Frequently Asked Questions
How is my condition diagnosed?
To accurately diagnose your condition, your RSI physician will first take a thorough medical history, perform a physical examination, and interview you about the location, type, and intensity of the pain you are experiencing. To further aid in the assessment, he or she may utilize one or more diagnostic tests to determine the source of the pain and the best course of treatment. These tests may include x-rays, ultrasound, magnetic resonance imaging (MRI), diagnostic epidural blocks, and/or discography – all of which can be performed on-site.
What is a discography?
A discogram in our practice is rarely performed as strictly a diagnostic tool. Rather we perform discograms and combine it with our intradiscal cell therapies. It is usually performed as an outpatient procedure and lasts approximately 30 minutes. Before the procedure begins, the patient will be asked to change into a dressing gown. During the discography, the patient will be lying down on his or her side on a special table. After the patient is properly positioned, the injection site on the back is sterilized. In some cases, an additional anesthetic injection is administered to minimize pain during the procedure and a sedative is provided to help the patient relax.
With the help of fluoroscopy guidance, a needle is then inserted through the skin and into each disc being examined. Then, a contrast dye is injected into each disc before the needle is removed. After each examined disc is injected with contrast dye, an x-ray is performed to see if the dye has traveled throughout the discs. In a healthy disc, the contrast dye will remain in the center; if the disc is damaged, the dye will leak outward through fissures. In a disrupted disc, the injection will also produce the same type of pain that has been a persistent symptom for the patient. The patient will be asked to identify this pain when it occurs and if it is their “typical” pain. Again this procedure in our practice is usually combined with the injection of PRP, Fibrin, or Stem Cells simultaneously.
What is a diagnostic ultrasound?
An ultrasound begins with the patient lying down on a procedure table as a water-based gel is applied to the area to be examined. The gel facilitates consistent contact between the body and the transducer, minimizing any air pockets that could obstruct visualization of the area. The transducer is kept firmly against the skin and moved back and forth to allow for detailed observation. The entire procedure usually takes 15 minutes.
Does RSI contract with Medicare and private insurance?
All charges must be paid at the time of service.
Upon request, the RSI staff will provide you with the fees and billing codes before services are performed, if applicable. We recommend that you contact your insurance carrier to verify your benefits. This step will help you to have a basic understanding of how (or whether) your insurance will reimburse you for services provided at RSI.
Unfortunately, insurance carriers are not always willing to provide their allowable fees or disclose which billing codes they will cover. At RSI, we do not have influence over what charges will or will not be reimbursed by insurance carriers to our patients.
What is platelet-rich plasma (PRP)?
Platelet-rich plasma (PRP) is blood plasma with a high concentration of platelets. Platelets are blood cells that contain large amounts of healing proteins. These proteins initiate and accelerate new tissue growth within tendons, ligaments, and intervertebral discs to repair damage and relieve symptoms for patients with tendinosis or other causes of chronic pain.
Injecting a patient’s own PRP into damaged tissue is an effective, safe, and minimally invasive treatment option. By enhancing the body’s own natural healing abilities, patients are able to enjoy a faster and more thorough healing process that relieves symptoms, allowing them to return to their regular activities.
What is PRP used for in our practice?
Platelet-rich plasma injections can be used to treat a wide range of musculoskeletal conditions, including:
- Intervertebral disc tears
- Degenerative disc disease
- Joint pain from arthritis
- Meniscal/labral tears
- Partial tendon tears
- Ligament sprains or tears
- Nerve inflammation
- Plantar fasciitis
RSI physicians have found Intradiscal PRP to be one of the safest and most effective treatments performed on patients with spinal disorders originating from disc disease.
This treatment can also be used in combination with surgery to accelerate the post-operative healing process and reduce the risk of infection.
Who is a candidate for Intradiscal PRP?
Patients who have not achieved pain relief through more conservative approaches (such as those involving medication, behavior modification, and physical therapy) are candidates for PRP.
Intradiscal PRP has been found to be particularly beneficial for patients suffering from pain that originates in the spinal disc. The RSI Research Management Team is investigating whether PRP is as effective as an epidural injection for inflamed nerves and arthritic facet joints.
Certain factors may prevent your RSI physician from recommending a particular procedure for a patient’s condition. Such factors may include, but are not limited to: narrow disc height; severe disc herniation; severe spinal stenosis; spinal instability; advanced stages of disc degeneration; or other general health concerns.
How does the PRP procedure work?
During the PRP injection procedure, blood is taken from the patient’s arm vein and placed in a processing unit that separates the platelets, white blood cells, and serum from the red blood cells. The platelets and plasma are then placed in a centrifuge, concentrated, and loaded into a sterile syringe.
PRP injection is performed on an outpatient basis, and typically takes about one hour to complete. During an intradiscal PRP procedure, patients lie comfortably on a fluoroscopy table, the skin is cleansed with an antiseptic solution, and local anesthesia and mild sedation may be used to reduce discomfort. Under the guidance of fluoroscopic images, your RSI physician will gently advance a needle into the painful disc levels. Following this step, PRP will be passed through the needle into each disc. The PRP will fill and seal the tears in the outer wall of the disc. Most patients experience some of their usual pain when the disc is distended and sealed by the PRP. This pain can usually be controlled well with oral medication. Once the procedure is completed, the needle will be removed. Patients have a small bandage placed on their back and rest in a recovery area until ready to go home. Typically, patients will experience increased pain and spasm for a few days, then return to their pre-injection status. In our study, the majority of patients started to see improvement in 2-3 weeks. This improvement continued until about the 3 month post-procedure timepoint.
Most patients require only one PRP injection, but a small number of patients will experience partial improvement and request to have another injection performed. We recommend waiting at least 3 months before making this decision. Our experience is that the majority of patients who have had a repeat injection will get further benefit with an additional injection of PRP. We have not yet had to perform a 3rd injection in any patients in our 6 years of performing this procedure. In our study, over 70% of patients continued to have significant improvement at the 2-year time point with only one injection.
Are there any risks or negative side effects associated with PRP?
As with all medical procedures, a PRP injection does involve some risk. Not all patients will experience pain relief, and symptoms may recur over time. Please consult your RSI physician directly regarding the risks and potential complications of this therapy.
What is stem cell therapy?
Despite being a relatively new advancement in regenerative medicine, autologous stem cell therapy holds the potential to become a new standard in the non-pharmacologic treatment of osteoarthritis and other common musculoskeletal conditions. Autologous cell therapy supports the self-healing process of injured tissue, providing relief from symptoms. When isolated, autologous cells have the unique ability to differentiate into other cell types, such as bone, cartilage, muscle and tendon.
At RSI, MSCs are harvested directly from the patient’s own blood, bone marrow, or adipose tissue to ensure biocompatibility. Prior to injection, the cells are carefully separated by centrifugation and undergo a number of other purification processes.
What is stem cell therapy used for in our practice?
Stem cell therapy injections are used primarily for more advanced stages of osteoarthritis in the knee and hip joints. Usually, we reserve stem cell therapy for those patients who have failed PRP therapy.
What is an epidural steroid injection?
An epidural steroid injection, or ESI, is a minimally invasive treatment used to relieve low back and leg pain (sciatica). ESIs have also been shown to be effective in treating pain in the neck (cervical) and mid-spine (thoracic) as well. While ESIs do not treat the underlying condition, they are often effective in relieving the chronic pain associated with a variety of spinal disorders.
Comprised of cortisone and a local anesthetic or saline solution, ESIs work by reducing inflammation and flushing out particles that cause swelling and pain. ESIs are more effective than oral painkillers and steroids, as the medication is delivered directly to the source of the pain and not dispersed throughout the body. ESIs are typically injected precisely into the epidural space at the site of the presumed pathology, the area between the dura (a membrane covering the spinal nerves) and the posterior disc space.
Who is a candidate for an epidural steroid injection?
ESIs are be used to relieve pain in the lower back, arms, legs and neck that originates from conditions such as:
- Lumbar spinal stenosis
- Lumbar disc herniation
- Degenerative disc disease
- Facet joint or nerve root cysts
- Disc annular tear
ESIs can be used alone to provide pain relief or as part of a rehabilitation program to help a patient perform his/her exercises with less discomfort. Duration of relief can vary dependent upon the condition being treated. If you have a disc extrusion, usually one or two injections will provide long term pain relief because this condition has a favorable natural history. Meaning that with time the extruded disc resorbs on its own. The ESI significantly reduces the pain and inflammation and will shorten the period of disability greatly. If you are being treated for spinal stenosis (a bony encroachment of the spinal canal), the duration of relief from one injection will be from 3 to 6 months, at which time the ESI may be repeated again. In some patients who are diligent with the spinal exercises, one injection can last up to one year.
How does an epidural steroid injection work?
Epidural steroid injections (ESIs) are administered under fluoroscopic x-ray guidance to ensure precise placement of the treatment needle. Local anesthesia is also applied prior to the injection to numb the area.
The procedure takes just a few minutes to perform, with most patients experiencing more pressure than pain during the injection. Patients will likely experience immediate pain relief due to the applied anesthetic, which will wear off within a few hours. Applying ice and taking Tylenol can help to relieve any pain at the injection site after the anesthetic has worn off.
What can patients expect after an epidural steroid injection?
After an epidural steroid injection, patients are able to walk and may resume all regular activities the next day. We recommend avoiding vigorous exercise for 48 hours post- procedure. Maximum benefits may take up to 7-10 days to see. Follow-up appointments normally occur one week after the therapy to evaluate the effectiveness of treatment and determine any further treatment. Usually, if there is significant relief physical therapy is started one week after the injection. If there is no relief, the patient’s condition is reevaluated to make sure the initial diagnosis is correct. We try to get our patients better with the least number of injections necessary.
What is a spinal facet injection?
Before administering a facet joint injection, your RSI physician will first numb the injection site with an anesthetic to reduce any potential discomfort. The treatment needle is then inserted directly into the facet joint through the patient’s back using fluoroscopic x-ray imaging. Once the needle is in place, a combination of anesthetic and cortisone are injected into the targeted joint.
The procedure takes less than 30 minutes to perform and is generally well tolerated by patients. Patients will experience immediate pain relief because of the anesthetic used in the injection. Some patients may experience mild pain at the injection site, which can be managed through Tylenol and ice. A facet joint injection may be repeated, however, if the results are good but only short term we proceed with other treatments such as facet injections with PRP or stem cells, or a radiofrequency denervation procedure for more long term treatment.
What are joint and tendon injections?
Joint and tendon injections are a minimally invasive treatment options used to relieve pain caused by inflammatory conditions such as bursitis or arthritis. During a joint or tendon injection, certain medications, such as corticosteroids or viscosupplementation (used to reduce inflammation and minimize pain), are injected into the affected joint or bursa. RSI physicians do not inject corticosteroids into tendons because studies have shown this will weaken the tendon and lead to further degeneration. However, bursa or intra-articular injections of steroids can be effective treatments if used judiciously.
If there is chronic tendonitis or a partial tendon tear, ultrasound is used to precisely guide the injection of PRP directly into the damaged tendon. Our success with this procedure is very high and rarely are stem cells used to treat tendon tears because PRP alone in our experience is usually enough to create healing of tendons.
To ensure precise administration of the cells or medications, RSI physicians perform these injections under ultrasound guidance. Ultrasound uses high-frequency sound waves to produce real-time images of the internal structures of the body, with no radiation or side effects.
These injections can be used to relieve pain in the:
- Shoulder/Rotator Cuff