Procedures that we offer here at CSPP include:

Regenerative Medicine For Spine & Joint

Blood plasma is the liquid component of blood that makes up about half of its total volume. Blood plasma that is rich in small cell fragments called platelets can be used to treat a number of musculoskeletal conditions. Platelets circulate in the blood of all mammals, and contain many growth factors that are known to stimulate the growth and healing of both bones and soft tissues. Osteoarthritis is one of the major conditions treated by platelet-rich plasma therapy. Osteoarthritis is a form of arthritis that involves the breakdown of cartilage in the joints. Platelet-rich plasma can also be used to heal tendon and ligament problems that result in hip pain, knee pain, shoulder pain, and elbow pain. Many of these problems stem from the wear and tear caused by the repetitive motions involved in certain sports, and athletes are increasingly using platelet-rich plasma therapy to treat tennis elbow and other sports injuries. 

Compared to cortisone injections and other methods of treating osteoarthritis and tendon injuries, platelet-rich plasma therapy has a low risk of complications. Because the injections actually heal the affected areas, the relief from osteoarthritis pain can last for an extended period of time. The treatment can also provide long-term relief from hip pain, knee pain, elbow pain, foot pain, and other pain caused by inflamed connective tissue. Improvements in these conditions are typically noticeable after a few weeks, and the pain relief gradually increases as the tissue is repaired. Since the plasma is drawn from the patient’s own body, there is almost no risk of rejection from this procedure.

Stem Cells are undifferentiated cells that have ability to replace dying cells and regenerate damaged tissue. A high concentration of these cells is obtained from the patient’s own bone marrow or fat tissues (adipose) or from a purified amniotic tissue. Our practice uses a sterile closed surgical process to obtain the stem cells. Once obtained, the cells are isolated with a specialized centrifuge and then injected into the painful area on the same day using special imaging to make sure the cells are placed exactly where they are needed.

Stem cell therapy is a form of regenerative medicine that obtains high concentrations of stem cells to create an environment for the body to heal itself without the need for medications or steroid injections. A high concentration of these cells is obtained from the patient’s own bone marrow or fat tissues (adipose) or from a purified amniotic tissue. When stem cells are injected into an area of injury, they enable the body’s natural healing processes to be dramatically accelerated. The cells can stimulate the formation of many different types of tissue including cartilage, tendon, ligaments, bone and fibrous connective tissues.

Stem Cell therapy is personalized medicine, and we develop a personalized treatment plan for each patient based on his or her particular pain condition.

Bone marrow aspirate concentrate (BMAC) is a promising cutting-edge regenerative therapy to help accelerate healing in moderate to severe osteoarthritis and tendon injuries. It is made from fluid taken from bone marrow, and contains stem cells that can help the healing of some bone and joint conditions. Bone marrow aspirate concentrate is obtained with a non-surgical, minimally invasive procedure.

Stem cells can be used to help with bone healing, cartilage repair and new blood vessel growth. The most common conditions it can be used to treat are moderate to severe osteoarthritis and tendon injuries in many areas of the body, including:

  • Knee Pain
  • Hip Pain
  • Shoulder Pain
  • Elbow Pain
  • Wrist/Hand Pain
  • Ankle & Foot Pain
  • Spine Pain

Amniotic stem cells (ASCs) are collectively the mixture of stem cells that can be obtained from the amniotic fluid as well as the amniotic membrane. Amniotic fluid is the protective liquid surrounding an unborn baby, and is discarded as medical waste during caesarean section deliveries. There is increasing evidence that this fluid is a source of valuable biological material, including stem cells with the potential for use in cell therapy and regenerative medicine.

The use of amniotic fluid stem cells is therefore generally considered to lack the ethical problems associated with the use of cells from embryos.

Alpha 2 macroglobulin, also known as A2M injection therapy, is a regenerative medicine technique frequently used to treat osteoarthritis, but is showing promise in many other applications as well.

Regenerative medicine encourages the body’s natural healing properties to overcome local areas of injury or disease, pain, or slow healing.

A2M is specifically used to promote tissue growth, prevent the breakdown of cartilage, and support the overall restoration of an affected joint.

A2M is one of the largest plasma proteins found in the blood, and it binds with specific damage-causing proteins. When the body has an injured joint, the A2M naturally occurring in the body may not present itself in a high enough concentration to accelerate healing. However, when injected in higher concentration into the damaged joint, it has been shown to target the destructive enzymes.

Epidural Injections

An epidural steroid injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the back or legs. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing. Different areas treated are:

  • Caudal Epidural Steroid Injection
  • Cervical Epidural Steroid Injection
  • Transforaminal Steroid Injection
  • Selective Nerve Root Block

Spinal Injections

Medial branch nerves are the very small nerve branches that communicate pain caused by the facet joints in the spine. These nerves do not control any muscles or sensation in the arms or legs. They are located along a bony groove in the low back and neck and over a bone in the mid back. If this procedure has been suggested, there is strong evidence to suspect that the facet joints are the source of a patient’s pain. Benefit may be obtained from having these medial branch nerves blocked with an anesthetic to see if a more permanent way of blocking these nerves would provide long-term pain relief. Blocking these medial branch nerves temporarily stops the transmission of pain signals from the joints to the brain. Different treatment areas are:

  • Lumbar Facet & Medical Branch Block
  • Thoracic Facet & Medical Branch Block
  • Cervical Facet & Medical Branch Block

Sympathetic Blocks

The sympathetic nerves run on the front surface of the spinal column (not in the spinal canal with the nerves from the central nervous system). The sympathetic nerves are part of the autonomic nervous system which controls basic functions. In other words, the autonomic nervous system is responsible for controlling things people do not have to think about or have direct control concerning their function. However, there is a connection between the central and autonomic nervous systems. Sometimes arm or leg pain is caused by a malfunction of the autonomic system secondary to an injury.

A sympathetic nerve block involves injecting medicine around the sympathetic nerves in a lumbar (back) or cervical (neck) area. By doing this, the system is temporarily blocked in hopes of reducing or eliminating pain. If the initial block is successful, then additional blocks are generally repeated and repeated again until the pain diminishes. Different treatments are:

  • Lumbar Sympathetic Plexus (Ganglion) Block
  • Stellate Ganglion Blocks

The celiac/lumbar/hypogastric plexus and splanchnic nerves are groups of nerves that come together near the spine to supply the internal abdominal or pelvic organs. A block using local anesthetic can increase circulation and decrease pain. When circulation is increased, more oxygen and nourishment are brought to the area. The duration of pain relief form this local anesthetic can vary from 1-2 hours to many hours or sometimes even days. If your pain is relieved by this procedure, a series of blocks may be desired as an attempt to break the pain cycle.

The celiac/lumbar/hypogastric plexus and splanchnic nerves are groups of nerves that come together near the spine to supply the internal abdominal or pelvic organs. A block using local anesthetic can increase circulation and decrease pain. When circulation is increased, more oxygen and nourishment are brought to the area. The duration of pain relief form this local anesthetic can vary from 1-2 hours to many hours or sometimes even days. If your pain is relieved by this procedure, a series of blocks may be desired as an attempt to break the pain cycle.

The ganglion impar is a group of nerve cells located in the front of the coccyx (tail bone), and is part of the sympathetic nervous system.

A ganglion impar block is a minimally-invasive procedure developed in 1990 that is used to reduce some of the symptoms of chronic pelvic or rectal pain by blocking nerve impulses. Abnormal signaling in the nerves of the ganglion impar due to over activity can result in chronic pain. Typically, this pain is felt in the region of the perineum and may be associated with nerve, organ, or tissue damage. It is often experienced as a vague or widely-distributed burning or discomfort in this area, which is controlled by the ganglion impar.

Ganglion impar blocks inhibit pain associated with the coccyx by injecting the ganglion impar with a local anesthetic.

Neuroablation Techniques

Radiofrequency ablation is a procedure that uses an electrical current to generate heat to destroy the pain fibers to facet joints or sacroiliac joints. It can also be used to disable other small nerves in a variety of locations. It is helpful because it can provide more long term relief than blocks with local anesthetic or steroid.

Radiofrequency ablation is a procedure that uses an electrical current to generate heat to destroy the pain fibers to facet joints or sacroiliac joints. It can also be used to disable other small nerves in a variety of locations. It is helpful because it can provide more long term relief than blocks with local anesthetic or steroid.

Neurolysis is a chemical ablation technique that is used to alleviate pain, and is only used when the disease has progressed to a point where no other pain treatments are effective.

A neurolytic agent such as alcohol, phenol, or glycerol is typically injected into the nervous system, and then chemical neurolysis causes deconstructive fibrosis. That disrupts the sympathetic ganglia, which results in a reduction of pain signals being transmitted throughout the nerves. The effects generally last for three to six months.

Radiofrequency ablation is a procedure that uses an electrical current to generate heat to destroy the pain fibers to facet joints or sacroiliac joints. It can also be used to disable other small nerves in a variety of locations. It is helpful because it can provide more long term relief than blocks with local anesthetic or steroid.

Joint Injections

Approximately 30 million adults in the United States suffer with joint pain, which is often debilitating and can keep people from staying active and even make daily chores seem impossible. Treatment options are not limited to pills or surgery, but can also include injections into the affected joint. Depending on the severity of your pain, injections can be another option for easing your joint pain and reducing inflammation, in order to get you moving again.

Joints form the connections between bones, and they provide support and help you move. Any damage to the joints from disease or injury can interfere with your movement and cause significant, chronic pain.

Many different conditions can lead to painful joints, including osteoarthritis, rheumatoid arthritis, bursitis, gout, strains, sprains, and other injuries. Joint pain is extremely common. In one national survey, about one-third of adults reported having joint pain within the past 30 days. Knee pain was the most common complaint, followed by shoulder and hip pain, but joint pain can affect any part of your body, from your ankles and feet to your shoulders and hands. As you get older, painful joints become increasingly more common.

For people who don’t find joint pain relief from oral or topical medications, the doctors at CSPP can inject a steroid medication (which may be combined with a local anesthetic) directly into the joint every 3 to 4 months. Steroid injections are most commonly used in patients with arthritis, joint disease, or tendinitis. The procedure is effective, but in most situations the effect be temporary. It can also have side effects; if steroid injections mask an injury, you could overuse the joint and damage it even further. Areas of treatment are:

  • Knee Injections
  • Shoulder Injections
  • Hip Injections
  • Sacroiliac Joint Injections

Kyphoplasty

Like vertebroplasty, kyphoplasty injects special cement into your vertebrae — with the additional step of creating space for the treatment with a balloon-like device. Kyphoplasty can restore a damaged vertebra’s height and may also relieve pain.

As with vertebroplasty, the effectiveness of kyphoplasty is under debate in the medical community — you should discuss the risks and benefits with your doctor.

Doctors might recommend kyphoplasty for cancer-damaged vertebrae or certain spinal fractures. In most cases, a weakening of the bones (osteoporosis) has caused the vertebrae to compress or collapse, causing pain or a hunched posture.

Peripheral Nerve Blocks

Peripheral nerve blocks are a type of regional anesthesia. The anesthetic is injected near a specific nerve or bundle of nerves to block sensations of pain from a specific area of the body. Nerve blocks usually last longer than local anesthesia. Some nerve blocks include:

  • Pudendal Nerve Block
  • Iliohypogastric Nerve Block
  • Ilioguinal Nerve Blocks
  • Genitofemoral Nerve Block
  • Femoral Nerve Block
  • Sciatic Nerve Block
  • Brachial Nerve Block
  • Trigeminal Nerve Block

Intercostal nerves are small nerves that travel along the lower border of the ribs. Irritation and inflammation of these nerves can cause pain in the mid-back, chest wall and abdominal area. Intercostal nerve blocks can be helpful in reducing pain from a variety of conditions that cause rib pain or chest wall pain, such as post-herpetic neuralgia.

Occipital nerves are located at the base of the skull in the midline and just behind the ears. They provide sensation to the scalp. Inflammation and irritation of these nerves can cause headaches that start at the base of the skull and travel to the top of the head or to the sides along the temples. Blocking these nerves can decrease the severity and frequency of headaches that are caused by these nerves. If the blocks are successful, radiofrequency ablation or cryoablation can provide more long term relief.

Implantable Devices

Spinal Cord Stimulation is the standard treatment for chronic back pain which cannot be cured by other treatment methods. By Spinal Cord Stimulation or SCS, we mean a treatment process in which mild electric currents are applied to block nerve impulses.

Spinal Cord Stimulation is specifically used to treat chronic back pain. It is even effective in treating chronic pains of the legs and arms. SCS aims to manage pain and also control pain medication. Doctors recommend it to patients who continue to suffer from backache even after surgery.  Patients who undergo SCS get relief from pain as the electric currents block the brain from registering the pain sensation from the affected area. Thus by interfering with the signals to the brain, it provides considerable relief.

Spinal Cord Stimulation is the most popular method today to provide relief from persistent pain. It is usually administered with the help of an internal pulse generator that comes with a battery. The system consists of the following items-

  • A pulse generator that creates the electronic pulses. It is implantable.
  • A lead with multiple electrodes that delivers the electronic pulses to the spinal cord. The number of electrodes is between 4 and 16.
  • An extension wire connects the lead to the pulse generator.
  • A hand-held remote control that is used to switch on the pulse generator and also adjust the pulses.

The pulse generator is placed below the skin of the back, near the spinal column through a small incision. No major surgery is required but local anesthesia is given. The electrodes lead to the nerve fibers of the spinal cord. The stimulator is also placed below the skin, usually in the upper buttock or the abdomen.

Through the remote control, the stimulator is activated which sends mild electric currents to the electrodes that connect to the nerve fibers creating a tingling sensation in the affected area.

The patient experiences reduction in pain when the stimulator is switched on as the electric signals interrupts the pain signals and don’t allow them to reach the brain.

SCS is a well-established pain treatment used in the U.S. for over 30 years.

It includes a small implanted device that transmits mild electrical pulses to the spinal cord.

The pulses calm the nerves and reduce pain signals to the brain.

HF10 is the only SCS treatment designated as superior by the FDA for getting the best results in both chronic back and leg pain.

A spinal cord stimulator (SCS) device is surgically placed under your skin and sends a mild electric current to your spinal cord. Thin wires carry current from a pulse generator to the nerve fibers of the spinal cord. When turned on, the SCS stimulates the nerves in the area where your pain is felt.

Intrathecal Pain Pumps perform targeted drug delivery. Patients receive pain medication targeted to the fluid surrounding the spinal cord, in an area called the intrathecal space. This allows the drugs to be delivered faster, and more effectively.

Intrathecal Baclofen Therapy (ITB) is a treatment using Lioresal® Intrathecal (baclofen) that is delivered into the fluid around your spinal cord (intrathecal) to help manage severe spasticity. For long term treatment, the drug is placed into a pump that is surgically placed under the skin of your abdomen.

Botulinum Toxin Injections

Botulinum toxin injections are used to reduce the excess muscle activity caused by dystonia. Botulinum toxin is produced naturally by a bacterium called Clostridium botulinum which is also associated with causing botulism, a rare form of food poisoning. However, although botulinum toxin is exceptionally toxic, when it is  purified and used in tiny, controlled doses, it can be used safely and effectively to relax excessive muscle contraction.

The injection enables the botulinum toxin to be targeted directly into the muscles affected by dystonia. The toxin has an effect on the nerves at their junction with the muscles. It acts as a blocker preventing release of the chemical messenger acetylcholine which is responsible for making the muscle contract. As a result, the signals that would normally be telling the muscle to contract are halted and the muscle spasms are reduced or eliminated.

Because each muscle affected by dystonia has to be injected separately, and also because there is a limit to the total quantity of toxin that can be injected into the body at one time, botulinum toxin is more suitable for treating dystonias which are focal to one or two areas of the body rather than generalised dystonia. However, sometimes the toxin is used to treat a specific part of the body in generalised dystonia as part of a wider treatment regime.

When injected into muscle in tiny amounts, botulinum A (Botox) can stop or reduce muscle spasm by blocking nerve signals to the muscle.

Discograms

The discs are soft, cushion-like pads that separate the bones of the spine. A disc may be painful when it bulges, herniates, tears or degenerates and may cause pain in the neck, mid-back, low back and arms, chest wall, abdomen or legs. Other structures in the spine may also cause similar pain such as the muscles, joints and nerves. Before performing discography, it has usually been determined that these other structures are not the sole source of pain.

Discography confirms or eliminates the disc(s) as a source of pain. During this procedure, a needle is placed into the discs themselves under x-ray guidance and contrast (dye) is injected. CT and MRI scans only demonstrate anatomy and cannot absolutely prove a patient’s pain source. In some instances, the discs may be abnormal on MRI or CT scans but not a source of pain.

Therefore, discography is done to identify painful disc(s) and help the surgeon plan the correct surgery or avoid surgery that may not be beneficial. Discography can also be used to determine the appropriate discs for IDET (intradiscal electrothermal therapy). Discography is usually done only if a patient’s pain is significant enough for them to consider surgery or IDET.

Trigger Point Injections

A trigger point injection can help soothe muscle pain, especially in your arms, legs, lower back and neck. It also can be used to treat fibromyalgia, tension headaches and myofascial pain. Trigger points are painful “knots” in your muscles. They form when a muscle can’t relax. The type of Trigger Point injections we treat are:

  • Piriformis Injections
  • Back Injections
  • Neck Injections
  • Extremity Injections

Superion Interspinous Spacer

The Superion InterSpinous Spacer (Superion Spacer) is a small H-shaped device made of titanium alloy that is designed to reduce the symptoms of moderate degenerative lumbar spinal stenosis. The device is implanted between two adjacent bones in the lower back, and limits movement at the location where the device is placed.

Spinal stenosis is defined as a narrowing of the passageways in the spine. The narrowing puts pressure on your nerves and spinal cord and can cause pain, numbness, tingling, and/or weakness in the leg(s) or legs and back. The device is designed to limit extension of the spinal level to relieve these symptoms.

The Superion Spacer benefits patients who suffer from pain, numbness, and/or cramping in their buttock, groin, or legs with or without back pain.

The device should help relieve the symptoms of moderate lumbar spinal stenosis by blocking extension of the affected spinal level.

Minimally Invasive Lumbar Decompression (MILD procedure)

The MILD procedure is a safe, effective, FDA-approved, non-surgical procedure that can help patients diagnosed with Lumbar Spinal Stenosis (LSS) stand longer and walk farther with less pain. It is a short, outpatient procedure that is performed through a tiny incision, smaller than a baby aspirin. It does not require general anesthesia, implants, or stitches.