If we are . . . → Read More: Most Major Insurances Accepted. Call Us To Make Sure 615-459-0100.]]> SMYRNA PAIN CONSULTANTS is a diversified clinic in which we strive to help you with your health needs. We offer Primary Care, Orthopedic care, Prescription Weight Loss, Physiotheraphy, Chiropractic, and other services.
We provide:

• Primary Care
• Muscle, Skeletal, Nerve, and Spine Problems
• Stabilized Diabetes
• Hypertension
• Sprains and Strains
• Prescription Weight Loss
• CDL and DOT physicals
• Joint Injections
• Facet Injections
• Trigger-point Injections
• Pregnancy, Strep, and Flu Tests

If we are not able to help you, we will direct you to the proper place.

Smyrna Pain Consultants is designed for patients with musculoskeletal back pain conditions. We are here to help our patients reduce the amount of medication they consume and support them in adjusting to a healthy lifestyle. We help in relieving chronic low back and neck pain. We do not handle long term pain management.

We provide prescription weight loss which assists our patients in reaching a healthy weight, relieving chronic low back pain resulting from unhealthy weight, and beginning the path to becoming a healthier individual. Our program is designed to help patients live more productive and fulfilling lives.

A facet injection is a minimally invasive procedure that can temporarily relieve neck or back pain caused by inflamed facet joints. The cause of facet joint pain (arthritis, injury, degeneration) is not well understood and can be similar in nature to disc pain. . . . → Read More: Facet Injections]]> The following information was taken from Mayfield Clinic’s website.  Click here for more information.

Overview

A facet injection is a minimally invasive procedure that can temporarily relieve neck or back pain caused by inflamed facet joints. The cause of facet joint pain (arthritis, injury, degeneration) is not well understood and can be similar in nature to disc pain. The procedure has two purposes. First, it can be used as a diagnostic test to see if the pain is actually coming from your facet joints. Second, it can be used as a treatment to relieve inflammation and pain caused by various spine conditions. The effects of facet injections tend to be temporary – providing relief for several days or even years. The goal is to reduce pain so that you may resume normal activities and a physical therapy program.

What is a facet injection / rhizotomy?

A facet injection includes both a long-lasting corticosteroid (e.g., triamcinolone or methylprednisolone) and an anesthetic numbing agent (e.g., lidocaine or bupivacaine). The drugs are delivered to the painful facet joint, either inside the joint capsule or in the tissue surrounding the joint capsule. Each vertebra has four facet joints, one pair that connects to the vertebra above (superior facets) and one pair that connects to the vertebra below (inferior facets) (see Anatomy of the Spine).

Corticosteroid injections can reduce inflammation and can be effective when delivered directly into the painful area. The pain relief can last from days to years, allowing you to improve your spinal condition with physical therapy and an exercise program.
Facet injections also provide diagnostic information for your physician. The injection “blocks” the pain in the same way a dentist uses an anesthetic injection to block pain in your jaw before working on your teeth. Injections into joints or nerves are sometimes called “blocks.” Successful facet injections may indicate that you could benefit from a facet rhizotomy – a procedure that uses an electrical current to destroy the nerve fibers carrying pain signals to the brain.

Who is a candidate?

If you have neck, arm, low back, or leg pain (sciatica) stemming from inflammation of the facet joints you may benefit from a facet injection. Typically, it is recommended for those who fail to respond to other conservative treatments, such as oral anti-inflammatory medication, rest, back braces or physical therapy. The doctor may wish to perform the injection as a diagnostic test to determine if the facet joint is causing your pain. Facet injections may be helpful in treating inflamed facet joints caused by:

• Spinal stenosis: A narrowing of the spinal canal and nerve root canal can cause back and leg pain, especially when walking.
• Spondylolysis: A weakness or fracture between the upper and lower facets of a vertebra. If the vertebra slips forward (spondylolisthesis), it can compress the nerve roots causing pain.
• Sciatica: Pain that courses along the sciatic nerve in the buttocks and down the legs. It is usually caused by compression of the 5th lumbar or 1st sacral spinal nerves.
• Herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve.
• Arthritis: Joint inflammation caused by degeneration of the cartilage; causes pain, swelling, redness, and restricted movement.
• Postoperative pain: Acute pain following discectomy or spinal decompression caused by disruption of the facet joint or spine muscles.

Facet injections should NOT be performed on people who have an infection, are pregnant, or have bleeding problems. It may slightly elevate the blood sugar levels in patients with diabetes, typically for less than 24 hours. It may also temporarily elevate blood pressure.

Who performs the procedure?

The types of physicians who administer facet injections include physiatrists (PM&R), radiologists, anesthesiologists, neurologists, and surgeons.

What happens before treatment?

The doctor who will perform the injection reviews your medical history and previous imaging studies to plan the best location for the injections. Be prepared to ask any questions you may have at this appointment.

Patients who are taking aspirin or blood thinning medication may need to stop taking it several days before the facet injection. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the injection.

The injection is usually performed in an outpatient Special Procedures suite that has access to fluoroscopy. Make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.

What happens during treatment?

At the time of your injection, you will be asked to sign consent forms, list medications you are presently taking, and if you have any allergies to medication. Depending on the number of facet joints being treated, the brief procedure may last 15-30 minutes followed by a recovery period.

Step 1: prepare the patient
Patients can remain awake for the entire process. Sedatives can be given to help lessen anxiety. Lying face down on the table, the patient receives a local anesthetic, which will numb the skin before the injection is given. If IV sedation is used, your blood pressure, heart rate and breathing are monitored during the procedure.

Step 2: insert the needle
With the aid of a fluoroscope (a special X-ray), the doctor directs a hollow needle through the skin and muscles of your back to the sensory nerves located in the facet joints. Fluoroscopy allows the doctor to watch the needle in real-time on the fluoroscope monitor to make sure that the needle goes to the specific facet joint (Fig. 1). Contrast may be injected into the facet joint to confirm entry. Some discomfort occurs but patients typically feel more pressure than pain.

Step 3: inject the medication
When the needle is in correct position, the doctor injects the anesthetic and corticosteroid medication into your facet joint capsule (Fig. 2). The needle is then removed. One or several joints may be injected depending on the location of the pain.

What happens after treatment?

Most patients can walk around immediately after the procedure. After being monitored for a short time, you can usually leave the office or suite. Someone must drive you home.

Typically patients resume full activity the next day. Soreness around the injection site may be relieved by using ice and taking a mild analgesic (Tylenol).

The doctor’s office may want to follow up with you 7 to 10 days after the procedure to ask about your symptoms and the level of pain relief obtained. You may want to record your levels of pain during the next couple of weeks in a diary. You may notice a slight increase in pain as the numbing medicine wears off and before the corticosteroid starts to take effect. If the facet joints that were treated are the source of pain, you may begin to notice pain relief starting two to seven days after the injection. If after 10 days there is no improvement, a second injection may be given. If after three injections there is little pain relief, then you are unlikely to gain any benefit from more injections. Further diagnostic tests may be needed to accurately diagnose your pain.

After the local anesthetic has worn off, you may continue to take your regular pain medicine. However, pain medication can mask the pain and interfere with accuracy of the diagnostic information obtained.

What are the results?

About 50% of patients experience some degree of pain relief [1]. The pain may be relieved for several days to several months – allowing you to participate in physical therapy. If prior injections were helpful and you experience a recurrence of pain, the procedure can be repeated up to 3 times a year. If you don’t experience any pain relief, further injections won’t be helpful.

If you suffer recurrent back pain and you’ve experienced good pain relief with facet injections, you may be a candidate for a facet rhizotomy (Fig. 3). Facet rhizotomy is a procedure that uses a radiofrequency probe to destroy some of the nerve fibers causing pain. During this procedure, an electrode is passed through the skin to the sensory nerves surrounding the facet joint. Once the electrode is in the exact position a radiofrequency heating current is applied to deaden the nerve fibers that carry pain signals to the brain.

What are the risks?

With few risks, facet injections are considered an appropriate nonsurgical treatment for some patients. The potential risks associated with inserting the needle include bleeding, infection, allergic reaction, headache, and nerve damage (rare). Corticosteroid side effects may cause weight gain, water retention, flushing (hot flashes), mood swings or insomnia, and elevated blood sugar levels in diabetics. These usually disappear within 3 days. Patients who are being treated for chronic conditions (e.g. heart disease, diabetes, rheumatoid arthritis, or those who cannot temporarily discontinue anti-clotting medication) should consult their personal physician for a risk assessment.

Sources & links

If you have more questions, please contact the Mayfield Clinic & Spine Institute at 800-325-7787 or 513-221-1100.

Sources

1. Bani A, Spetzger U, Gilsbach JM. Indications for and Benefits of Lumbar Facet Joint Block. Neurosurg Focus 13(2), 2002.

Links

www.spineuniverse.com
www.spine-health.com

Glossary

anesthetic: an agent that causes loss of sensation with or without the loss of consciousness.

corticosteroid: a hormone produced by the adrenal gland or synthetically. Regulates salt and water balance and has an anti-inflammatory effect.

facet joints: joints located on the top and bottom of each vertebra that connect the vertebrae to each other and permit back motion.

facet rhizotomy: a procedure that uses a radiofrequency current to deaden the nerves surrounding the facet joint and prevent pain signals from reaching the brain.

fluoroscopy: an imaging device that uses x-ray or other radiation to view structures in the body in real time, or “live.” Also called a C-arm.

herniated disc: a condition in which the gel-like center of an intervertebral disc ruptures through the tough disc wall irritating surrounding nerves and causing pain.

sciatica: pain that courses along the sciatic nerve in the buttocks and down the legs. Usually caused by compression of the 5th lumbar or 1st sacral spinal nerves.

spinal stenosis: the narrowing of the spinal canal and nerve-root canal along with the enlargement of the facet joints.

spondylolysis: a weakness or fracture between the upper and lower facets of a vertebra, an area called the pars interarticularis.

updated: 6.2010
reviewed by: Thomas Berger, MD and Scott Basham, NP

©2010 Mayfield Clinic.

The spine or backbone is made of 33 individual bony vertebrae. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist, while protecting the spinal cord from injury. A healthy spine provides . . . → Read More: Anatomy of the Spine]]> The following is from Mayfield’s Clinic’s website.  Click here to view the original article.

Overview

The spine or backbone is made of 33 individual bony vertebrae. This spinal column provides the main support for your body, allowing you to stand upright, bend, and twist, while protecting the spinal cord from injury. A healthy spine provides strength, is flexible, and allows movement in several planes. Strong bones and muscles, flexible tendons and ligaments, and sensitive nerves contribute to a healthy spine. Yet, any of these structures affected by strain, injury, or disease can cause pain.

Spinal curves

At birth, a baby’s spine is C-shaped. As the child develops learning to crawl and then walk, the spine adapts from four-legged to two-legged locomotion. An adult spine has natural curves that form an S-shape. Yet, in this upright posture, the spine is constantly being pulled forward by the weight of the body. Viewed from the side, the cervical and lumbar regions have a lordotic, or slight concave curve, and the thoracic and sacral regions have a kyphotic, or gentle convex curve (Fig. 1). The spine’s curves work like a coiled spring to absorb shock, maintain balance, and allow the full range of motion throughout the spinal column.

These natural curves are maintained by the muscles and correct posture. Good posture involves training your body to stand, walk, sit, and lie so that the least amount of strain is placed on supporting muscles and ligaments during movement or weight-bearing activities (see Posture).

An abnormal forward curve of the lumbar spine is lordosis, also called sway back. An abnormal curve of the thoracic spine is kyphosis, also called hunchback. Sometimes the spine abnormally curves from side-to-side, in a condition called scoliosis. A mild curvature (less than 20 degrees) is usually not noticeable or a health concern. However, moderate curves (between 25 to 40 degrees) and major curves (over 45 degrees) are treated with braces or surgery. Scoliosis can put pressure on the heart and lungs as well as limit physical activity.

Muscles

The two main muscle groups that affect the spine are extensors and flexors. The extensor muscles enable us to stand up and lift objects. The extensors are attached to the back of the spine. The flexor muscles are in the front and include the abdominal muscles. These muscles enable us to flex, or bend forward, and are important in lifting and controlling the arch in the lower back.

The back muscles stabilize your spine. Something as common as poor muscle tone or a large belly can pull your entire body out of alignment. Misalignment puts incredible strain on the spine (see Exercise for a Healthy Back).

Vertebrae

Vertebrae are the 33 individual bones that interlock with each other to form the spinal column. The vertebrae are numbered and divided into regions: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal (Fig. 2). Only the top 24 bones are moveable; the vertebrae of the sacrum and coccyx are fused. The vertebrae in each region have unique fea­tures that help them perform their main functions.

Cervical region – the main function of the cervical spine is to support the weight of the head (about 10 pounds). The seven cervical vertebrae are numbered C1 to C7. The cervical region has the greatest range of motion because of two specialized vertebrae that connect to the skull. The first vertebra (C1) is the ring-shaped atlas that connects directly to the skull. This joint allows for the nodding or “yes” motion of the head. The second vertebra (C2) is the peg-shaped axis, which has a special projection called the odontoid process, that the atlas pivots around. This joint allows for the side-to-side or “no” motion of the head.

Thoracic region –the main function of the thoracic spine is to protect the organs of the chest by providing attachment for the rib cage. The 12 thoracic vertebrae are numbered T1 to T12. The range of motion in the thoracic spine is limited.

Lumbar region –the main function of the lumbar spine is to bear the weight of the body. The five lumbar vertebrae are numbered L1 to L5. These vertebrae are much larger in size for their weight-bearing function.

Sacral region –the main function of the sacrum is to provide attachment for the iliac (hip) bones and protect the pelvic organs. There are five sacral vertebrae, which are fused together. Together with the iliac bones, they form a ring called the pelvic girdle.

Coccyx region –the four fused bones of the coccyx or tailbone don’t really have a function. It is an embryology remnant of a tail from our primate ancestors.

While vertebrae have unique regional features, every vertebra has three functional parts (Fig. 3):

• an anterior drum-shaped body designed to bear weight and withstand compression (purple)
• a posterior arch-shaped bone that protects the spinal cord (teal)
• posterior star-shaped processes designed as outriggers for muscle attachment (beige)

Intervertebral discs

Each of the 24 moveable vertebrae in your spine are separated and cushioned by an intervertebral disc, keeping them from rubbing together. Discs are designed like a radial car tire. The outer ring, called the annulus fibrous, has criss-crossing fibrous bands, much like a tire tread. These bands attach between the bodies of each vertebra and contain the gel-filled center called the nucleus pulposus, much like a tire tube (Fig. 4).

Discs function like coiled springs. The criss-crossing fibers of the annulus pull the vertebral bodies together against the elastic resistance of the gel-filled nucleus. The nucleus acts like a ball-bearing when you move, allowing the vertebral bodies to roll over the incompressible gel. The gel-filled nucleus is composed mostly of fluid. This fluid absorbed during the night as you lie down and is pushed out during the day as you move upright.

With age, our discs increasingly lose the ability to reabsorb fluid and become brittle and flatter; this is why we get shorter as we grow older. Also diseases, such as osteoarthritis and osteoporosis, cause bone spurs (osteophytes) to grow. Injury and strain can cause discs to bulge or herniate, a condition in which the nucleus is pushed out through the annulus to compress the nerve roots causing back pain.

Vertebral arch & spinal canal

On the back of each vertebra body are bony projections that form the vertebral arch. The arch is made of two supporting pedicles and two arched laminae (Fig. 5). The hollow spinal canal contains the spinal cord, fat, connective tissue, and blood supply of the cord. Under each pedicle, a pair of spinal nerves exits the spinal cord and pass through the intervertebral foramen to branch out to your body.

Surgeons often remove the lamina of the vertebral arch (laminectomy) to access and decompress the spinal cord and nerves to treat spinal stenosis, tumors, or herniated discs.

Seven processes arise from the vertebral arch: the central spinous process, two transverse processes, two superior facets, and two inferior facets.

Facet joints

The facet joints of the spine allow back motion. Each vertebra has four facet joints, one pair that connects to the vertebra above (superior facets) and one pair that connects to the vertebra below (inferior facets) (Fig. 6).

Ligaments

The ligaments are strong fibrous bands that hold the vertebrae together, stabilize the spine, and protect the discs. The three major ligaments of the spine are the ligamentum flavum, anterior longitudinal ligament (ALL), and posterior longitudinal ligament (PLL) (Fig. 7). The ALL and PLL are continuous bands that run from the top to the bottom of the spinal column along the vertebral bodies. They prevent excessive movement of the vertebral bones. The ligamentum flavum attaches between the lamina of each vertebra.

Spinal cord

The spinal cord is about 18 inches long and is the thickness of your thumb. It runs within the protective spinal canal from the brainstem to the 1st lumbar vertebra. At the end of the spinal cord, the cord fibers separate into the cauda equina and continue down through the spinal canal to your tailbone before branching off to your legs and feet. The spinal cord serves as an information super-highway, relaying messages between the brain and the body. The brain sends motor messages to the limbs and body through the spinal cord allowing for movement. The limbs and body send sensory messages to the brain through the spinal cord about what we feel and touch. Sometimes the spinal cord can react without sending information to the brain. These special pathways, called spinal reflexes, are designed to immediately protect our body from harm.

The nerve cells that make up your spinal cord itself are called upper motor neurons. The nerves that branch off your spinal cord down your back and neck are called lower motor neurons. These nerves exit between each of your vertebrae and go to all parts of your body.

Any damage to the spinal cord can result in a loss of sensory and motor function below the level of injury. For example, an injury to the thoracic or lumbar area may cause motor and sensory loss of the legs and trunk (called paraplegia). An injury to the cervical (neck) area may cause sensory and motor loss of the arms and legs (called tetraplegia, formerly known as quadriplegia).

Spinal nerves

Thirty-one pairs of spinal nerves branch off the spinal cord. The spinal nerves act as “telephone lines,” carrying messages back and forth between your body and spinal cord to control sensation and movement. Each spinal nerve has two roots (Fig. 8). The ventral (front) root carries motor impulses from the brain and the dorsal (back) root carries sensory impulses to the brain. The ventral and dorsal roots fuse together to form a spinal nerve, which travels down the spinal canal, alongside the cord, until it reaches its exit hole – the intervertebral foramen (Fig. 9). Once the nerve passes through the intervertebral foramen, it branches; each branch has both motor and sensory fibers. The smaller branch (called the posterior primary ramus) turns posteriorly to supply the skin and muscles of the back of the body. The larger branch (called the anterior primary ramus) turns anteriorly to supply the skin and muscles of the front of the body and forms most of the major nerves.

The spinal nerves are numbered according to the vertebrae above which it exits the spinal canal. The 8 cervical spinal nerves are C1 through C8, the 12 thoracic spinal nerves are T1 through T12, the 5 lumbar spinal nerves are L1 through L5, and the 5 sacral spinal nerves are S1 through S5. There is 1 coccygeal nerve.

The spinal nerves innervate specific areas and form a striped pattern across the body called dermatomes (Fig. 10). Doctors use this pattern to diagnose the location of a spinal problem based on the area of pain or muscle weakness. For example leg pain (sciatica) usually indicates a problem near the L4-S3 nerves.

Coverings & spaces

The spinal cord is covered with the same three membranes as the brain, called meninges. The inner membrane is the pia mater, which is intimately attached to the cord. The next membrane is the arachnoid mater. The outer membrane is the tough dura mater (Fig. 8). Between these membranes are spaces used in diagnostic and treatment procedures. The space between the pia and arachnoid mater is the wide subarachnoid space, which surrounds the spinal cord and contains cerebrospinal fluid (CSF). This space is most often accessed when performing a lumbar puncture to sample and test CSF or during a myelogram to inject contrast dye. The space between the dura mater and the bone is the epidural space. This space is most often accessed to deliver anesthetic numbing agents, commonly called an epidural, and to inject steroid medication (see Epidural Steroid Injections).

Sources & links

If you have more questions, please contact the Mayfield Clinic & Spine Institute at 800-325-7787 or 513-221-1100.

Links
www.spine-health.com
www.spineuniverse.com

Glossary

dorsal: the back or posterior side of the body.

kyphosis: an abnormal forward curvature of the thoracic spine, also called hunchback.

lordosis: an abnormal curvature of the lumbar spine, also called swayback.

paraplegia: paralysis of both legs and lower body below the arms indicating an injury in the thoracic or lumbar spine.

quadraplegia: paralysis of both legs and arms indicating an injury to the cervical spine.

scoliosis: an abnormal side-to-side curvature of the spine.

ventral: the front or anterior side of the body.

Click here to read Back Pain: A Guide For Understanding from Spine-Health.com:  Trusted Info For . . . → Read More: Back Pain: A Guide For Understanding]]> The following link will take you to Spine-Health’s website.  We are not connected to them in anyway other than to share this important information with you about your back pain.

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