The Regenerative Spine and Joint Institute (RSJI) Approach

We offer the most advanced, personalized, precision and science based regenerative medicine interventions, for the treatment of spine 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 Disc Index (a proprietary classification of the disc state of degeneration). The above evaluation system was developed after treating patients with disc related problems for over 25 years and performing bio-cellular interventions, for the last 10 years.

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 disc conditions.

B.E.T.R BIO-STEM DISC

  • What is the B.E.T.R Bio-Stem Disc?

    B.E.T.R Bio-Stem Disc is an advanced, proprietary biologic tissue engineering system designed to enhance the process of disc repair and regeneration. The type of repair recommended will be based on the pre-operative evaluation of the Degenerative Disc Index and Patient Regenerative Index

    B.E.T.R Bio Disc

    Is used initially to treat patients with symptomatic DDD who are having mild to moderate symptoms and have minimal degenerative changes in the disc. It consists of injecting a combination of substances called Biologic Stimulants into the disc. It contains 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 disc disease and herniated discs.

    See Biologic Stimulant Therapies

    B.E.T.R Stem Disc

    This system was designed for patients who have failed the above interventions or have moderate to advanced symptomatic DDD. It consists of using proprietary tissue engineering techniques in the Intervertebral Disc 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 symptomatic DDD and herniated discs.

    See Bio-Cellular Grafts Therapies

    Who is a candidate for Bio-Stem Disc therapy?

    Patients with painful degenerative disc disease or herniated discs, who have failed conservative therapy and or surgical procedures. The best candidates have early to moderated-advanced changes, small to moderate disc herniation and no significant central spinal canal stenosis. The procedure is not recommended in patients with complete disc collapse or large herniated disc compressing the spinal canal.

    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 fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied.

    According to the type of biologic graft or technique used, adipose tissue or bone marrow concentrate is used to obtain mesenchymal stem cells and growth factors.

    Next, the skin overlying the respective discs 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 discs. Under fluoroscopic guidance (X-ray machine), a special needle is inserted into the respective disc. You may feel temporary discomfort during this time. Once the needle(s) are in the proper position, a small amount of contrast will be injected into the disc to verify proper location. Afterwards, the specific tissue graft or biologic 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 require stronger pain medications when advanced grafting has been performed.

DISCOGRAPHY

  • What Are Intervertebral Discs?

    The discs are gel like pads that separate the vertebral bodies of your spine. If provides stability, range of motion and most importantly, they act as shock absorbers. Certain conditions can create changes in the internal structure of the disc creating a painful condition. The source of the pain can be the disc itself, ligaments surrounding the spinal canal or nerves (being irritated by a herniated disc or a tear on the disc). Pain can be referred to your arms, legs, and neck and back, hips, abdomen and chest wall. Other structures such as muscles, joints and ligaments in your spine, along with internal organs, can produce similar symptoms.

    What Is Discography ?

    Sometimes, in spite of diagnostic tests such as MRI, CT Scan and Myelogram, the source of the pain remains unknown. Discography is a minimally invasive test, designed to confirm whether the intervertebral disc is the source of the pain. Studies have demonstrated that the presence or absence of a herniated or degenerative disc, do not correlate with pain in a significant number of patients. In these specific situations, discography is useful not only in identifying the source of pain, but it will help the surgeon or interventional pain medicine specialist plan the correct treatment.

    The information obtained during discography is used to plan the specific tissue engineering technique require to enhance the disc ability to repair itself. Is an essential tool in planning regenerative medicine interventions.

    The Procedure

    The procedure can be performed as an outpatient, in the office, hospital or out patient surgical facility. Usually the procedure is performed under local anesthetic with intravenous sedation, 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 fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied.

    Next, the skin overlying the respective discs will be cleansed with special solutions, sterilizing the local. Then a solution of local anesthetic (numbing medication) is infiltrated in the skin and deeper tissues overlying the discs. Under fluoroscopic guidance (X-ray machine), a special needle is inserted into the respective disc. You may feel temporary discomfort during this time. Once the needle(s) are in the proper position, a small amount of contrast will be injected into the disc. Your doctor will ask you to describe what you feel as the dye is being injected. During this time, you will communicate as accurately as possible, your experience. If discomfort is reproduced at the usual location, your physician will then ask you to describe the intensity, in a scale from 1-10. The procedure usually takes around 20-30 minutes, according to the number of discs being evaluated.

    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.

DIAGNOSTIC AND THERAPEUTIC NERVE INJECITONS

  • What Is a Diagnostic Nerve Injection?

     

     

    It is a procedure in which a specific nerve in your spine (Lumbar, Cervical, Thoracic), is injected with a solution of local anesthetic and sometimes steroids (anti-inflammatory medications), for the purpose of accurately diagnosing and treating the source of your pain. Besides the spine, there are other nerves such as the: occipital nerve (base of the neck), ilio-inguinal nerve (groin), median nerve (wrist), intercostal nerve (under the rib) which can be injected.

    When Is a Diagnostic Nerve Injection indicated?

    There are times in which the source of the pain has not been clearly identified or the treatment of a specific condition, has not responded to conservative treatment or surgery. Since pain cannot be imaged (pain is a molecular level reaction in a nerve), modern technology such as MRI, CT Scan and others, frequently fails to identify the source of the pain. By injecting the nerve and observing the clinical response, we are able to detect the specific source of the pain.

    What Are Some Common Pain Syndromes in Which a Diagnostic Nerve Block Can Be Helpful?

    Patients with the following conditions usually benefit from diagnostic nerve injections: post spine surgery pain, failure to obtain relief from epidural injections, patients with multiple levels of spine degeneration, non specific pain symptoms, etc.

    The Procedure

    Usually the procedure is performed under local anesthetic alone. Some patients that are apprehensive may benefit from intravenous sedation. This decision will be made based on individual preference and medical necessity. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. The specific nerve area will be scrub and cleansed in a sterile fashion. When necessary, an X-ray machine which provides constant imaging (called fluoroscopy) will be used. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with mild and brief stinging sensations. Once the area is numb, your doctor will insert a very small needle into the appropriate nerve area. A small amount of contrast ( X-ray dye) will be injected to confirm proper needle placement. Following this, a solution of local anesthetic and steroid will be injected around the nerve. The patient response is observed prior to discharge and a pain graphic is given to tract the response for the first 4 hours. If most of the pain is resolved during this time, the injection is confirmatory and diagnostic. If no significant improvement is noted, the structure injected is not the source of the pain or the pain is localized in the central nervous system.

    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 response. If no sedation was used, according to your specific condition, you may proceed to the post procedure observation area. When indicated, you will be given a post procedure evaluation form to assess the effectiveness of the injections. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for follow up and to determine if a repeat injection may be necessary. Frequently, according to your specific response, more injections may be indicated. Restrictions after the injection will be based on specific needs and medical necessity.

    What treatments are available if the results are positive and diagnostic for a specific nerve?

    If the steroid response is short lasting or has failed in two occasions, it usually means that there is some degree of nerve damage. In this case we recommend treatments that are designed to repair and regenerate the nerve. For more information see Bio-Cellular Regenerative Interventions.

    For more information see Bio-Cellular Regenerative Therapies.

EPIDURAL INJECTIONS

  • What Is the Epidural Space?

    It is the space between the spinal sac membrane called the dura (which contains the spinal cord, nerves and fluid) and the epidural ligament, better known as the ligamentum flavum. It contains fatty tissue, blood vessels and it surrounds the nerves, as they exit the spinal column. The epidural space starts at the base of the neck and ends in the sacral canal.

    What Is an Epidural Steroid Injection?

     

    It is a procedure in which a specific steroid (which is a potent anti inflammatory medication) is injected in the epidural space in order to decrease inflammation around the nerves and discs, located in the cervical, thoracic and lumbo-sacral area. By reducing the inflammation, it allows the nerve to recover from the injury. The duration of pain relief will vary according to the specific condition being treated. The relief can be permanent or can last from days to months.

    What Are the Indications and conditions that can benefit with an Epidural Steroid Injection (ESI)?

    ESI are mainly indicated when other conservative methods such as chiropractic care, acupuncture, physical therapy, medications and other non-interventional treatments have failed .There are many conditions, which can potentially benefit from an ESI, the most frequent indication is nerve pain cause by either disc compression or bony canal irritation. This condition is known as radiculitis or radiculopathy. It is usually associated with arm, neck, back or leg pain (commonly referred to as sciatica). Other conditions such as spinal stenosis, low back pain from a herniated disc and other less frequent conditions such as shingles, may respond to epidural steroid injections.

    How is the procedure performed?

    Usually the procedure is performed under local anesthetic alone, in either our office or in an outpatient surgical facility. Some patients that are apprehensive may benefit from intravenous sedation. This decision will be made based on individual preference and medical necessity. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. Next, your neck, upper or lower back area will be scrub and cleansed in a sterile fashion. With the aid of an X-ray machine, which provides constant imaging (called fluoroscopy) the specific area to be injected, will be identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with mild and brief stinging sensations. Once the area is numb, your doctor will insert an epidural needle into the appropriate epidural space under x-ray guidance. A small amount of contrast (X-ray dye) will be injected to confirm proper needle placement. Following this, a solution of local anesthetic and steroid will be injected in the epidural space.

    How many injections are usually needed?

    In the past, the standard protocol was to perform a series of three injections two weeks apart. This is no longer recommended or necessary. The number of injections is determined by the clinical response. We usually repeat the injection in two weeks if the patient did not achieved the desired amount of pain relief. If after the second injection there is no significant pain relief, is mainly due to nerve damage and not inflammation. Since steroids do not have the ability to regenerate tissue, in this cases when recommend Epidural Bio-Cellular Regenerative Interventions

    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. If no sedation was used, according to your specific condition, you may proceed to the post procedure observation area. When indicated, you will be given a post procedure evaluation form to assess the effectiveness of the injections. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for follow up and to determine if a repeat injection may be necessary. Frequently, according to your specific response, more injections may be indicated. It is not advisable that you drive the day of the procedure.

    For more information see Bio-Cellular Regenerative Therapies.

B.E.T.R BIO STEM SPINAL NERVE

  • What is the B.E.T.R Bio-Stem Nerve?

    Is an advanced, proprietary biologic tissue engineering system designed to enhance the process of spinal nerves 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 spinal 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 spinal nerve conditions.
    See: Bio-Cellular Regenerative Therapies.

    B.E.T.R Stem Nerve

    This system was designed for patients who have failed the above interventions, spine surgery or have moderate to advanced symptomatic spinal nerve pain or damage. It consists of using proprietary tissue engineering techniques injecting the spinal 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 spinal nerve damage.
    See Bio-Cellular Grafts Therapies

    Who is a candidate for Bio-Stem Nerve therapy?

    Patients with painful degenerative, post surgical or traumatic spinal nervelesions who have failed conservative therapy and or surgical procedures.

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

    Almost any isolated spinal nerve (outside the spine) with injury or painful degeneration can be treated. Common conditions such as Sciatica (pinched nerve in the low back) , Cervical radiculitis (pinched nerve in the neck), Thoracic radiculitis (pinched nerve in the chest area), Post Laminectomy/Fusion (Neck and Low back), others.

    How is the procedure performed?

    The procedure is performed in our state of the art facility. Local anesthesiawith intravenous sedation is utilized, in order to facilitate relaxation and assist in comfort. Also an intravenous antibiotic will be administered prior to the procedure ( depending on the specific biologic treatment). 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 fluoroscopic ( live X ray)or sonographic (Ultrasound) guidance a special needle is inserted around the peripheral spinal nerves. 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 pain medications.

    For more information see Bio-Cellular Regenerative Therapies.

SACROILIAC JOINT INJECTION

  • What Is the Sacroiliac Joint?

     

     

    The sacroiliac joint (SIJ) is a large joint in the region of the low back are and buttock. It connects the pelvis with the spine (sacrum). It acts as a shock absorber from forces transmitted from the upper body to the legs. As a joint, it has limited motion.

    What causes Sacroiliac Joint pain?

    A better term is (Sacroiliac Joint Complex) pain, since most of the time, the source of the pain is in the surrounding ligaments (ilio-lumbar, sacroiliac, sacro-tuberous, etc). Ligament pain is usually seen in the following conditions: post partum, post traumatic, ligament laxity associated with degenerative processes, post-spine surgery, poor bio-mechanics lower extremity, strain, others.

    There are times when the pain comes mainly from the joint such as: degenerative arthritis, rheumatoid arthritis, ankylosin spondylosis, septic arthritis, traumatic arthritis, others.

    What Is a Sacroiliac Joint Injection?

    It is a procedure in which a local anesthetic (numbing medication) and a steroid (long acting anti inflammatory) is injected in the SIJ and surrounding ligaments .

    What Are the Indications for Sacroiliac Joint Injections?

    There are two main indications for Sacroiliac Joint Injections.

    Diagnostic: In a significant number of patient with persistent buttock, low back and leg pain, in which an accurate diagnosis have not been obtained, a SIJ injection can determine or exclude the source of pain. With this information, a more specific and accurate treatment can be prescribed.

    Therapeutic: Utilized when the patients have failed other non interventional treatments such as: physical therapy, chiropractic, bio-mechanical, acupuncture, medications, etc.

    The Procedure

    Usually the procedure is performed under local anesthetic alone. Some patients that are apprehensive may benefit from intravenous sedation. This decision will be made based on individual preference and medical necessity. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the procedure bed lying on your stomach. Blood pressure and cardiac monitors will be applied.

    Next, your sacroiliac area will be scrub and cleansed in a sterile fashion. With the aid of Sonography (ultrasound) which provides constant (Non radiation) imaging), the specific area to be injected will be identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with a mild and brief stinging sensation. Once the area is numb, your doctor will insert a small needle into the appropriate sacroiliac joint, under sonographic guidance. A solution of local anesthetic and steroid (long acting anti-inflammatory) will be injected in the joint.

    The local anesthetic provides the diagnostic information,. If the patient reports immediate pain relief lasting from 1- 4hours, the source of the pain is confirmed as coming from the sacroiliac joint complex. If no significant pain relief is present during this time, the source of the pain is not the SIJ. The steroid injection will provide pain relief for a short time in patients with significant inflammation. Steroid injections are frequently effective only in early cases or when the source of the pain is mainly inflammatory.

    What is the Next Step if the Steroid Injection Does Not Work

    With steroids injections, the duration of the pain relief is usually short term. We limit the use of steroids in joint to only one injection, since the steroids can be associated with significant side effects and have no regenerative value.

    The most effective therapies are designed to restore the SIJ ligament complex strength and function, and decrease the degenerative and inflammatory changes in the joint. This can only be achieved with interventions such as Prolotherapy and Bio-Cellular Regenerative Interventions.

    For more information see Bio-Cellular Regenerative Therapies.

FACET JOINT INJECTIONS

Lumbar, Thoracic, and Cervical


What Are the Facets Joints?

Facet joints are small joints the size of your thumb nail, located in pairs from the cervical spine, thoracic spine, and lumbar spine. These structures interlock with the vertebra above and below, and provide stability and motion (rotation, flexion and extension) for the entire spine. Multiple conditions such as trauma, degeneration and post-surgical changes can create significant inflammation in these joints. When this occurs, it can produce neck, upper and lower back, and buttock pain; it can even sometimes extend to the arm and legs.

What Are the Indications for Facet Joint Injections?

There are two main reasons to perform facet joint injections: diagnostic and therapeutic. The diagnosis of low back and neck pain can sometimes be challenging and inconclusive. Even with advance diagnostic imaging (such as CT Scan, MRI, X-Ray) and conventional tests (EMG, Nerve Conduction Studies) and a comprehensive physical examination, sometimes the source of the pain remains unknown. In this situation, facet joint injections prove to be an essential component in diagnosing and providing a more effective treatment. Second, by injecting an anti-inflammatory medication (steroids) in the joint, significant pain reduction can be achieved, facilitating physical therapy and chiropractic care. This is ultimately leads to restoring function and improving range of motion.

The Procedure

Usually the procedure is performed under local anesthetic alone, in the office or an outpatient surgical facility. Some patients that are apprehensive may benefit from intravenous sedation. This decision will be made based on individual preference and medical necessity. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. Next, your neck, upper or lower back area will be scrub and cleansed in a sterile fashion. With the aid of an X-ray machine, which provides constant imaging (called fluoroscopy), the specific area to be injected will be identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with mild and brief stinging sensations. Once the area is numb, your doctor will insert a small needle into the appropriate facet joint, under x-ray guidance. A small amount of contrast ( X-ray dye) will be injected to confirm proper needle placement. Following this, a solution of local anesthetic and steroid (long acting anti-inflammatory) will be injected in the joint.

How Many Injections are Usually Needed?

The number of injections is determined by the clinical response. We usually repeat the injection in two weeks if the patient did not achieve the desired amount of pain relief. If after the second injection, there is no significant pain relief, this response is mainly due to significant degenerative changes in the joint. Since steroids do not have the ability to regenerate tissue, in this cases there are two treatment pathways that can be followed: perform a lumbar facet nerve Rhizotomy (a procedure which creates a heat induced lesion in the nerve) and can potentially achieve good pain relief for up to 6 months. However, it does not stimulate healing in the facets joints. The second procedure which we recommend is Bio-Cellular Regenerative Interventions. Frequently, this tends to be the most successful intervention because it stimulates tissue healing and repair in the facet joints. Frequently we combine both Rhizotomy and Regenerative Bio-Cellular Injections.

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. If no sedation was used, according to your specific condition, you may proceed to the post procedure observation area. Immediately after the procedure, you will be evaluated to assess for specific response. A post procedure evaluation form to assess the effectiveness of the injections will be given to the patient prior to discharge. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for follow up and to determine if a repeat injection may be necessary. Frequently, according to your specific response, more injections may be indicated. It is not advisable that you drive the day of the procedure.

For more information see Bio-Cellular Regenerative Therapies.

RADIOFREQUENCY THERMAL COAGULATION

What Is a Rhizotomy?

A procedure in which a radio frequency device is attached to a special needle in order to coagulate the median branch nerve of the facets (Cervical, Lumbar, Thoracic), and other sensory branches of peripheral nerves. The lesion is created, by heating the nerve to 80°C for approximately 80-90 seconds. This technology is similar to the microwave oven, in which radio waves create vibration in the foodcells ultimately heating the cells.

Who Is a Candidate for a Rhizotomy?

Patients experiencing facet pain previously diagnosed by facet injections, resulting in excellent, but short lasting relief. The purpose of the median branch rhizotomy is to create long lasting relief, so that improve function and rehabilitation can be accomplished.

The Procedure

The procedure is usually performed in the office or outpatient surgical facility. Usually the procedure is performed under local anesthetic with intravenous sedation, in order to facilitate relaxation and assist in comfort. This decision will be made based on individual preference and medical necessity. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied.

Next, the skin overlying the facets area is cleansed with a sterile solution. Then a solution of local anesthetic (numbing medication) is infiltrated in the skin and deeper tissues overlying the respective facet joints median nerve. Under fluoroscopic guidance (X-ray machine), a special needle is inserted in the facet nerve and coagulated with the radio frequency device. The procedure usually takes 30 minutes and is frequently combined with Bio-Cellular Regenerative Interventions.

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. If no sedation was used, according to your specific condition, you may proceed to the post procedure observation area. Immediately after the procedure, you will be evaluated to assess for specific response. Post procedure instructions will be given in a pre-printed form. It can take as long as three weeks before the full benefit from the Rhizotomy can be noticed. It is not advisable that you drive the day of the procedure.

PERCUTANEOUS DISC DECOMPRESSION

 

What is a Percutaneous Disc Decompression?

A minimally invasive procedure developed to treat patients with contained or small disc herniation, causing persistent leg or arm pain. Disc decompression is a removal of a specific amount of the nucleus, which is the gel-like substance in the center of the disc, in order to decrease the pressure and reduce the herniation. The procedure is performed under X-ray guidance, inserting a special needle through the skin and into the nucleus. With a special device (spine wand) a portion of the nucleus is mechanically removed through a small incision. The end result is a decrease in the size of the herniated disc, relieving the pressure on the nerve or ligaments of the spine. Once the spine wand is removed, the small opening in the disc seals by itself.

Who Is a Candidate for Disc Decompression?

Percutaneous disc decompression is reserved for patients with mainly persistent leg pain due to a small and contained disc herniation not responding to conservative therapy such as: medications, chiropractic care, physical therapy and injections. These patients do not have significant neurological deficits (leg weakness or inability to control their bowel or bladder functions). This is considered a minimally-invasive procedure, and performed as an outpatient. Multiple discs can be treated during the same procedure. Recently, patients with low back pain and contained disc herniation have been treated successfully with disc decompression.

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 in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. Next, your upper or lower back area will be scrub and cleansed in a sterile fashion. With the aid of an X-ray guidance, which provides constant imaging (called fluoroscopy), the inter- vertebral discs are identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with mild and brief stinging sensations. Once the area is numb, your doctor will insert a special device into the appropriate disc nucleus, under x-ray guidance. A small amount of contrast (X-ray dye) will be injected to confirm proper needle placement. Then, part of the nucleus is removed by using the Dekompressor device, which actually removes one to two cc of nucleus material. The procedure usually takes about 20 minutes and is associated with minimum post – operative discomfort. This procedure is frequently combined with Bio-Cellular Regenerative Interventions in order to enhance the disc ability to repair the annulus and nucleus cells.

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 for the post -operative period which may include an antibiotic, a muscle relaxant and an analgesic/anti-inflammatory. The post procedure discomfort is usually minor and can be manage with ice packs and and medications. Specific instructions are given to the patient for the post operative period.

For more information see Bio-Cellular Regenerative Therapies.

INTRADISCAL ELECTROTHERAMAL THERAPY

What Is an IDET?

A relatively new treatment for back pain resulting from problems within the cushioning discs is intradiscal electrothermal annuloplasty, also called IntraDiscal Electrothermal Therapy (IDET). This outpatient procedure applies high heat directly to the inside of the disc. Different mechanisms of action have been postulated to explain how the IDET works. It can destroy the small nerve endings in the posterior wall of the disc (annulus) responsible for pain transmission. The high heat can produce several changes in the protein matrix in the nucleus (gel inside the disc) decreasing the ongoing inflammatory process. Last, it can potentially help sealed the tears in the annulus (fibrous outer wall) of the disc.

Who Is a Candidate for an IDET?

Patients suffering from mainly low back pain, due to a painful disc, which failed conservative therapy including but not limited to: physical therapy, chiropractic care, medication management and injections. The diagnosis and identification of a specific disc as the source of pain is achieved by a diagnostic test called discography. If the patients symptoms are mainly low back pain, buttock, and occasionally referred leg pain. Patients must have a significant amount of disc space present (at least 50 % or original level) and no evidence of neurological deficits.

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 in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. Next, your lower back area will be scrub and cleansed in a sterile fashion. With the aid of an X-ray guidance, which provides constant imaging (called fluoroscopy), the inter- vertebral discs are identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with mild and brief stinging sensations. Once the area is numb, your doctor will insert a special needle into the appropriate disc nucleus, under x-ray guidance. A small amount of contrast (X-ray dye) will be injected to confirm proper needle placement. Then, the Electro-Thermal Catheter is inserted and positioned inside the disc in the back wall of the annulus. Proper position is confirmed by X-ray and of the posterior disc wall is performed for approximately 17 minutes, to a maximum of 90 degrees Centigrade. The procedure usually takes about 30 minutes and is associated with minimum post -operative discomfort.

This procedure is frequently combined with Bio-Cellular Regenerative Interventions in order to enhance the disc ability to repair the annulus and nucleus cells.

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, a muscle relaxant and an analgesic/anti-inflammatory. The post procedure discomfort is usually minor and can be manage with ice packs and medications.

SPINAL CORD STIMULATION

What Is Spinal Cord Stimulation?

If you or someone you care about has been living with chronic pain, spinal cord stimulation (SCS) may provide new hope. Spinal cord stimulation is a medical therapy for people who suffer from certain types of chronic neuropathic pain. SCS is not a cure for pain. The objective with this therapy is to reduce a patient’s pain to a manageable level, so the patient can return to a more normal lifestyle. Spinal cord stimulation is actually part of a broader category of therapies called neuro-stimulation, which includes peripheral nerve stimulation. Neuro-stimulation therapies are used for pain relief or symptom relief from certain types of chronic pain and neurological disorders.

Spinal cord stimulation and peripheral nerve stimulation use an implanted device—a spinal cord stimulator (sometimes called a pacemaker for pain)—to deliver low levels of electrical energy directly to nerve fibers. This direct approach to treating pain at its source can be very effective.

The type of neuro-stimulation that might be appropriate for your condition depends upon many factors, including the cause of your pain or neurologic disorder as well as its type and location.

What is Neuro-stimulation?

Neuro-stimulation is the stimulation of the spinal cord by tiny electrical impulses. An implanted lead (a flexible insulated wire), which is powered by an implanted battery or receiver, is placed near your spinal cord. This lead and an implanted neuro-stimulator send electrical impulses that block the pain messages to your brain.

Some patients describe the feeling of neuro-stimulation as “tingling.” You can also think of neuro-stimulation as the rubbing of your “funny bone” after you’ve bumped it. Rubbing masks the feeling of pain just as the tingling produced by the neuro-stimulation system masks the feeling of pain.

Who is a candidate for Spinal Cord Stimulation?

Patients with nerve related pain syndromes, which have failed surgical interventions, as well as biologic regenerative therapies. The following criteria are used to determine whether or not neurostimulation is appropriate for chronic pain sufferers:

  • More conservative therapies have failed to adequately help thepain.
  • An observable pathology exists that is associated with the pain.
  • Further traditional surgical intervention is not indicated.
  • No serious untreated drug habituation for your pain condition exists.
  • Psychological evaluation and clearance for implantation have been received
  • No medical issues exist that would present problems with doing the surgery.

Neuro-stimulation Trial

In order to have a neuro-stimulation system implanted, you must first have a successful neurostimulation trial. The trial screening procedure, or test of a short test stimulation period in the operating room and an evaluation period of several days at home. During the evaluation period, your doctor determines your response to neurostimulation and your level of pain relief. It also gives you an opportunity to experience the system and enables the doctor to assess your battery requirements.

During the trial screening, your doctor will place a lead in your back to deliver electrical stimulation to the spinal cord. The lead placement is one of the keys to successful results with a neuro-stimulation system. Your involvement is very important to proper placement, so be sure to follow your doctor’s instructions carefully.

Typically, you will receive a local anesthetic and mild sedatives to keep you comfortable during the procedure. After that, your doctor will place the lead in your back.

There are two types of neuro-stimulation trials: percutaneous and “cut-down.” For the percutaneous trial, a needle is placed in your back. Through it, the test stimulation lead is inserted into the desired area of the spine. The end of the lead that remains on the outside of your body is secured to your back with surgical tape. After the trial period concludes (usually after several days), the lead will be removed. The percutaneous test stimulation is similar to an epidural nerve block, except that the lead will be inserted and left in your back during the trial.

After the lead is placed, your doctor will connect the lead wires to an external screener that allows your nurse or doctor to adjust your stimulation.

Implant Procedure

If your neuro-stimulation trial is successful, you may be a candidate for permanent implantation of a neuro-stimulation system.

The surgical procedure to implant the neuro-stimulation system may require a brief hospital stay. Before the surgery, you and your doctor will decide where to position the neuro-stimulator for your comfort. During the surgical procedure, an incision is made over the spine so that your doctor can place the lead and connect it to the extension. The extension is tunneled under the skin and connected to the neuro-stimulator. Your doctor will then form a pocket under your skin (usually in the abdominal area) that is large enough to hold the neuro- stimulator. Once the extension is connected to the neuro-stimulator, the incisions are closed and the surgery is complete.

Fully implanted neuro-stimulation system (left) and a neuro- stimulation system with an external power source (right).

A Treatment with Real Advantages

Spinal cord stimulation has three significant advantages. First, it can be very effective in reducing chronic pain from certain conditions. Second, you can have an SCS trial before you have a permanent system implanted. An SCS trial allows you to see if the therapy will work for you. And lastly, the implanted device can be turned off permanently or removed if you don’t achieve the desired level of
relief.

KYPHOPLASTY AND VERTEBROPLASTY

What Is Kyphoplasty and Vertebroplasty?

A minimally invasive procedure utilized in the treatment of patients who suffer from painful vertebral compression fractures, not responding to conservative therapy. During a Vertebroplasty, a special bone cement is injected into the fracture vertebrae. Once the cement hardens, the fracture is stable and the pain is significantly improved.

A Kyphoplasty is a procedure designed to restore the vertebrae height by inflating a special balloon inside the fracture vertebrae, prior to injecting the bone cement. The balloon is the deflated and bone cement is injected to fill the vertebral space. Ultimately attempting to prevent the humpback deformity associated with vertebral compression fractures.

Who is Candidate for Percutaneous Kyphoplasty and Vertebroplasty?

Patients who are in significant pain and have failed conservative treatments, including strong pain medications, prolonged bed-rest, injections or external bracing.

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 in the fluoroscopy bed lying on your stomach. Blood pressure and cardiac monitors will be applied. Next, your upper or lower back area will be scrub and cleansed in a sterile fashion. With the aid of an X-ray guidance, which provides constant imaging (called fluoroscopy), the vertebral fractures are identified. The physician will then inject a small amount of local anesthetic in the skin and deeper tissues to numb the area. This may be associated with mild and brief stinging sensations. Once the area is numb, your doctor will make a small nick in the skin, then insert a special needle into the appropriate fracture vertebrae, under x-ray guidance. A biocompatible bone cement is injected through the needle into the vertebral body. The needle is then removed, and the cement allowed to hardened (usually within 10 minutes). The small skin nick is covered with a bandage. The whole procedure takes between 30 minutes to 2 hours (depending on how many vertebrae are treated).

After the Procedure

You will go back to the post anesthesia care unit, where you will be monitored for 30-60 minutes after the procedure. During this time you will resting on your back with the head up at 30 degrees for 45 minutes. This ensures the cement is fully hardened and there no excessive movement n the vertebrae. Typically, most patients resume normal activities within 24-48 hours. Some patients experience immediate pain relief after the procedure, others may take up to 48 hours. 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 for the post – operative period which may include a muscle relaxant and an analgesic/anti-inflammatory. The post procedure discomfort is usually minor and can be manage with ice packs and medications.

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What Are Trigger Points?

Trigger points are commonly defined areas of taut muscle bands or palpable knots in the muscle, which are painful. Often, these trigger points can cause localized pain or even referred pain to other areas of your body, which can mimic conditions such as a pinch nerve in your neck or back. They can occur from direct muscle injuries, poor posture, repetitive strain, or secondarily from spine conditions such as a herniated disc. Although most of the time they respond to conservative measures such as massage, muscle relaxants and physical therapy, sometimes trigger point injections are required.

What Are Trigger Point Injections?

Trigger point injections are specific types of local muscle injections use to treat the painful taut bands responsible for pain and spasm. Common medications use in trigger point injections is local anesthetics combined with different substances designed to enhance the muscles ability to heal. Common substances utilized are: glucose, testosterone, IGF-1, PRP (platelet rich plasma) and Ozone. The purpose of the injection is to decrease pain by healing the muscle and subsequently able to restore function and proper bio-mechanics.

The Procedure

The injection is performed in the examination room or the procedure suite (if you are having a different procedure). You will be examined under sonography (ultrasound imaging) and the trigger points will be identified and marked. The skin area will be sterilized with alcohol and numb with a local anesthetic. A small needle is then inserted into the specific site and a specific volume of the medication is injected. The procedure is repeated in the remaining trigger points. Trigger point injections are sometimes repeated, depending on the results and degree of improvement.

For more information see Bio-Cellular Regenerative Therapies.

TRIGGER POINT INJECTIONS

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What Are Trigger Points?

Trigger points are commonly defined areas of taut muscle bands or palpable knots in the muscle, which are painful. Often, these trigger points can cause localized pain or even referred pain to other areas of your body, which can mimic conditions such as a pinch nerve in your neck or back. They can occur from direct muscle injuries, poor posture, repetitive strain, or secondarily from spine conditions such as a herniated disc. Although most of the time they respond to conservative measures such as massage, muscle relaxants and physical therapy, sometimes trigger point injections are required.

What Are Trigger Point Injections?

Trigger point injections are specific types of local muscle injections use to treat the painful taut bands responsible for pain and spasm. Common medications use in trigger point injections is local anesthetics combined with different substances designed to enhance the muscles ability to heal. Common substances utilized are: glucose, testosterone, IGF-1, PRP (platelet rich plasma) and Ozone. The purpose of the injection is to decrease pain by healing the muscle and subsequently able to restore function and proper bio-mechanics.

The Procedure

The injection is performed in the examination room or the procedure suite (if you are having a different procedure). You will be examined under sonography (ultrasound imaging) and the trigger points will be identified and marked. The skin area will be sterilized with alcohol and numb with a local anesthetic. A small needle is then inserted into the specific site and a specific volume of the medication is injected. The procedure is repeated in the remaining trigger points. Trigger point injections are sometimes repeated, depending on the results and degree of improvement.

For more information see Bio-Cellular Regenerative Therapies.