Book an Appintment with Dr. Mikhail Kogan

Specialties: Pain Management, Anesthesiology.

Dr. Sekhar Upadhyayula, MD and Dr. Mikhail Kogan MD

Dr. Sekhar and Dr. Mikhail Kogan are member of American Society of Anesthesiologists.

Pain Solutions New York -

Call on 718-544-1171 or visit for Appointment.

Epidural Steroid Injection

The Epidural Steroid Injection is a procedure where numbing medicine (anesthetic) and anti- inflammatory medicine (steroid) is injected into the epidural space to treat pain caused by irritation of the spinal nerves.

Cervical Facet Joint Injection

The Cervical Facet Joint Injection is a procedure used to block or decrease pain caused by problems in the upper (neck area) spine.

Sacroiliac Joint Pain

The sacroiliac joint (SI joint) is that the joint bridging rock bottom section of the spine (sacrum) to the bones of the pelvis. These joints support the higher body after we are standing. After time, the SI joint will develop arthritis and become painful, significantly once walking and climb stairs.

Pain originating within the sacroiliac joint is mostly within the lower back, buttocks and thighs.

Where is that the sacroiliac joint?
The sacroiliac joint connects the last section of the spine to the sacrum and to the pelvis. The integrity of the sacroiliac joint depends on robust ligaments that case and cover the joint, each the front and back. These ligaments compress and stabilize the joint, keeping it along and limiting its’ motion.

How the sacroiliac joint causes lower back pain?
The ligaments that case the sacroiliac joint could also be stretched owing to injury or degenerate owing to age, permitting the joint to possess excessive motion. This excessive motion could inflame and disrupt the joint and stimulate the nerves causing pain. The pressure on the joint caused by excessive weight is additionally a possible reason for pain.
Your physician may seek advice from sacroiliac joint pain by alternative terms like sacroiliitis, SI joint degeneration, SI joint inflammation, SI joint syndrome, SI joint disruption and SI joint strain/sprain.

How do the symptoms of sacroiliac joint pain present?
The most common symptom of sacroiliac joint disorders is pain within the lower back, buttock and generally within the same facet leg. this could gift as sciatica like symptoms (leg pain, burning, numbness, and tingling) that mimic lumbar disc or radicular low back pain, pain that radiates down into the legs. most often it radiates to the buttock and thigh.

Causes of sacroiliac joint disorders
Causes of sacroiliac joint disorders are often split into 5 categories:
• Traumatic (lifting, fall, accident)
• Biomechanical (leg length discrepancy, previous lumbar fusion)
• secretion (pregnancy / childbirth)
• Inflammatory joint illness (sacroiliitis) related to a generalized unhealthy condition
• Degeneration (age connected wear and tear)

Diagnosing sacroiliac joint pain
In order to diagnose the sacroiliac joint because the pain generator, your physician can usually begin with a history and a physical examination. throughout the physical examination, your physician could try and verify if the sacroiliac joint is that the reason behind pain through movement of the joint. If this joint movement recreates the pain, the SI joint could also be the reason for the pain.
Your physician may use X-rays, CT-scan or mri to assist diagnose the sacroiliac joint. it's additionally necessary to recollect that quite one condition (like a disc problem) will co-exist with sacroiliac joint disorders. this implies that even within the sacroiliac problem is addressed , pain should still be gift within the space. Your doctor should discuss this with you.
Finally, your physician could request sacroiliac joint injections as a diagnostic assay. Sacroiliac joint injections involve injecting a numbing medication into the sacroiliac joint. If the injection alleviates your symptoms, then your sacroiliac joint could also be the seemingly supply of your pain.
These injections aren't tired the office however are tired a fluoroscopic suite. The response to the injection could last for hours, days or weeks and depends on the illness process. what's hunted for may be a temporary resolution of your pain grievance that brought you to the doctor. This temporary resolution needs to be dramatic at seventieth pain relief or additional.

Treatment could involve physiotherapy and SI joint injections to manage the pain. For patients who aren't any longer responding to conservative care, an SI joint fusion is also steered as a minimally invasive surgical choice.
We're Minimally Invasive at Lone-Star State Back Institute in Dallas-Fort price
Our surgeons usually use robotics, intraoperative CT imaging systems, and computer-assisted navigation that help us specifically address the supply of a patient’s neck or back pain while not touching healthy tissue or unrelated components of the spine. As a result, our patients experience:

  • Faster recovery times
  • Reduced risk of complications
  • Faster come back to figure, sports, and different hobbies
We take the time to totally review a patient’s medical history, imaging results, and diagnostic tests before we have a tendency to advocate surgical treatment. Before several surgeries, a nine-doctor, peer-review committee can meet to guage the projected treatment arrange, therefore a patient can receive multiple skilled opinions while not having to severally visit varied surgeons. However, in several cases we discover that surgery isn’t necessary to deal with neck and back pain, which conservative, non-surgical treatments like physical therapy will yield helpful results. In fact, fewer than ten percent of our patients ever need surgery to expertise pain relief.

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Facet Joint Injection

An aspect joint injection is a comparatively easy, straightforward procedure, and is typically performed in an workplace based mostly procedure suite or in an ambulant surgical center.

As with several spinal injections, facet joint injections are best performed mistreatment radiology (live X-ray) for steering to properly target and place the needle (and to assist avoid nerve injury or alternative injury).

Commonly, the procedure is performed with none sedation, however, an IV line are often started if relaxing medication is required.
The patient lies on a procedure table, and therefore the heal the area to be tested is well cleaned.
The physician treats a little area of skin with a desensitizing medication (anesthetic), which can sting for a number of seconds.
The doctor uses X-ray steerage (fluoroscope) to direct a really little needle into the side joint.
A small amount of distinction dye is then injected to verify that the needle is within the joint which medication is contained within the joint.
Following this confirmation, a small mixture of anesthetic (such as lidocaine) and anti inflammatory medication (steroid/cortisone) is then slowly injected into the joint.

The injection itself only takes many minutes, however the complete procedure typically takes between fifteen and thirty minutes.

Immediately Following the Injection

1- After the procedure, the patient usually remains resting within the recovery area for twenty to thirty minutes, and so is asked to perform some movements or activities that may typically provoke their pain.

2- Patients might or might not acquire pain relief within the 1st few hours once the injection, relying upon whether or not or not the joints targeted are the most supply of their pain. If the joint or joints being targeted don't seem to be inflicting their pain, a patient won't acquire immediate relief from the injection.

3- On occasion, patients might feel numb or have a rather weak or odd feeling in their neck or back for many hours once the injection.

4- The patient can consult with the doctor any immediate pain relief, and any queries or issues.

The Day of the Injection
On the day of the injection, patients are usually suggested as follows:

1- Avoid doing any strenuous activities.

2- Patients should limit pain medication among the primary four to 6 hours when the injection in order that the diagnostic info obtained is correct.

3- Avoid driving, unless specifically approved by the treating doctor.

4- If sedation was used, the patient mustn't drive for twenty-four hours when the procedure.

The Week once the facet Injection

Patients might notice a small increase in pain lasting for many days because the desensitizing medication wears off and before the Cortone Acetate starts to require result.

In the week following the injection, common recommendations include:

If the area is uncomfortable within the initial 2 to 3 days once the injection, fastidiously applying ice or a chill pack to the overall area of the injection site can usually offer pain relief.

Read additional regarding Ice Packs for Back Pain Relief

Patients might still take their regular pain medication once the procedure.

On the day once the procedure, patients might come back to their regular activities.

Patients could also be referred for physical {therapy|physiotherapy|physiatrics|therapy} or manual therapy once theinjection whereas the desensitizing  medication is effective and/or over consecutive many weeks whereas the Cortone Acetate is functioning.

Read a lot of concern physical therapy for Low Back Pain Relief

When the pain is improved, it's recommended to begin regular exercise and activities carefully. though the pain relief is important, it's still necessary to extend activities step by step over one to 2 weeks to avoid recurrence of pain.


Epidural steroid injection- A standard treatment option for several varieties of low back pain

Epidural steroid injections (ESIs) are a standard treatment option for several varieties of low back pain particularly when in the course of radicular leg pain, a condition normally called sciatica.
An Epidural steroid injection reduces pain as a result of it contains corticosteroids that mimic the consequences of the naturally occurring hormones cortisone and hydrocortisone that serves to reduce inflammation around irritated nerves. The result of the steroid is temporary and therefore the cause of the nerve irritation, normally the chronic changes of the disc resulting in a bulge or rupture nevertheless remains. Worse, there is a likelihood these hormones in such unnaturally high concentrations would possibly truly weaken the spinal bones, ligaments, and therefore the tendons of close muscles combining the problem. ESI's are sometimes restricted to only some a year as a result of steroid injections additionally suppress the body's natural secretion balance and might result in adrenal insufficiency, a significant medical condition. Delaying repeat injections is likely to permit your body an opportunity to come back to its normal balance though there's very little proof to support this notion. the chance of those facet effects might increase with the number of steroid injections received and the dose given in every injection.

Risks factors-
>>Death of nearby bone (osteonecrosis)
>>Joint infection
>>Nerve injury
>>Skin and soft tissue thinning around injection web site
>>Temporary flare of pain and inflammation within the joint
>>Tendon weakening or rupture
>>Thinning of nearby bone (osteoporosis)
>>Whitening or lightening of the skin around injection web site

Modern medical science has finally developed an efficient alternative to endless injections or just living with the pain - Spinal Decompression medical aid. Performed on a special, computer controlled table similar in some ways in which to a normal traction table one disc level is isolated and by utilizing specific traction and relaxation cycles throughout the treatment, along side proper positioning, negative pressure will truly be created inside the disc.
It works by gently separating the sinning disc five to seven millimeters making negative pressure (or a vacuum) within the disc promoting the retraction of the bulging disc tissue. This negative pressure also pulls water, oxygen, and nutrients into the disc, thereby re-hydrating a degenerated disc and transfer within the nutrients required to start the healing method. because the disc retracts the pressure comes off the nerve eliminating the irritation that triggered the inflammatory method.

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Epidural Steroid Injections

Epidural injections are administered for relieving the pain suffered by the patients in their spine. Epidural injections are used for treating low back pain for quite sixty years. These injections contain steroids, anesthetics and anti inflammatory medications.
They perform the task of decreasing the inflammation and swelling that is inflicting the back and leg pain. The epidural injections deliver the medication contained in them into the epidural space of the spine.

What are the major indicators for having Epidural Injections?

Epidural injections are sometimes indicated for people who are affected by chronic back pain or sciatica and haven't been able to find relief from the never ending pain through the use of typical treatment ways. Patients with a bulging or slipped disc are perfect candidates for receiving epidural injections.
In addition to the present, spinal stenosis is another medical condition that an epidural injection will sway be terribly helpful. Victims of a car accident who have suffered a spinal injury or individuals convalescent from failed back surgery syndrome will realize epidural injections terribly effective for assuaging their back pain.

What does Epidural Injections entail?

Epidural injections involve these of a hypodermic needle to deliver corticosteroids into the epidural space of the spine that alleviates the pain and inflammation that the patient has been suffering from. The medicine nature of the corticosteroids decreases the inflammation within the spinal discs and within the process relives the pressure on the spinal nerves.
In some cases, the epidural injections are used to deliver an anesthetic to the spinal nerves that stops them from sending pain signals to the brain and therefore curb the pain being felt by the patient. the utilization of radiology improves the accuracy and effectualness of the epidural injections.

How will Epidural Injections facilitate the doctor offer treatment?

Epidural injections will provide instant relief from the never ending back and leg pain. Their ability to right away decrease the chronic pain within the spine is extremely useful for seattle pain doctors in managing the pain symptoms of patients. With the pain taken care of, the doctors will direct their attention towards solving the other symptoms of the patient.   

What to expect when having Epidural Injections?

The epidural injections are administered using a hypodermic needle. you'll be asked to lie down on your stomach. The doctor goes to apply anti-septic solution and a local anesthetic on the skin of the area above the epidural space wherever the injection is to be inserted.
The anti-septic goes to clear the bacteria whereas the anesthetic can numb the area so you are doing not feel any kind of pain once the injection is inserted into the epidural space. once ensuring that the needle is placed at the proper spot victimization X-ray steering, the seattle pain management doctor goes to inject the contents of the injection into the epidural space. A band-aid goes to be applied over the injection web site once the procedure has been completed.

There are three varieties of epidural injections:

Interlaminar injection – oldest technique – injection of steroid between the “lamina” bones.

Transforaminal Epidural – the latest technique, interjects medication specifically wherever the nerve root is being pinched.

Caudal Epidural – places the steroid medication very low within the spine then it migrates to alleviate pain at multiple levels.

What are the risks of having Epidural Injections?

Infection remains the most risk of epidural injections. There's additionally a chance of a reaction happening to the medication that's delivered within the injection. However, the risks and complications related to epidural injections are uncommon.
What are the benefits of having Epidural Injections?

The most necessary benefit of epidural injections is fast relief from acute or chronic back or leg pain. Dozens of studies are looking at epidural injections and have shown that in over seventy fifth of individuals, excellent pain relief is achieved. This might last from days to months.

Dr. Mikhail Kogan - Back pain and Cancer pain Specialis

Dr. Kogan is known for achieving dramatic improvement in pain without major surger also promoted to Director of Pain Management Service at Elmhurst Hospital.

Dr. Mikhail Kogan is an Interventional Pain Management Specialist with extended expertise in treating back pain and cancer pain. He currently is an Assistant Clinical Professor at Mount Sinai School of Medicine at Elmhurst Hospital Center. Dr. Kogan is board certified in anesthesiology and pain management. After completing his anesthesiology residency at St. Vincent's Medical Center in NYC, Dr. Kogan was fortunate to attend a pain management fellowship at the State University of New York in Buffalo, where he trained under two of the world’s most prominent specialists in pain management, Dr. Mark Lema and Dr. Oscar DeLeon. A significant part of his training was conducted at Roswell Park Cancer Institute. In 2000, Dr. Kogan was promoted to Director of Pain Management Service at Elmhurst Hospital. During the past six years, Dr. Kogan has developed pain management service into a premiere minimally invasive pain management practice with an emphasis on minimally invasive spinal techniques. Dr. Kogan continues to utilize the latest, most cutting edge spinal interventions including percutaneous disc decompressor, radio frequency neurolysis and spinal implantable devices. While Dr. Kogan's education and certifications attest to his knowledge, it is his patients’ satisfaction that justify his recognition in this area. Dr. Kogan is known for achieving dramatic improvement in pain without major surgery. Dr. Kogan prides himself on being a compassionate, caring physician with an excellent bedside manner. Dr. Kogan is a member of the American Society of Anesthesiologists and the American Society of Regional Anesthesia and Pain Medicine.

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