Is Your Low Back Pain From Arthritis? Written by Christopher S. Vihlen, M.D.

by TOI Admin May 21, 2018
Back pain is very common with multiple possible sources for the pain.  If the pain starts in the back and travels into the thigh and/or below the knee, the problem is probably sciatica, a pinched nerve in the back. However, if the pain is primarily in the back, possibly with some pain in the buttocks and thighs, then the problem could very well be arthritis.


The arthritis that could be causing the back pain is in the small joints in your back called facet joints. Your spine, from your neck to your low back, is made up of 24 vertebrae. Each vertebrae can bend or flex with the ones above and below at the facet joints. And, like any joint in the body, the facet joints can develop arthritis. This is usually from overuse.
Treatment for facet joint pain includes physical therapy, oral medications, injections, and surgery. Often, in that order. 


Injections are usually done after more conservative treatment, such as physical therapy and oral medications, have not offered substantial relief. These injections have traditionally included steroid injections into the painful joint or joints. However, research has supported a procedure directed at the nerves which block the pain signal traveling from the joint to your brain. This is called radiofrequency neurotomy 


Radiofrequency neurotomy is a procedure that uses heat to destroy tiny nerves that transmit the painful signal in your facet joints up to your brain. So, although the arthritis persists, you don’t suffer its affects all day, every day. The procedure starts with sterilizing and numbing the skin. Then small needles are inserted towards the responsible nerves using x-ray guidance. Once the needles are in position, a special machine generates very focal precise heat to burn a short segment of the nerve. The painful signal can no longer travel back to the brain.


To confirm you are a good candidate for the radiofrequency neurotomy, two preliminary diagnostic injections are performed using local numbing medicine. If numbing the offending nerves, which go to the painful arthritic joints, relieves your pain, then you are a good candidate. These preliminary injections are called medial branch blocks. They get this name because the small nerves which ultimately get burned are called the “medial branches,” and we are “blocking” them with numbing medicine. This preliminary injection only lasts hours, but 
it is a good test to prove you will ultimately benefit from the radiofrequency neurotomy. 
If you have back pain and would like to know more about various treatments, please contact The Orthopaedic Institute.
Christopher S. Vihlen, M.D. is a board certified diagnostic radiologist. He completed his undergraduate education at Vanderbilt University and went on to attend the University of Florida College of Medicine. His residency and fellowship training were also completed at the University of Florida. Dr. Vihlen practices out of TOI’s Gainesville location.

Outpatient Joint Replacement

by TOI Admin March 27, 2018

Written By: Joseph R. Locker, M.D.

“Same-day” or ambulatory joint replacement surgery is on the rise in the United States. Predictions are by 2027 over 50% of joint replacements will be done as an outpatient. Why the shift? What are the risks and benefits? Are you a potential candidate? Read on for more information.

What is Outpatient Joint Replacement?

Outpatient surgery assumes the patient spends less than 23 hours at a facility. Currently, Florida laws do not allow for overnight stays at Ambulatory Surgery Centers (ASCs), so for now, it means going home the same day as surgery. It could mean a hip, knee, partial knee, or shoulder replacement.

Why is Outpatient gaining popularity?

With the advances in surgical techniques, anesthesia, and pain management most total joint patients spend less than 2 days in the hospital. For a certain subset, there is an ability to go home the same day. Outpatient is not for everyone and is decided by the patient and surgeon on a case by case basis.

What are the required factors for outpatient?

    1. Engaged healthy patients: patients with significant medical problems or those with a less healthy body weight are ideally done at the hospital to allow overnight observation. The younger, healthier patients are better candidates.
    2. An at-home support system: there must be help at home for the therapy and discharge from the ASC. If you live alone it may be difficult to go straight home from surgery.
    3. Pre-op and post-op preparation: training on crutches or a walker before surgery, preparing the house, and exercises after are extremely important to allow rapid recovery.
    4. Pain management: the evolution of pain control relies on the avoidance of heavy narcotics so fewer side effects of nausea, vomiting, and other things.
    5. Minimally invasive surgical techniques: surgery must be efficient with limited tissue damage and less pain.

Is it safe?

Yes, studies have shown that outpatient joint replacements in the right patients are not only safe but generally leads to better patient satisfaction than surgeries at the hospital.

Is the cost the same?

Generally, the overall cost is much less than in hospital stays, which can lead to thousands of dollars of savings for a patient.


Do most insurances plans cover this?

Insurances, including Medicare, are moving more and more towards reimbursing for outpatient joints. It depends on the private insurer currently, with Medicare only allowing outpatient total knees, and those have to be done at the hospital, although Medicare currently allows outpatient partial knee replacement.

How do I know if I am a candidate?

 Talk to your TOI surgeon. They can discuss the different options with you to determine if outpatient joint replacement surgery is right for you.

#TOIHealthTips: Lift Those Weights

by TOI Admin April 27, 2017


#TOIHealthTips: Stay Active As You Age

by TOI Admin April 20, 2017


Text Neck and How to Avoid It

by TOI Admin April 18, 2017

Neck pain can be...  well, it can be a "pain in the neck". Several factors can contribute to the cause of neck pain, like an injury, inflammation, or the aging process. Another huge contributing factor to neck pain results from the avid use of smartphones and tablets. Here is How to Avoid Neck Pain from Texting.

Welcome to TOI's Blog!

TOI's Blog is dedicated to patient education with topics addressing current issues in health and medicine. We will also blog about some of our other favorite things, like community events, our wonderful employees, helping the environment and whatever else comes to our minds! We hope the information contained in our blog is fun to read, assists you in making educated decisions regarding your health, and supports your decision to select TOI when you are in need of quality musculoskeletal care.


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