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Medical Procedures

A partner of Surgical Care Affiliates (SCA), our center is AAAHC certified meeting the rigorous standards to ensure quality, safe and efficient patient care. We strive to make our facility a family friendly atmosphere, so you and your loved ones can have a stress-free experience.

Procedures & Services

Doctors at Parkway Surgery Center specialize in less invasive surgical procedures that are less complex in nature and do not require extended overnight stays. For more complex procedures that require overnight stays, our surgeons operate at several area hospitals. See below for more details:

Patients are seen by appointment only, which helps us ensure your procedure begins on time. No walk-ins accepted. Parkway Surgery Center does not provide emergency services.

Spinal Pain Management – Non-invasive & Invasive

Non-invasive treatment for back & neck pain may include one or more of the following:

  • Activity modification: bed rest, job restrictions, exercise
  • Medications: analgesics, steroids, muscle relaxants
  • Education

Invasive techniques include the following types of injection therapy:

Epidural Steroid Injection: The injection of steroid or “cortisone-like” medication into the spinal canal in order to decrease inflammation and pain in the area of pinched nerves, ruptured discs, or bone spurs.

Trigger Point Injections: The injection of local anesthetics and anti-inflammatory medication into muscles to relieve tight, achy muscles.

Bursa Injection: The injection of anesthetic and/or steroid in the small fluid filled sacs that provide cushion around joints in the body.

Joint Injection: The injection of anesthetic and/or steroid into a joint that is causing pain.

Facet Injection: The injection of steroid medications into the joints between the vertebrae.

Selective Nerve Blocks: The injections of local anesthetics and/or steroid medication in the vicinity of nerves in order to decrease pain from an area of the body. These can be therapeutic or diagnostic.

Medial Branch Block: The injection of numbing medicine around some tiny nerves near the spine. These nerves transmit pain signals from the facet joints in the back. This procedure is typically done as a test, to make sure the patient would benefit from a Radiofrequency Ablation.

Radiofrequency Ablation (Rhizotomy): This non-surgical procedure is used to “turn off” the nerves that supply the facet joints in the back, using localized heat to inhibit the ability of nerves to transmit pain signals. This typically lasts longer than a regular injection, usually 12-18 months.

Discogram: This procedure is performed to determine if an abnormal disc is causing a patient’s pain. Fluid is injected into discs in the back where a patient’s pain is localized. If the disc is abnormal, this will mimic the patient’s usual pain. The fluid is seen under x-ray and it can be determined if a disc is the source of pain for a patient.

Spinal Cord Stimulator: This implantable medical device is used to treat chronic pain. An electrical impulse generated by the device near the spinal cord provides a “tingling” sensation that can block out the patient’s pain. A trial is usually done before the permanent device is placed, using a temporary lead connected to an external control. The patient controls the level of stimulation to cover their pain.

General Information

A majority of the procedures are done under x-ray guidance, which allows the physician to see the bony anatomy of a patient.

A local anesthetic is used to numb the skin for all procedures.

The type of steroid used varies with every procedure and is not used with all procedures. They are cortisone-like medications that last a long time.

For a majority of procedures the patient will be asked to lay on a table for the procedure. This allows the physician to easily x-ray the spine. The staff will try to make the patient as comfortable as possible.

We ask that the patient stay for a few minutes after the procedure to make sure they are feeling well before leaving the surgery center.

Injections won’t stop all low back and leg pain, but they can reduce pain and break the pain cycle. This cycle may begin when back pain makes it difficult to perform everyday activities. A decrease in movement can then slow down healing. By assisting you in becoming active again, injections can help speed patient recovery. Some individuals may feel more relief from an injection than others. And some individuals may need more than one injection to get relief.

Operative & Non-Operative Spine Care

Non-operative management of spinal pain may include one or more of the following:

  • Activity modification: bed rest, job restrictions, exercise
  • Medications: analgesics, steroids, muscle relaxants
  • Education

Conservative (non-operative) management of spinal pain is not always successful and surgery may become necessary. Your doctor may recommend spinal surgery if, after conservative treatment, you have increasing numbness or weakness of the legs, loss of bladder or bowel control, severe pain, or severe limitations on your lifestyle due to pain. The type of surgery recommended will depend upon your diagnosis and symptoms.

Treatment of Compression Fractures

The bones in your spine are called vertebrae. The thick portion of bone at the front of each vertebra is referred to as the vertebral body. A vertebral compression fracture occurs when the vertebral body fractures and collapses.

Operative treatment options include:

  • Vertebroplasty: A minimally invasive treatment involving the placement of a special stabilizing material into a damaged vertebra. The material hardens and stabilizes the vertebra, preventing further collapse, and may reduce the pain caused by bone rubbing against bone. Patients can resume normal activities almost immediately.
  • Balloon Kyphoplasty: A minimally invasive treatment in which orthopedic balloons are used to gently elevate bone fragments in an attempt to return them to the correct position. Once the vertebra is in the correct position, the balloon is deflated and removed, creating a cavity within the vertebral body. The cavity is then filled with a special cement to support the surrounding bone and prevent further collapse.

Treatment of Spine & Disk Problems

Disks are the soft pads of tissue between the vertebrae. The disks absorb shock caused by movement. The most common back problems occur when disks tear, bulge, or rupture. When this happens, an injured disk can no longer cushion the vertebrae and absorb shock. The disk may press on or pinch a nerve. This can lead to pain, stiffness, and other symptoms.

Operative treatment options include:

  • Laminotomy: A portion of the lamina (back of the spinal canal) is removed from the vertebra above and below the pinched nerve. The small opening created is sometimes enough to take pressure off the nerve. But in most cases, disk matter or a bone spur that is pressing on the nerve is also removed.
  • Laminectomy: The entire lamina is removed from the affected vertebra. The opening created may be enough to take pressure off the nerve. If needed, the surgeon can also remove any bone spurs or disk matter still pressing on the nerve.
  • Diskectomy: A portion of the disk nucleus is removed, releasing the pressure on the nerve.

As a disk degenerates and flattens, the vertebrae slip back and forth. This is referred to as instability and can irritate nerves.

Operative treatment options include:

  • Spinal fusion: Adjacent vertebrae are joined together, or fused. This limits the movement of these bones, which may help relieve pain. Fusion can be done from the front (anterior) side of the body or the back (posterior) side of the body. The neurosurgeon decides which is best for each individual patient.

 

Median Nerve Entrapment – Carpal Tunnel Syndrome

The most predominant peripheral nerve problem is medial nerve entrapment, or carpal tunnel syndrome. Carpal tunnel syndrome occurs when the median nerve in the wrist becomes inflamed after being aggravated by repetitive movements such as typing on a computer keyboard. Over time, the repetitive movements can cause compression of the median nerve. Symptoms can include hand and wrist pain, a burning sensation in the middle and index fingers, thumb and finger numbness, and difficulty holding objects without dropping them.

Conservative (non-operative) Treatment Options: The main objective of conservative treatment is to reduce or eliminate repetitive injury to the median nerve. In some cases, this can be accomplished by immobilizing the wrist with a splint to minimize or stop pressure on the nerves. Patients may also be given hand and wrist exercises to complete both during and after work hours. If rest, splinting, and exercise are not successful, patients may also be prescribed anti-inflammatory medications or cortisone injections to reduce swelling.

If patients experience severe pain with persistent neurological symptoms that cannot be eliminated through conservative treatment options, surgery may be recommended to relieve the pressure on the median nerve. The most common procedure is called a carpal tunnel release, which involves the surgeon opening the wrist and cutting the ligament at the bottom of the wrist to relieve pressure.

Occipital Nerve Entrapment

Occipital nerve entrapment is a term used to describe pain originating from the base of the skull that often radiates to the back, side and front of the head, as well as behind the eyes. The occipital nerves are inflamed and sensitive because they are trapped within the muscles through which they pass.

Conservative (non-operative) treatment options: Treatment may include oral medications designed to reduce inflammation and spasms, localized therapeutic injections, and/or physical therapy.

Operative Treatment: If surgery is necessary, options include occipital neurectomy, occipital nerve block, C2 nerve root decompression, and joint stabilization.

Ulnar Nerve Entrapment

The ulnar nerve travels between the tip of the elbow and the inner elbow bone on the posterior portion of the elbow. The nerve can be pinched by normal or swollen structures after injury or following frequent elbow bending while pulling levers, reaching or lifting. Pain over the forearm, especially the inner side and numbness of the little and ring finger can be experienced.

Conservative (non-operative) treatment options: Treatment can include limiting elbow bending (i.e., the movement that is causing the pain), anti-inflammatory medications, patient education, and the use of elbow pads.

Operative Treatment: If surgery becomes necessary, an ulnar nerve release is performed, which simply removes the medial epicondyle on the inside edge of the elbow, releasing the pressure caused by the bony bump.

Anesthesia

What is anesthesia?

Anesthesia is the loss of sensation or consciousness created by the administration of medications by a doctor specially trained in this process. While under the influence of anesthesia, patient’s vital functions are constantly monitored and adjusted with medication as needed. Anesthesia is used to relax (sedate) you, block pain sensations (analgesia and anesthesia), induce sleepiness and forgetfulness (amnesia) or make you unconscious for your surgery. The anesthetic option chosen for your individual procedure will be based on your physical condition in collaboration with your surgeon. According to a 1999 report from the Institute of Medicine, anesthesia care today is nearly 50 times safer than it was 20 years ago.

Preparing for anesthesia:

A nurse from the Surgery Center and the anesthesia group will contact you to perform a brief interview and answer your questions. You will be given instruction about when to stop eating or drinking, what medications to take on the day of surgery, and what time to arrive at the facility.

You will need to give written consent for surgery, and anesthesia, as well as to receive other necessary medications. Your surgeon will explain why your surgery is needed, what it will involve, its risks and expected outcome, and how long it will take you to recover. Your anesthesiologist will have the same discussion with you about your anesthesia care.

Who administers anesthesia?

Our anesthesia physicians are all Board Certified by the American Board of Anesthesiology. A First Colonies anesthesiologist stays with you for the entire procedure, constantly monitoring every important function of your body and individually modifying your anesthetic to ensure maximum safety and comfort.

Recovering from anesthesia:

Immediately after surgery, you will be taken to a post-anesthesia care unit (PACU), often called the recovery room, where nurses will observe and assist in your immediate recovery. A nurse will check your vital signs, bandages and ask about your discomfort level. Some effects of anesthesia may persist for many hours after the procedure. You may have some numbness or reduced sensation in the part of your body that was anesthetized with local or regional anesthesia.

Other common side effects of anesthesia are closely monitored and managed to decrease your discomfort. These side effects include:

  • Nausea and vomiting. In most cases, nausea after anesthesia can be treated and does not last long.
  • A mild drop in body temperature (hypothermia). You may feel cold and shiver when you are waking up.
  • A responsible adult must drive you home and remain with you until the effects of anesthesia have subsided, usually within 24 hours.
  • You will remain sleepy so plan to rest. In most cases you can resume activity in a few days.
  • Plan a light meal for after your surgery such as soup and saltines. You will start with liquids at the surgery center.
  • You may receive a prescription for medication to relieve incisional discomfort. Take any medication with a light snack.
  • Follow the instructions provided by your Surgeon. These will be reviewed with you and your caregiver by your nurse at the surgical center.
  • A member of our nursing staff will call you after your surgery to review your progress but you may contact your surgeon’s office for any major concerns you may have prior to this call.