The Regenerative Spine and Joint Institute (RSJI) Approach

We offer the most advanced, personalized, precision and science based regenerative medicine intervention, for the treatment of peripheral nerve related conditions. Our approach and treatment decisions are based on the evaluation of the Patient Regenerative Index, (a proprietary classification of your body’s ability to heal), in conjunction with the Degenerative Nerve Index (a proprietary classification of the nerve state of degeneration).

We utilize The B.E.T.R System with Bio-Cellular Therapies, which is an accurate, reproducible, comprehensive and science-based system. “B.E.T.R,” was developed based on the principles of Biologic Enhancement of Tissue Repair, which defines our ultimate treatment goal. By utilizing specific biologic tissue engineering techniques, we can successfully treat early to the advanced degenerative or traumatic peripheral nerve conditions.

Is an advanced, proprietary biologic tissue engineering system designed to enhance the process of peripheral nerve repair and regeneration. There are two main types of nerve procedures and they are named according to the specific biologic tools used.

B.E.T.R Bio Nerve

This technique is used initially to treat patients with symptomatic peripheral nerve conditions who are having mild to moderate symptoms and have minimal degenerative changes . It consists of injecting a combination of substances called Biologic Stimulants into the peripheral nerves. These stimulants, contain powerful growth factors (substances which stimulates multiple cell functions) capable of producing significant improvement in function and tissue repair. Biologic Stimulants can be highly successful and cost effective in patients with early symptomatic degenerative or traumatic peripheral nerve conditions. See Biologic Stimulant Therapies

B.E.T.R Stem Nervve

This system was designed for patients who have failed the above interventions or have moderate to advanced symptomatic degenerative or traumatic peripheral nerve conditions. It consists of using proprietary tissue engineering techniques injecting the peripheral nerves with a combination of Bio-Cellular Grafts (growth factors, biologic scaffolds and mesenchymal stem cells obtained from your own bone marrow or adipose tissue). It is considered the most advanced regenerative treatment available for patients with moderate to advanced degenerative or traumatic peripheral neuropathies . See Bio-Cellular Grafts Therapies

Who is a candidate for Bio-Stem Nerve therapy?

Patients with painful degenerative or traumatic peripheral nerve lesions who have failed conservative therapy and or surgical procedures.

What type of peripheral nerve conditions can be treated with the Bio-Stem Tendon Nerve therapy?

Almost any isolated peripheral nerve with injury or painful degeneration can be treated. However, the success rate in patients with systemic neuropathies (all over the body) is not significant. The following is an example of common neuropathies we treat.

  • Elbow: Ulnar Neuropathy, Radial Neuropathy
  • Knee: Post Surgical Neuropathy, Peroneal Nerve Neuropathy
  • Ankle: Dorsalis Pedis Neuropathy
  • Foot: Tarsal Tunnel Syndrome
  • Hip: Meralgia Paresthetica
  • Head and Neck: Occipital Neuropathy

How is the procedure performed?

The procedure is performed in our state of the art facility. Local anesthesia with intravenous sedation is utilized, in order to facilitate relaxation and assist in comfort. Also an intravenous antibiotic will be administered prior to the procedure. You will be taken to the procedure suite, place in the surgical bed lying on your stomach or back depending on the type of technique. Blood pressure and cardiac monitors will be applied.

According to the type repair, you may undergo a bone marrow aspiration (from your iliac crest) or lipoaspirate grafting (from abdominal or flank adipose tissue)in order to obtain mesenchymal mesenchymal stem cells. For patients undergoing Biologic Stimulant Therapies or Amniotic Tissue Grafts, the procedure is usually performed under local anesthesia with no need for intravenous sedation or antibiotics.

Next, the skin overlying the respective areas are will be cleansed with special sterilizing solutions. Then a solution of local anesthetic (numbing medication) is infiltrated in the skin and deeper tissues overlying the tendons or ligaments. Under sonographic guidance (ultrasonography) a special needle is inserted into the peripheral nerves. You may feel temporary discomfort during this time. Afterwards, the specific biologic tissue graft or biologic stimulant is carefully injected with a proprietary technique. The needle is then removed, bandages applied and the patient is taken to the post procedure suite.

After the procedure

You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for post procedure evaluation in approximately one week. Medications will be given post procedure to assist in managing any discomfort. The post procedure discomfort is usually minor and can be manage with ice packs and medications. However, some patients

Musculoskeletal System Image 2Musculoskeletal System Image 1

Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Ultrasound exams do not use radiation (as used in x-rays or fluoroscopy). Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels.

What is an ultrasound guided Carpal Tunnel Release?

It is a minimally invasive percutaneous procedure, which uses ultrasound guidance in order to precisely visualized anatomical landmarks during carpal tunnel release procedures. During the procedure the carpal tunnel ligament, is precisely incised and partially released in order to relieve pressure on the compressed median nerve. By utilizing ultrasound guidance, a more invasive or expensive open or endoscopic surgical released is avoided.

Who is a candidate for ultrasound guided carpal tunnel release (UGCTR)?

UGPTR is indicated in patients with carpal tunnel syndrome who have failed non-interventional conservative therapy (NDAIDS, Physical Therapy, Chiropractic Care, Splint Therapy) or injection therapy with steroids or Bio-Cellular Regenerative Therapies. We utilized this interventions in patient with early to moderate carpal tunnel syndrome, without significant muscle atrophy or severe nerve damage.

What is the advantage of an ultrasound guided carpal tunnel release (UGCTR) over the endoscopic or open release procedure?

Recent research shows that in a 2 year follow up, patients who underwent UGCTR, had less complications and better satisfaction when compared to open or endoscopic surgery.

The Procedure

Usually the procedure is performed under intravenous sedation with local anesthetic supplementation. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place on your back. Blood pressure and cardiac monitors will be applied. Next, hand and arm will be scrub and cleansed in a sterile fashion. With ultrasound guidance, local anesthetic is injected in the skin and deep tissues. Under ultrasound guidance, utilizing a small cutting needle is utilized to incise the carpal ligament in multiple areas. This creates a partial tear, which relives pressure on the median nerve. Afterwards, depending on the patient specific conditions, a lipo-aspirate graft along with growth factors (platelet rich plasma) is placed between the nerve and the ligament. This is utilized in order to enhance the healing response the damage nerve.

After the Procedure

You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for post procedure evaluation in approximately one week. Medications prescribed for the post -operative period may include: an antibiotic or opioid analgesic. The post procedure discomfort is usually minor and can be manage with ice packs and medications.