Blog - OSC

What is Kyphoplasty by OSC’s Dr Mark McFarland D.O.

By oscblog | Published: May 4, 2024

Dr Mark McFarland, DO of Orthopaedic & Spine Center

Call (757) 596-1900 for a consultation with Dr McFarland

Kyphoplasty is a unique, minimally-invasive way to treat compression fractures of the thoracic and lumbar spine. Most fractures of the aged spine are related to osteoporosis and can lead to a “bent forward” posture called kyphosis. The kyphoplasty procedure can help restore the height of the collapsed vertebrae and relieve a patient of pain by repairing the bone with a strong internal scaffold of bone cement.

Dr McFarland performs a spinal examination

The procedure can be done under conscious sedation or general anesthesic and usually takes around 15-25 minutes to complete. A small needle is passed through the skin and into both sides of the broken vertebrae. Next, small tubes are placed over the needles and small balloons are placed into the bone. The balloons are elevated under pressure to help restore the bone, correct the patient’s posture and reduce the kyphosis. Next, bone cement is placed into the bone to stabilize the fracture, just like an internal cast.

After the kyphoplasty procedure, the bone is very strong and usually the pain will be significantly reduced immediately. Mild residual pain may last up to another 2 weeks after the procedure.

Orthopaedic & Spine Center

Call (757) 596-1900 for a consultation with Dr McFarland
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A Day In the Life of an Orthopaedic Physician Assistant

By oscblog | Published: May 2, 2024

by Orthopaedic & Spine Center’s Tonia Yocum, PA-C

(Physicians Assistant - Certified)

On a typical surgical day, I am up and out of bed at 5:15 AM. I leave the house at 6:00 AM and normally arrive at the hospital around 6:30 AM. I usually change into surgical scrubs when I arrive, although I wear a lab coat when rounding on our post-operative patients.

Tonia Yocum

My days in the hospital are divided into two distinct parts: (1) rounding (visiting and evaluating) patients who have already had surgery and; (2) assisting Dr. Jeffrey Carlson with his orthopaedic surgical cases in the operating room.

Upon arrival at the hospital, I usually complete rounds (evaluations) on post-operative patients. When I am in a patient room, my activities include:
• Asking the patient how they are feeling while checking the surgical area for any abnormalities (if I find anything of concern, I report it to Dr. Carlson immediately)
• Answering any questions they may have about their surgery and recovery
• Outlining expectations of what will happen during the day at the hospital & helping them feel comfortable with the planned therapies (mainly ambulating with physical therapy),
• Reviewing their lab results, vitals and writing SOAP (Subjective, Objective, Assessment Plan – medical format) notes in their chart.

OSC's State of the Art Orthopaedic Facility

Around 7:30 AM, I report to operating room for first surgical case of the day. Part of the surgical P.A.’s job involves pre-operative preparation. I spend time with each of our surgical patients before surgery and these are some of the responsibilities I have:
• Speaking with the patient before surgery to answer any last minute questions and to reassure the patient if they are anxious about their surgery
• Discussing post-operative instructions
• Listening to patient’s heart and lungs
• Assessing vital signs
• Asking the patient pre-operative questions (Example: Did you have anything to eat or drink after Midnight?)

If everything checks out okay with the patient, I then pull together all of the information necessary for Dr. Carlson to proceed with the surgery. This includes patient demographical information, their history & physical and MRI images. Dr. Carlson will review this information before the surgery and may refer to it during the surgery.

At this point, the patient has been prepared for surgery and has been seen by the anesthesiologist, who has started an IV and sedated the patient to help them become less anxious. The patient is wheeled into the OR and I then begin to assist with the surgery. Some of the duties I perform are:
• Helping the surgical team transfer patient to O.R bed
• Standing-by during patient intubation
• Positioning the patient properly on O.R table
• Scrubbing- in for the surgical case
• Opening surgical instruments
• Making sure all necessary equipment is available and ready
• Draping the surgical patient
• Performing suction, retraction, tying, suturing during the operation
• Applying dressing to surgical area

At 10:10 AM, we finish our first surgical case. The patient is extubated and transferred back to a hospital bed. I write post-operative notes & orders specific to our patient that will be used by the nursing staff while the patient remains in the hospital. I then assist with transferring the patient to recovery room.

At 10:25 AM, I start the process over again with our second surgical patient of the day. My evaluation lasts until 10:40 AM. I then start writing some orders and grab a quick snack before returning to the OR.

Dr. Carlson and I have successfully completed 5 surgical cases today. I did get to grab a bite of lunch after our second surgical case and another quick snack around 5:00 PM. Today, my day at the hospital ends at 7:15 PM. I now leave for my second job, being a wife and mother!

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Bad to the Bone - Medical Humor

By oscblog | Published: April 25, 2024

Who Says Orthopaedic Surgeons Have No Humerus!

Dr Jeffrey Carlson M.D. may be the first spinal surgeon to have performed a cervical fusion in Virginia on an outpatient basis. Dr Carlson may be the first spine specialist to have performed a cervical disc arthroplasty on the Virginia Peninsula. He may be a consummate professional, highly skilled and one of the best spinal surgeons in the country.

But Dr Carlson definitely has a sense of humor

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Dr. Jeffrey Carlson Named Chief-of Surgery

By oscblog | Published: April 16, 2024

Leading Spinal Surgeon Dr. Jeffrey Carlson M.D.

Appointment at Bon Secours Mary Immaculate Hospital

Orthopaedic & Spine Center is delighted to announce that Jeffrey R. Carlson, MD, was recently named Chief-of-Surgery at Mary Immaculate Hospital in Newport News, VA. Dr. Carlson is the President and Managing Partner at Orthopaedic and Spine Center in Newport News, VA and is a Fellowship-trained and board-certified Orthopaedic Spine Surgeon. Dr. Carlson has practiced at OSC since July of 1999, after completing an extensive medical education and further fellowship training.

Dr Carlson preps for surgery

Dr. Carlson received his undergraduate degree from The University of Maryland and attended Medical School at George Washington University in Washington, DC. He then completed a General Surgery Internship at Dartmouth-Hitchcock Medical Center and moved on to residency at Harvard University’s Combined Orthopaedic Program. After completing residency, Dr. Carlson went on to complete two separate fellowships: one in Orthopaedic Trauma at Massachusetts General and another in Orthopaedic Spine Surgery at Brigham and Women’s Hospital, both in Boston, MA.

An innovator in the field of spinal surgery, Dr. Carlson is known as the first surgeon on the Virginia Peninsula to perform Cervical Disc Arthroplasty (CDA), and also as the first in Virginia to perform a cervical fusion in an Ambulatory Surgery Center.

Dr. Carlson is an active member of the American Medical Association, the North American Spine Society, a member of the AO North America Spine Faculty, and an active member of the International Association for Minimally Invasive Spine Surgery. A published researcher and scholar, Dr. Carlson teaches advanced spinal surgery techniques to physicians here in the United States and around the world. He was recently named as one of the “Top 200 Spine Surgeons to Know” by the internationally-recognized journal Becker’s Orthopaedic and Spine Review. as was one of only 5 Virginia spine/neurosurgeons chosen for this recognition.

Dr. Carlson is also heavily involved in the community, is a benefactor and active contributor to such organizations as the Arthritis Foundation, as a patron of the arts and is active in his church. He lives in Newport News, VA with his wife, Sandra, and their 3 children.

Contact Orthopaedic & Spine Center for a consultation with Dr Carlson

Tel: (757) 596-1900

Email: [email protected]

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Knee Pain Relief and the Confessions of a Big Baby

By oscblog | Published: April 8, 2024

Written by an Orthopaedic & Spine Center Staffer (who shall remain anonymous)

My knees ache! Carrying around this extra weight for all these years is not helping. “Lose weight”, says my doctor. How can I exercise to get the weight off when my knees are so painful? It is a vicious cycle: Lose weight with more exercise to stop aching; can’t exercise to lose weight because my knees ache from all the extra weight! My friend had a cortisone shot in her knee (done by her orthopedic specialist) and said it helped her pain for at least two months. Forget it! Just pass the potato chips and the foot stool! Steroid shot? No way, I hate needles!

If I can just talk myself into the shot, I could get relief from my pain and start exercising to lose the weight, I could then stop the pain for the long haul. That seems like a much better cycle to be in.

Perhaps there is some comfort in knowing that the stuff inside the needle is actually a synthetic version of a substance that is produced by our own bodies. When our bodies are under stress, the adrenal gland produces cortisone that is released into the blood stream. However, the cortisone produced by the body does not last long and it is definitely not going directly to my bad knees. When a patient is given an injection to the knee, the cortisone goes right to the area of the problem. Now, cortisone is not going to relieve the pain, but it relieves inflammation, which can cause pain. It may also take a few days to work, but lasts much longer than the steroids our bodies produce.

On the outside of the skin, an anesthetic will be used so the injection site shouldn’t hurt. Since the cortisone may take a few days to make a difference in my discomfort, an anesthetic like Lidocaine or Marcaine may be included in the injection to numb my pain, fortunately with the same needle!

OSC pain spoecialists Dr Jenny Andrus and Dr Raj Sureja

Dr Jenny Andrus & Dr Raj Sureja - Interventional Pain Management Specialists

There might also be some comfort in knowing that the orthopedic physician has very specially trained hands that will use ultrasound to guide the injection. The ultrasound wand is placed near the site of the injection and the computer screen shows the physician exactly where the needle should go for the synthetic cortisone to provide the most benefit. It would be amazing to see the inside of my knee on the computer! It is reassuring to know that it is not just a random, blind jab, but a carefully guided placement of medicine. Having this information really helps calm my nerves about this procedure.

So, now that I have gained power through knowledge, I will take a deep breath, cover my eyes and invest in my future health!

Posted in Interventional Pain Management | Tagged , , , , , | 1 Comment

Different Types of Epidurals

By oscblog | Published: March 20, 2024

An Overview of the Different Types of Epidural Injection Used for Interventional Pain Management

Did you know that there are different types of epidural steroid injections? Everyone thinks of an epidural as the procedure you have to relieve pain and make you go numb before having a baby. But, this kind of epidural is different from the steroid epidural that is done, either within the cervical or the lumbar spine, and which provides long term pain relief.

First of all, you should only seek care from a skilled physician who has experience in providing epidural injections. At OSC, Dr. Mark McFarland, a fellowship-trained spine specialist does them in the lumbar spine, as do the two Interventional Pain Management Specialists (Dr Jenny Andrus & Dr Raj Sureja), who do cervical and lumbar. The facility where your epidural is being performed should use fluoroscopy (a special X-ray using dye) to make sure your epidural is being done in the right place and that it is not being done “blindly”. At OSC, we have two state-of-the-art “C ARM” fluoroscopy machines. They are called “C Arms” because they look like a great big letter “C”.

It should be noted that an epidural does not penetrate into the spinal cord, the vertebral bone or into the spinal nerves. The physician will look for the epidural space, near the nerve that is inflamed and will place the medication near the nerve itself. At no time should the needle ever enter the spinal cord. Sometimes patients believe this to be true and it frightens them away from having an epidural.

You can get an epidural in your cervical spine (neck) or in your lumbar spine (lower back). The cervical epidural is used for pain that is caused by some kind of problem in the cervical spine, like a disc herniation or spinal stenosis. However, the pain can be felt in the neck, head, shoulder, or arm. The lumbar epidural is for problems with the lumbar spine, characterized by pain in the lower back, buttock or leg. Cervical Epidurals usually provide pain relief for patients anywhere from a few months to several years. Lumbar epidurals typically do not last quite as long and can provide pain relief for up to a year in most cases.

Intralaminar Epidurals are most commonly performed and involve the injection happening in the middle or mid-line area of the spine. Sometimes this approach works well and provides pain relief. In cases where the nerves along the side of the spine are inflamed or where there are discs that are herniated to either side, a Transforaminal Epidural may be best. These Epidurals are done with a more diagonal or side approach so that the affected nerve(s) and or disc can be better treated.

Contact Orthopaedic & Spine Center today for a consultation.

Tel: (757) 596-1900

Email: [email protected]

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Once, Twice, Three Times an Epidural!

By oscblog | Published: February 16, 2024

A Real -Life OSC Patient Talks About Her Pain Management Experience and Use of Epidurals

Hello, it’s me! (that was also the title of a great Todd Rungren song in the 70s)

Yes, I am back again and this time, it is to talk about having epidurals, not once, not twice, but three or more times.

Back in 2011, during the early summer, I had an epidural injection (which didn’t work) quickly followed by another epidural injection (that did work). The second epidural injection was one or two discs lower that the first one, but it really did the trick! I lived almost totally pain-free for about 7 months. Yes, I might get a minor twinge here and there, if I slept wrong, but the relief from the epidural injection was palpable and wonderful! I had forgotten what it was like to have pain free nights, able to sleep restfully and days at work that were not marred with searing pain in my neck, trapezoids and shoulder region. It was sheer bliss, and for someone who hates needles and passes out very easily, I have become the world’s biggest advocate of epidurals,because they work!

Dr Jenny Andrus - Interventional Pain Management Specialist

So, now that I am starting to feel pain again, I ran, not walked, to schedule my next epidural, because I want the pain relief that it afforded me. I began to wonder, just how many epidurals can you have safely over a year or over a lifetime? To answer my question, I consulted Dr. Jenny Andrus, a Pain Management Specialist here at OSC. Dr. Andrus told me that you can safely have multiple epidurals in a year, but usually not more than 3 or 4. Too much steroid can be a bad thing, so a good physician makes sure to monitor how much steroid is administered to an individual over a certain period of time. A person who has a herniated disc or other spinal issue can safely have epidurals through-out their lifetime for pain management. This is wonderful news for persons who cannot have surgery for medical reasons or for those who just choose not to have spinal surgery. Sometimes, as in my case, better pain relief is afforded by having two injections, at different vertebral levels, done closely, within a few weeks. This gets a good amount of steroid near the inflamed nerve root, allowing it to heal, the inflammation to lessen and providing pain relief. It is amazing how much misinformation there is about epidurals, but if I can help to set the record straight, I am happy to do so!

Contact Dr Jenny Andrus for a consultation through Orthopaedic & Spine Center

Tel: (757) 596-1900

Email: [email protected]

 

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Another Epidural and Another Chance at Pain-free Living?

By oscblog | Published: January 30, 2024

A Real-Life OSC Patient Recounts Her Experience with Epidural Injections and our Interventional Pain Management Team

Okay, as promised, here is my update on my third epidural. I had it last Tuesday and was actually eagerly awaiting it to provide me with pain relief.

OSC's Interventional Pain Management Team: Dr Andrus & Dr Sureja

The preparations were as before, no taking any anti-inflammatory medication for three days prior to the procedure. I checked-in and although I was a tad bit nervous (which I think is normal anytime you are getting a needle stuck into your back) I was relatively calm and serene.

Because the clothing I was wearing was easily manipulated, I did not even need to change into a gown for the procedure. I laid on the table in the procedure room and assumed “the position”, laying on my stomach on the gently sloping “prop” that holds your body in place for the injection. This prop provides a place for your face to rest, somewhat like a massage table. I felt like I was much more prepared this time, and although I did not enjoy the injection process itself, I did not get as faint as I normally have in the past. When they numb your back where they will insert the catheter, it feels like a sting.

Then the injection of the dye feels weird…I really cannot describe it, because having something injected into your intrathecal space is not an everyday occurrence, nor is it something for which you are easily prepared to describe.

It just feels plain weird!

It was over very quickly and I was sitting up and getting my bearings soon. I collected my belongings and went into the waiting room to rest for about 15 minutes before they would release me into the care of my in-laws, who again unselfishly offered to collect me and drive me home.

While I was sitting there, several of the staff asked me if I was okay and I said that I thought so. They all said that I looked very pale and that I should sit still and drink some cool water.

So, I did.

Then after about 15 minutes, they said that my color had returned and that I was free to go. I headed home and iced my neck and took it easy for the rest of the day. I again had some problems with insomnia and leg heaviness, but those subsided by the next day.

So, let’s see if I will get the same level of relief that I did previously. I certainly hope so!

Contact OSC’s Interventional Pain Management Team

Dr Jenny Andrus & Dr Raj Sureja

Tel: (757) 596-1900

Email: [email protected]

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Second Time is A Charm!

By oscblog | Published: January 29, 2024

I must say that having patience is not a characteristic that I would readily associate with myself and I absolutely despise waiting long for anything. So, I truly was pleased that I began to feel REAL, NOTICEABLE relief after just a few days. The best part was that it kept getting better and better. For so long, I have been in pain from my neck, shoulder and arm, that I forgot how it felt not to have the burning, knife like pain constantly with me. But, I happily report that I quickly got used to the pain-free feeling! I was truly amazed that this time, my cervical epidural worked like a charm! I did not experience arm pain, shoulder pain, neck pain or anything. I could sleep on my stomach again! I could turn my head easily to look over my shoulder to back the car out of the driveway. I could watch TV and not be crippled if I held my head in one position for too long. I could lay on my husband’s chest in bed and not feel shooting pain when I did so. This was astounding to me…how much of my life that I had changed, or how I had to make accommodation for my herniated disc and the pain. I never really realized how much my life had been negatively impacted by its effects on things I normally take for granted. I felt very blessed to have found something that helped me without having to resort to surgery. I felt peaceful in the knowledge that I could be helped. That was an amazing thing to feel.

My last EPI was on May 24th of 2011. Until the end of October, I was almost completely pain free, unless I really did something to cause my neck to ache. Around the first of November, I began to feel twinges again, in my neck and upper arm. Drats! I know that many other people have regular EPIs to maintain their pain free status, but I had hoped mine might last longer. However, I am grateful that I was able to get 5 months of pain-free time and now, even though the pain is there, it is manageable. I DO know that I will be returning to have another EPI soon; however, because I want to be pain-free again. It really is astounding that I would be looking forward to having another injection into my spine. After 47 years, I guess I am finally growing up and facing my fears! Imagine that!

I’ll keep you posted on my continued progress. Take care everyone!

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My Second Steroidal Epidural Procedure!

By oscblog | Published: January 15, 2024

A Patient’s Journey to Pain Relief with OSC Orthopedic Associates

After my initial epidural procedure failed to give me as much pain relief as I was hoping for, Dr Mark McFarland recommended I try a second cortisone procedure before moving to the surgical option to remove the herniated disk.

I head into to see Dr. Raj Sureja for my second cervical epidural - cue dramatic drum rolll please

I found this great Youtube video by Dr Sureja explaining the process of injecting cortisone into the spine and why this helps relieve pain:

This time, I am much less anxious about what my experience will be. Knowledge is power, right? I know that I might get dizzy or feel faint, but I also know that the epidural really doesn’t hurt and that it will be over soon.

Dr. Sureja comes in and is his usual gentle and wonderful self. He decides to do my epidural at a level below the last one, to see if this time, I get some relief from the medication.

I lay down on my stomach on the table and again, during the procedure, I being to feel faint. I hate the fact that I just get so faint whenever I am scared or feel pain. Dr. Sureja says it is the Vagus Nerve Reflex that causes this and that it happens to other people as well. Luckily, this time, I recover from my faintness very quickly and my blood pressure does not drop as low. After a short waiting period after the procedure, I am released into the care of my long-suffering in-laws, who have again volunteered to pick me up and take me home.

Dr Raj Sureja with orthopedic colleague, Dr Jenny Andrus of OSC

When I arrive home, I quickly get my ice pack and head for the bed, to lay flat and to ice the injection site. I pray that I will not get the severe headache that I got last time, so I try to lie still, watch TV and nap. After a few hours, my husband comes home from work and fixes me dinner. I am just fine to get up and eat at the table. Later that evening, I do experience some leg jitters and insomnia. However, these side-effects are nothing compared to those that I experienced after the first epidural. Hallelujah, no headache, no flushing and no other problems! The whole experience seemed to go much more smoothly, in large part, because I wasn’t so afraid and I didn’t work myself up before I went to have the injection. Now, the fun part begins…waiting to see if I feel better.

Next time…..Second Time is a Charm!

Posted in Dr. Raj N. Sureja MD | Tagged , , , , , | 2 Comments