Endoscopic posterior foraminotomy/discectomy is performed through a small tube placed through a small skin incision at the back of the neck. The small tube allows the surgeon to place an endoscope through the tube and to use tools through the endoscope to remove disc (discectomy) or to free the nerve from compression (foraminotomy).

TY - JOUR. T1 - Long-term patient outcomes after posterior cervical foraminotomy. T2 - An analysis of 151 cases: Clinical article. AU - Bydon, Mohamad. AU - Mathios, Dimitrios. AU - Macki, Mohamed. AU - De La Garza-Ramos, Rafael. AU - Sciubba, Daniel M.. AU - Witham, Timothy F.. AU - Wolinsky, Jean Paul. AU - Gokaslan, Ziya L.. AU - Bydon, Ali. PY - 2014/11/1. Y1 - 2014/11/1. N2 - Object. The authors conducted a study to investigate the rate and timing of reoperation due to symptom recurrence after unilateral posterior cervical foraminotomy (PCF). Methods. The authors retrospectively reviewed demographic, surgical, and clinical data from 151 patients who underwent unilateral PCF at their institution with an average follow-up of 4.15 years. The main outcome variables were reoperation rate, time to reoperation, and short- and long-term radiculopathy improvement rates. Kaplan-Meier analyses were conducted to assess risk of reoperation and recurrence of radiculopathy over time. Results. After index ...

Background: Radiculopathy caused by foraminal nerve root compression is a common pathology in the lumbar spine. Surgical decompression via a conventional open foraminotomy is the treatment of choice when surgery is indicated. Minimally invasive tubular foraminotomy through a contralateral approach is a potentially effective surgical alternative. Objective: The aim of this retrospective cohort study was…

Foraminotomy is a type of spine surgery performed to relieve pressure on a spinal nerve root. Foraminotomy is used to treat a condition known as spinal stenosis, which can occur in any part of the back or neck. Learn more about the risks and benefits of this procedure.

Looking for information on Cervical Foraminotomy in Gillette? We have compiled a list of businesses and services around Gillette that should help you with your search. We hope this page helps you find information on Cervical Foraminotomy in Gillette.

Looking for information on Cervical Foraminotomy in Broken Arrow? We have compiled a list of businesses and services around Broken Arrow that should help you with your search. We hope this page helps you find information on Cervical Foraminotomy in Broken Arrow.

Is a Foraminotomy right for me? Learn how a minimally invasive foraminotomy can permanently reverse your neck or back pain & restore your quality of life.

L4-5 Disc Herniation with Laminectomy, Discectomy and Foraminotomy. Features the L4-5 (anomalous L5-6) focal disc herniation showing compression of the right side nerve root. A. Incision in lower back to expose the L4-5 (L5-6) disc space; Incision of the lumbosacral spine labeling L4-5, L5-6, ligamentum flavum and lamina; B. Surgical removal of the lamina and ligamentum flavum through the open surgical exposure; C. Removal of the herniated disc material.

Orthopaedic Specialists in Raleigh and Durham North Carolina provide Minimally invasive posterior cervical foraminotomy & discectomy. To learn how Triangle Orthopaedic Associates of North Carolina contact us.

Foraminotomy, laminotomy and laminectomy are all types of decompression surgeries that involve widening the spinal canal to relieve pain due to nerve compression. Each procedure focuses on a different part of the spinal anatomy, and the exact location of the source of the pain will determine which surgery is to be used in each case.

Exciting Medical Journey starts with PlacidWay. Learn about Cervical Thoracic and Lumbar Laminectomy or Foraminotomy, Spine Care Surgery in Egypt. Explore 100+ affordable treatment packages.

During foraminotomy surgery, after under general anesthesia, you will be placed face down on a specialized table with your head slightly flexed.. Your surgeon will make a small incision in or near the midline of your posterior neck, and carefully dissect through muscle to gain access to the spine.. The surgeon will then remove bone, ligament, and any other tissue that is obstructing the passageway of your spinal nerve roots.. Special drills, curettes, and ronguers are used to remove any bone spurs or bony overgrowth that causes spinal nerve root compression.. Once completed, your surgeon will be able to directly visualize your spinal nerves, ensuring adequate decompression.. ...

Lumbar foraminotomy is a decompression surgery involving the removal of bone and tissue obstructing the neuroforamen to release the pressure on the spinal nerve roots. Dr. Ryan Stuckey treats bone spurs, herniated intervertebral disc in Houston, TX.

Foraminotomy is surgery that widens the opening in your spine where nerve roots leave your spinal canal. You may have a narrowing of the nerve opening (foraminal stenosis).

Herniated disc surgeries are known as microdiscectomy and foraminotomy, which can be performed together to treat a compressed or bulging disc.

Dr Gabriel performs Cervical Foraminotomy surgery to relieve the symptoms of pinched nerve by expanding the neural foramen in Columbus OH. Check to know more info.

Foraminotomy is a spinal decompression surgery which widens the spinal passageway. Are you suffering from chronic neck/back pain due to pinched nerves? Contact us.

Atlanta Endoscopic Foraminotomy 1-800-ORTHO-11 - Ortho Sport & Spine Physicians offers Georgia patients minimally invasive treatments for patients suffering from back pain due to compression.

Facet joint foraminotomy surgery can be performed when bone spurs growing on and around these spinal joints contribute to neuroforaminal stenosis.

Treatment for chronic spinal nerve compression and back pain can include percutaneous foraminotomy. Contact neurosurgical expert Dr. Gravori today for more.

Degenerative spinal conditions refer to a gradual loss of normal structure and/or function of the spine over time. Dr Jeremy Wang offers foraminotomy and spinal fusion in Houston, TX.

The Average cost of Cervical Foraminotomy in India started from 5000 USD to 8000 USD depending on your medical condition, hospital location and surgeon experience.

Cervical Posterior Foraminotomy Portland OR - Kellogg M.D. Brain & Spine offers Cervical Posterior Foraminotomy. Our practice serves Portland OR and surrounding areas.

Most patients with spinal stenosis or disc prolapsed respond well to non-surgical treatments. However, there are situations when you may want to go ahead with spine surgery.. One main goal of spinal stenosis surgery is to free up area for your spinal cord and/or the nerve roots. Thats called decompression. By giving your spinal cord and nerve roots more space to pass through, we hope to decrease your pain from nerve inflammation.. Another goal of spinal stenosis surgery is to increase your motor strength in your arms or legs. If youve lost sensation in your arms or legs, we also hope to restore that. To remove the tissue thats pressing on a nerve, we may perform one of the following types of surgery.. Foraminotomy: If part of the disc or a bone spur (osteophyte) is pressing on a nerve as it leaves the vertebra (through an exit called the foramen), a foraminotomy may be done. Otomy means to make an opening. So a foraminotomy is making the opening of the foramen larger, so the nerve can exit ...

A posterior cervical microforaminotomy/discectomy is performed to remove pressure from a nerve root in the cervical spine. Spine surgeon Dr Shanu Gambhir in Sydney, Penrith, Bella Vista, Wagga Wagga and Orange, NSW treats disc herniation by using minimally invasive spine surgery.

The spinal canal and intervertebral foraminae are bony tunnels in the spine through which run the spinal cord and spinal nerves (nerve roots) respectively. When the size of these tunnels is reduced, there is less room for the spinal nerves and/or spinal cord, the consequence of which may be pressure on these structures. Disorders that can cause nerve root compression include spinal stenosis, degenerative disc disease, a bulging or prolapsed intervertebral disc, bony spurs (osteophytes), or spondylosis (osteoarthritis of the spine). Commonly, two or more of these conditions are seen together.. Intervertebral discs sit between each bone (vertebrae) in the spine. They act as shock absorbers as well as allowing normal movement between the bones in your neck. Each disc has a strong outer ring of fibres (annulus fibrosis), and a soft jelly-like central portion (nucleus pulposis). The annulus is the toughest part of the disc, and connects each vertebral bone. The soft and juicy nucleus of the disc ...

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Centers RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.. ...

There were some interesting findings in the demographic data for the study population. Firstly, 20 cases (54%) of ASD occurred at a level below the index segment and 28 cases (78.3%) were at the lower cervical area (C6-T1). Previous studies reported that lower segments have greater influence on the cervical ROM [4]. Once ACDF is performed, the motion at the index level is fixed and a compensation mechanism is triggered to maintain the cervical ROM. Lin et al. [17] reported that the cervical ROM decreases after ACDF, while the ROM at the upper and lower segments increases. They also reported a significant correlation between the ROM for the lower segment and that of the entire cervical region [17]. The findings in the current study support previous reports indicating the lower segments contribute substantially to the cervical ROM.. Secondly, the previous surgery in 32 cases (86.4%) was ACDF and 12 (37.5%) of these were performed using a standalone technique. ACDF is a widely accepted standard ...

Due to the coronavirus outbreak worldwide, global demand for some personal protective equipment (PPE) is exceeding supply. In addition, manufacturing of PPE and many other wound care and infection prevention products have been impacted by global response to coronavirus. While you may see product availability reduction in the near-term, please be assured Medline continues to work to diversify production and provide your supply needs. As always, please reach out to your Medline sales representative with any specific questions or follow up. ...

Hi ,. Iam a 43 years old male from Pakistan . I had history of left leg pain since 25 years. In 1998 i had severe episode of left leg pain and numbness with loss of Flexion . An MRI revelaed very large L5-S1 herniation . I was advised immediate surgery but due to certain reasons i continued to manage my condition without it . In 2004 i started having urine stream slowness and had another MRI. Neurosurgeon was unsure of urine symptoms but as always urged for a surgery which i underwent . A micro discectomy was performed. It restored some sensation of my left leg but numbed my left leg as well . The urine and pain symptoms resolved . In 3 months i started having tingling in genitals and urine problems again . But none of the test concluded an existing severe retention problem so i was put on exercises and SOS drugs. It had been 6 years to my surgery and all symptoms have gradually severed but my doctors say that a repeat surgery of l5/S1 would be very difficult and may worsen condition . In ...

Place a hay inside your fist. Today press. Notice that is youll not much has the capacity to move across the hay. This can be, primarily, when you yourself have a nerve whats occurring within your back. Your back or nerves (the hay) are now being crammed due to the impinging by bone/and-or disc material.. Decompression is actually a surgical treatment to alleviate strain and alleviate discomfort caused by this impingement. A tiny portion of the bone over the nerve root, named disc content or lamina from underneath the nerve root is removed to provide the nerve house.. You can find 3 common types of spinal decompression treatments, which can be carried out using minimally invasive techniques:. Laminotomy/ - that is foraminotomy Shaving off area of the lamina to make a greater starting to alleviate the pinched ...

TYPES OF BACK SURGERY: Typically, people with back pain or spinal conditions resort to surgery when many other treatments have failed. Each type of back surgery comes with its own risks and benefits. Spinal fusion is the most common back surgery; the vertebrae are joined together, limiting motion between the bones of the spine, as well as the stretching of nerves. In a laminectomy, bone spurs (or ligaments) are removed alleviating pressure on spinal nerves. A foraminotomy procedure is one in which the surgeon cuts away bone at the sides of the vertebrae to widen the space where the nerve roots exit the spine, thereby relieving pressure on the nerves. When a patient has a bulging or slipped disc, which cushions the vertebrae, a surgeon will perform a discectomy to remove all parts of the disk. In a disc replacement surgery, a damaged disc is removed and replaced with an artificial disc, permitting continued motion of the spine. In an interlaminar implant surgery, a U-shaped device is placed ...

4 Claimant is presently 50 years old. 5 On October 5, 1984, while employed at the aluminum plant in Columbia Falls, Montana, claimant injured his low back and was found to have an L5-S1 disc bulge with left S1 radiculopathy. (Uncontested Fact 1; (February 10, 2000 report of Dr. John V. Stephens.)) Nearly a year later, he underwent a hemilaminectomy, facetectomy, and foraminotomy at L5-S1, with discectomy at L5-S1 and interbody fusion at L5-S1, posterolateral fusion at L4-S1. (Dr. Stephens Report.) 6 At the time of the claimants industrial injury, ARCO operated the aluminum plant and was self insured. (See Uncontested Fact 2.) It accepted liability for the claim. It has determined that claimant is permanently totally disabled and is paying him permanent total disability benefits. (See Uncontested Fact 3.) 7 Claimant continues to suffer constant pain in his back and leg. The degree of his pain is reflected by the fact that he takes multiple medications on a regular basis, including a narcotic ...

Microdiscectomy (minimally invasive spine procedure) - This is an operation on the lumbar spine that is performed using a very small incision and removes only the portion of the ruptured disc that is pinching the spinal nerve causing pain.The surgery is performed under operating microscope.. Decompressive Laminectomy with or without fusion and/or instrumentation - This surgery is done to treat spinal stenosis and relieve pressure on the spinal cord or spinal nerves. Laminectomy removes bone and/or thickened tissue that is narrowing the spinal canal and squeezing the spinal cord and nerves. Sometime along with it foraminotomy is performed to relieve the pressure on exiting nerve root. This procedure is done by surgically cutting into the back.. Posterior and Anterior Lumbar Interbody Fusion - In this procedure, the surgeon joins (fuses) two lumbar vertebrae. This helps stabilize the vertebrae in this part of the spine.. Pain ...

An Iraqi patient came with intermittent claudication and inability to walk more than 100 meter of stand for 5 min with bilateral drop feet for several months. MRI done (bad quality) showing complete stenosis at L4-5. The patient underwent complete laminectomy L4 with bilateral L5 foraminotomy. Despite the roots were free, but remained stretched over the moderately bulge and mobile disc L4-5. Considering these facts, discectomy L4-5 with bilateral cleaning was done to achieve total decompression of the L5 roots ...

Diagnoses:. Acquired Spondylolisthesis; Right L5 Radicular Syndrome of lower legs (with subtle right foot drop); Lumbar Foraminal Stenosis; Polyneuropathy; Hip Pain; Leg Pain; Lower Back pain; History of L4-L5 hardware removal, instrumentation and fusion on July 29th 2013; History of L4-L5 fusion Summary:. The client was referred to Case Management on February 2013. He had an EMG showing evidence of right L4-L5 radiculopathy with both acute and chronic features with a subtle right foot drop. Surgery was initially scheduled for March 2013, but had been delayed for further evaluation after inconsistent findings. The client was not comfortable with undergoing surgery if there is a possibility that symptoms would not be resolved. The client was unable to carry out activities of daily living without being in significant pain, and could no longer drive his car due to pain; he was not working. In July 2013, it was determined the client would undergo bilateral foraminotomy, fusion and decompression. The ...

In July of 2009 YOSHIKI was diagnosed with cervical foraminal stenosis and had both a cervical laminectomy and a cervical foraminotomy performed. Over the past six month, his condition has worsened, and he has been experiencing numbness in his hands and arms. After detailed examination, he was diagnosed with radiculopay of his left arm and cervical disc herniation. It was decided he would undergo surgery as his doctor had determined that he would have no hope for recovery should his condition continue to worsen ...

Indicated for post-operative stabilization following spinal fusion, laminectomy/ laminotomy, foraminotomy, laproscopic disc replacement, IDET procedures, and multi-level decompression; burst fracture and facet syndrome; and chronic and mechanical low back pain ...

Foraminotomy is an operation that cleans out or enlarges the bony gap (foramen) where by a nerve root exits the spinal canal. Bulging discs or joints thickened with age can cause narrowing of the House by which the spinal nerve exits and might push about the nerve, leading to pain, numbness, and weak point in an arm or leg ...

Microforaminotomy is a type of minimally invasive spine surgery that helps relieve pressure on your spinal cord or nerve roots. Smaller incisions and a faster recovery may make this procedure more attractive than open foraminotomy.

A traditional spine surgery could require a patient to remain in the hospital for a long time. Healing may not occur for up to one-year post operation. Weeks and even months decrease recovery period when minimally invasive surgery is performed. A patients stay in the hospital can also be shorter. There are certain standards to be fulfilled in order to be considered a great candidate for minimally invasive spinal surgery. Some procedures unfortunately require fixed methods to be carried out such as bone grafts or when metal rods need to be installed within the back. Ideal candidate for minimally invasive surgery are those suffering from degenerative disc disease, scoliosis, spinal tumors, and compression fracture. A patient and their surgeon will decide whether a conventional or minimally invasive procedure is perfect for them. Endoscopic spine operations include laminectomies, discectomies, cervical foraminotomy, lumbar interbody fusion, and the placement of pedicle screws. Again, their doctor ...

A traditional spine surgery could require a patient to remain in the hospital for a long time. Complete healing may not happen for up to one-year of operation. Weeks and even months decrease recovery period when minimally invasive surgery is performed. A patients stay in the hospital can also be shorter. There are certain standards to be fulfilled in order to be considered a great candidate for minimally invasive spinal surgery. Some procedures unfortunately require traditional methods to be performed like bone grafts or when metal rods need to be installed within the back. Ideal candidate for minimally invasive surgery are those suffering from degenerative disc disease, scoliosis, spinal tumors, and compression fracture. A patient and their surgeon will decide whether a conventional or minimally invasive procedure is perfect for them. Endoscopic spine operations include laminectomies, discectomies, cervical foraminotomy, lumbar interbody fusion, and the placement of pedicle screws. Again, ...

Dr. Tommy Tomizawa, M.D., adds It was decided upon consultation that he will undergo emergency surgery as the condition of his neck at present will interfere not only with his career as an artist, but also with everyday life. From viewing the results of the MRI and CT scans, the damage is so severe that it is apparent that he has experienced considerable pain while performing. As this would be his second such procedure, we eliminated the option of a cervical foraminotomy, an operation in which a portion of bone is removed. Yoshikis symptoms reappeared at the Visual Japan Summit festival, which was held last October in Japan. By the time he performed in January of this year at New Yorks Carnegie Hall, he had already lost the sensation in his left hand. The symptoms worsened this March following the U.K. Wembley performance, but he continued recording. Even in his condition at that state, Yoshiki stated that he wanted to see things through to the end. However, due to the worsening of his ...

Trans-foraminal Endoscopic Discectomy (TFED) is a minimally invasive spine surgery technique. Trans-foraminal Endoscopic Discectomy (TFED) Treatment CLinic in mumbai.

Endoscopic Spine Surgery Endoscopic Discectomy Endoscopic Facet Rhizotomy Endoscopic Foraminotomy Endoscopic Spine Surgery Back Pain Management Acupuncture Chiropractic Treatment Epidural Steroid Injections Massage Therapy Pain Management Treatments Physical Therapy Radiofrequency Nerve Ablation Spinal Cord Stimulator Diagnostic Procedures Branch Nerve Blocks

There is normally a little extra space around the spinal cord and spinal nerves, but if enough of the disc is pushed out of place, then these structures may be compressed.. Disc herniation is could be a direct result of an accident, fall, or repetitive strain. Most common symptoms include: leg pain, muscle weakness, and tingling sensations in the abdominal region.. MRI scans (special x-ray) usually identify most cases of disc herniation. To alleviate pain caused by disc herniation, your Tower Orthopaedics specialist may suggest endoscopic surgery. Your doctor may relieve the nerve compression by removing the intervertebral disc (called a disectomy). Also pressure on the nerve can be relieved by trimming or removing the roof, or lamina, of the vertebra to create more space for the nerve (called laminectomy).. The Endoscopic discectomy procedure is performed under a local anesthesia. During this procedure a small, specially-designed, endoscopic probe is inserted through the skin of the back ...

Endoscopic discectomy, a common type of endoscopic spinal surgery, is a minimally invasive surgical procedure used to remove herniated disc material…

Selective Endoscopic Discectomy s a minimally invasive spine surgery technique that utilizes an endoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain.

Dr Anuj Patel in Hiram, Marietta and Atlanta, GA offers lumbar endoscopic discectomy, a minimally invasive procedure to treat herniated or ruptured disc.

Intralaminar lumbar endoscopic discectomy is performed through a small tube placed through a small skin incision in the lower back.

Two operations can be employed to decompress a trapped nerve in the neck, ngteriro cervical discectomy with fusion or disc replacement and posterior cervical foraminotomy The most common is an anterior cervical discectomy. This involves, under general anaesthetic, a horizontal incision in the front of the neck after which the surgeon approaches the front of the cervical vertebra. Although passing some important structures such as the carotid artery, jugular vein, oesophagus and trachea, the approach is relatively simple and follows natural tissue planes without needing to damage muscles. Once arriving at the front of the cervical vertebra, the surgeon ensures the correct level with an intra-operative x-ray. With an anterior cervical discectomy, almost the entire disc is removed allowing the surgeon to pass through to the back of the vertebra where the nerve root lies. In the case of brachialgia due to a disc prolapse, the lump of disc which has herniated out can be removed. In the case of ...

Dr Charles Hogan performs spinal surgery, spinal laminectomy, anterior spinal fusion, foraminotomy and nucleoplasty in OKC and Tulsa in Oklahoma.

Degenerative scoliosis surgery, Chiari malformation surgery, Spinal cord stimulator insertion, Pseudoarthrosis procedur...e, Revision spinal surgery, Diskectomy, Minimally invasive surgery, Laminectomy, Spinal fusion, Foraminotomy, Degenerative scoliosis, Lumbar radiculopathy, Discogenic back pain, Cervical myelopathy, Failed back syndrome, Pseudarthrosis, Kyphosis, Cervical spondylosis, Lumbar spinal stenosis, Cervical kyphosis, Scoliosis, Degenerative disk disease, Chiari malformation. ...

Glossary items beginning with F (5).. Facet - A posterior structure of a vertebra which articulates with a facet of an adjacent vertebra to form a facet joint that allows motion in the spinal column. Each vertebra has two superior and two inferior facets. This is frequently where arthritic spurs can cause compression of nerve roots or canal stenosis.. Flatback Syndrome/Fixed Sagittal Imbalance Syndrome - Forward posture usually due to a flattened lumbar spine from postoperative or degenerative changes. When viewed from the side, the patients head may be several centimeters in front of their hips.. Foramen - An opening allowing for the emerging of spinal nerve roots between two vertebrae.. Foraminotomy - A procedure carried out in conjunction with disc surgery. The foramen (openings for the individual nerve roots to pass from the spine) may become narrowed because of disc impingement, intervertebral collapse, and spondylolisthesis. The surgical widening of the foramen is an attempt to relieve ...

A doctor gynecologist for 5 days progressed severe LBP with left sciatica came to the hospital with MRI lumbar spine showing huge PLD L4-5 left side. On examination, SLRS was positive in the right leg, shooting to the left and 10 degrees in the left. Severe weakness of dorsiflexion left foot with hypalgesia of the S1 territory left side. She was in agonizing pain and she was operated 3 hours after admission. A 15 mm incision was done after image-intensifier control. Fenestration after drilling the medial aspect of the left L4-5 facet before violating the ligamentum flavum was done and foraminotomy of left L5 root was performed. The root was severely compressed, for what the hard fragments were pulled down to the disc space and removed. Prompt postoperative recovery off her sciatica and immediate normalization of the power ...

This minimally-invasive procedure is performed through a small tubular device. It is designed to relieve pain caused by herniated discs pressing on nerve roots. The surgery is performed under local or epidural anesthesia, allowing the patient to leave the hospital the same day.

This minimally invasive laser spine surgery treats herniated, extruded, degenerative, or protruded discs in the anterior cervical area of the spine, or the front of the neck.. It is usually is performed under local anesthesia (sometimes under general) and makes use of specially designed micro-instruments, a discectome (a hollow probe containing a knife for cutting) and a laser probe that are inserted into the disc space through a small incision and under x-ray guidance. The micro-instruments allow the surgeon a much more precise view of what is causing the issues with the herniated or degenerative disc. Although there is the small cut being made, most of the muscle and tissue around the disc is being dilated instead of being cut. This means that the patient will most likely be able to leave the hospital the same day they came in, and the surgery usually takes less than 30 minutes to perform. During the procedure, small pieces of the disc are removed with the discectome. The laser is used to ...

Patients with previous diagnosis of non-ischemic dilated cardiomyopathy. were included. Bone-marrow was collected from in the antero-superior iliac crest and mononuclear stem-cells were isolated by centrifugation in the density rate Ficoll-Hypaque 1.077 media. Surgical technique - The approach was through a left mini-thoracotomy. Twenty small injections of cellular suspension were directly made through a 21F butterfly needle(total=5 ml), in the anterior, lateral, posterior and apical faces of the left ventricle(average 9.6 ± 2.6 x 107 cells). After the procedure, the patients were kept in the post-operative intensive care unit for a minimum period of 24 hours. They were released from the hospital in a period that varied from five to seven days ...

An endoscopic discectomy treatment will be required to prevent the activity, usually done through combination. Benefits of non-invasive surgery treatment include smaller cuts, quicker restoration times, and less discomfort.