutes, and you will be under our care for about 45 minutes.
Stellate Ganglion Block (Non-Surgical)
The stellate ganglion is a group of nerves located in the seventh cervical vertebra.
In our outpatient Surgical Center this procedure will be completed under fluoroscopy (low-dose X-ray) guidance. The stellate ganglion block reduces pain down to your arms by injecting a local anesthetic to the sympathetic nerve tissue located on either side of the voicebox, and is performed in a series of six. The procedure will last approximately five minutes. You will be asked to receive physical therapy to the affected extremity after each individual treatment.
Expected effects are hoarseness, difficulty swallowing, the sensation of a lump in the throat, and drooping eyelids. These are features of the block and are mild and transient, lasting up to several hours.
Although rare, complications or side effects of this procedure are: bruising, hematoma, intravascular injection and feeling faint. If this occurs, we have staff trained to handle the situation safely.
Percutaneous Discectomy (Nucleoplasty) (Surgical)
This minimally invasive procedure requires no incision and is typically used to treat herniated discs.
A local anesthetic is injected to numb the affected area and a thin needle is then inserted into the herniated disc. Our expert surgeons use X-ray to help guide the needle into the herniated disc. Radiowaves are then transmitted through the needle to dissolve the damaged or herniated portion of the disc.
Candidates for this procedure are selected based on certain criteria, and suffer from back and lumbar radicular pain. Patients who may benefit from discectomy include (1) those patients with persistent back and/or lumbar radicular pain with documented herniated discs with good response from epidural injections but without long term effect or reoccurrence of symptoms (2) patients that failed conservative therapy (3) those who have a positive findings on discogram.
In the case that conscious sedation is provided by an anesthesiologist, you are to remain nothing by mouth 8 hours prior to the procedure. Medications may be taken with only a sip of water up to three hours before your procedure. You will need an escort to drive you home. The procedure takes an average of one hour, and after another hour of recovery you will be able to go home.
There is very little discomfort associated with the procedure, and many patients feel immediate relief afterwards once pressure from the herniated or bulging disc is relieved. Patients can resume work or normal activity several days after the procedure. Since the procedure relieves pain, medication other than those taken prior to the procedure are rarely required. A specific physical therapy program will be prescribed for 12 weeks after procedure.
Facet Joint Blocks (Diagnostic)
Facet joints are located on both sides of each vertebra providing our spine with flexibility and allowing us to bed.
Facet joint blocks are used to potentially diagnose arthritis or traumatic injury by injecting an anesthetic. Whether the pain is numbed by the injection and for how long will determine the cause of the pain and the proper procedures to alleviate pain.
Conditions commonly diagnosed with facet joint blocks:
- Arthritis
- Traumatic injury
Nerve Root Blocks (Diagnostic)
A nerve root block is used to determine whether the nerve root is the cause of a patient’s pain.
An X-ray guided injection with a local anesthetic is inserted into the targeted area. Whether the anesthetic causes numbness will allow the doctor to know if this is the cause of pain and how to move forward with treatment.
Conditions commonly diagnosed with nerve root blocks:
- Cervical radiculopathy (pinched nerve)
- Lumbar radiculopathy (sciatica)
Spinal Discography (Diagnostic)
Soft, jelly-like discs between each vertebrae serve as cushions to prevent the vertebrae from rubbing against each other.
A damaged disc can cause inflammation and pressure on nerves. A spinal discography can determine which disc is causing the pain and to which condition the pain is due.
Conditions commonly diagnosed with spinal discography:
- Arthritis
- Herniated disc
- Bulging disc
- Torn disc
- Degenerative disc disease
Vein Disorders
Healthy leg veins contain valves that open and close to assist the return of blood back to the heart. Venous reflux disease develops when the valves that keep blood flowing from the legs back to the heart become damaged or diseased. This can cause blood to pool in your legs, which can lead to a progression of symptoms. At Montvale Health Associates, we provide expert, compassionate care in treatment of vein disorders.
Spider Veins
Spider veins, medically known as telangietasias, are dilated skin veins less than 2 mm. in diameter. They are small blue to red appearing blood vessels that lie close to the surface of the skin and occur either in lines or web-like patterns. They are usually visible on the legs but sometimes are visible around the nose and lips and are commonly referred to as “broken veins”. While they can occasionally ache, burn or itch, they are usually not symptomatic. While unsightly, spider veins are not harmful.
Varicose Veins
Varicose veins are rope-like blue vessels under the skin, usually ¼ inch or larger in diameter.. Varicose veins are unsightly and often painful. A clotted varicose vein causes a condition called phlebitis, in which the skin overlying the site of the clot becomes hot, red and painful. Besides the visible symptoms, physical symptoms include fatigue, restless legs at night, heaviness in the legs, pain, aching, itching, throbbing and swelling, burning or a cramping sensation.
Left Untreated, Venous Reflux Can Progress to Other Conditions
Leg Swelling (Edema)
Beyond the purely cosmetic concerns about spider veins and the pain, fatigue and discomfort that result from varicose veins, venous reflux is a progressive disease that can lead to other, more significant circulatory problems as it worsens. Swelling of the leg is a further sign that damaged or diseased vein valves are not functioning properly. Since the blood cannot be effectively returned to the heart, it pools in the leg, resulting in higher than normal pressure (venous hypertension), and causes the leg to swell. This swelling is called edema.
Skin Changes
In addition, when blood flow out of the legs through superficial and perforating veins is inadequate, this higher-than-normal pressure can result in damage to the skin. Progression of venous reflux can lead to changes in the skin’s color (hyperpigmentation) as well as changes in skin texture.
Venous Ulcers
The most severe stage of venous reflux disease is when the inadequate blood flow results in an ulcer, commonly near the ankle. In fact, damaged or diseased perforating veins are the source of venous reflux in nearly two-thirds of venous ulcer patients. These ulcers are raw and painful wounds which may not always be healed using only antibiotics or salves.
Vein Treatments
After a comprehensive evaluation that includes an ultra-sound examination of the veins, Montvale Health vein specialists will determine the optimal treatment for each patient’s needs. Our experts are experienced in offering the most progressive approaches in treating patients with advanced symptoms of venous reflux, including venous leg ulcers.
Treatments include:
- VNUS Closure™ procedure
- Ambulatory Phlebectomy
- Sclerotherapy
- Treating Venous Ulcers
The VNUS Closure Procedure, an alternative treatment option to traditional vein stripping surgery, brings state-of-the-art technology to an age-old disease.
The Closure procedure is performed on an outpatient basis. Using ultrasound guidance, your physician will position the Closure catheter into the diseased vein through a small opening in the skin. The slender catheter delivers radiofrequency (RF) energy to the catheter, which heats the vein wall. As the vein wall is heated and the catheter withdrawn, the collagen in the wall shrinks and the vein closes. Once the diseased vein is closed, blood is re-routed to other healthy veins.
Following the procedure, a simple bandage is placed over the insertion site, and additional compression may be provided to aid healing. Your doctor may encourage you to walk at frequent intervals and to refrain from prolonged standing and strenuous activities for a period of time.
Patients who undergo the Closure procedure typically resume normal activities within a day.
In summary, The Closure procedure includes:
- Relief of symptoms
- Resume normal activity within a day
- Outpatient procedure
- Local or general anesthesia
- Good cosmetic outcome with minimal to no scarring, bruising or swelling
Sclerotherapy
Sclerotherapy is a cosmetic medical procedure used to treat varicose veins and spider veins. A tiny needle is used to inject a solution directly into the vein. The solution irritates the lining of the vessel, causing it to swell and stick together, and the blood to clot. Over time, the body will absorb the treated vein. Mild discomfort may occur, and a cramping sensation may be felt for 1 to 2 minutes when larger veins are injected.
The number of veins injected in one session varies, depending on the size and location of the veins, and the patient’s overall medical condition. Anywhere from one to several sclerotherapy sessions may be needed for any vein region. Medically prescribed support hose and/or bandages may need to be worn for several days to several weeks to assist in resolution of the veins. In general, spider veins respond to treatment in 3 to 6 weeks, and larger veins respond in 3 to 4 months.
At Montvale Health Associates, Dr. James Geuder uses the Syris™ Scientific illumination system which helps magnify the patients’ spider veins to improve sclerotherapy procedural accuracy and reduces tissue damage.
Treating the Venous Ulcer (Treating Perforating Veins)
In the United States it is estimated that up to 1.8 million people are afflicted with venous ulcers which are the most common chronic wounds treated in wound care centers.1,2 More than half of the venous ulcers treated are recurring ulcerations, or wounds that might have healed before, but later return.
Conventional treatments for venous ulcer patients include the use of antibiotics, salves, and compression therapy. But these treatments have often resulted in high failure and recurrence rates.
Attempts to heal the skin without correcting the underlying venous insufficiency can lead to a delayed ulcer healing and recurrence.1, 3, 4, 5
The VNUS ClosureRFS™ stylet allows your doctor to offer you a minimally-invasive option to traditional surgery for the venous ulcers on your legs. It is the only endovenous ablation device specifically cleared by the FDA for the treatment of incompetent perforating veins, the most common origin of leg ulcers. This outpatient treatment can be either the primary procedure or it can be performed in addition to another outpatient leg vein Closure™ procedure, using the VNUS ClosureFAST™ catheter, when chronic venous insufficiency disease of your large saphenous veins has been diagnosed.
