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Jackson Neurosurgery  Clinic’s Dr. Adam Lewis recently completed a transcontinental medical missionary trip with Onbelay Medical to the central African nation of Uganda in which he brought world-class expertise in neurosurgical skill and training to a region with limited resources and desperate need.

A team of On-Belay employees and surgeons traveled to Kampala, Uganda to partner with local surgeons at Mulago Hospital, African Renewal Ministries and Wentz Medical Clinic to perform over 25 desperately needed complex spine and orthopedic surgeries.

Over the course of 10 months, On-Belay Medical worked with many of the company’s suppliers to gather donations of spine implants and instrumentation.  These valuable supplies are scarcely available in Uganda. The equipment and supplies were transported on a container ship in April to prepare for the team’s arrival.

The week was spent collaborating, teaching and performing surgeries that uncommon in Uganda because of the limitation of the facilities and necessary resources. The long-term goal of both teams is to develop an on-going partnership between On-Belay Medical and the healthcare professionals in Uganda.

The resources and facilities were far from what he was accustomed to in state-of-the-art American operating suites.  However, he along with the rest of the team of American and Ugandan surgeons, medical doctors, nurses and other healthcare providers were able to evaluate and bring life-saving help to many citizens of Uganda as well as international refugees fleeing war-torn South Sudan.


Here is a photo of the entire team outside of the healthcare facility.

 This is the hospital where patients were brought for evaluation, surgical treatment, and recovery.

Makeshift Clinic in Refugee Camp

Interior of a Ugandan Ambulance

Although the facilities and equipment were much more rudimentary than we are used to hearing the United States, the team of medical missionaries and dedicated Ugandan health professionals were able to bring a level of care that was able to change and save lives.

 Dr. Adam Lewis consulting and teaching Ugandan surgeons and medical doctors regarding one of the neurosurgical cases.

Dr. Adam Lewis Preparing to evaluate an incoming patient.

Dr. Adam Lewis reviewing spinal images with the medical team to plan the best surgical solution for one of the patients.

Note from a team member reporting good news of a refugee patient that was recovering well following Dr. Adam Lewis providing needed equipment and surgical skill to accomplish a brain surgery saving the man's life.

What is Viscosupplementation?

  • Viscosupplementation is a non-surgical medical treatment for degenerative or osteoarthritis of the knees. It involves using a small needle to inject medication into the knee joints to lubricate the degenerative joint. The medication injected into the joint is called hyaluronic acid.
  • Hyaluronic acid occurs normally in the joints but the concentration decreases as the joints degenerate. The goal of replacing this compound in the joint is to decrease friction, improve motion of the joint, reduce pain, and hopefully delay or prevent the need for surgery on the joint.
  • Degenerative and painful knee joints often decrease one's ability to participate in exercise or rehab of the knee. By decreasing the pain associated with osteoarthritis of the knee, many people are able to engage in activities that strengthen the muscles around the knee and improve range of motion. Such increased physical activities have significant benefits, not only to the knee joints but to the entire body. Improved activity levels and overall health also can significantly improve individuals’ quality-of-life and overall sense of well-being.
  • Viscosupplementation injections are outpatient procedures usually performed in your physician's office, often with the use of ultrasound or fluoroscopy (x-ray) guidance for precision placement of the medication. They require only local anesthetic and usually only take a few minutes to complete. The usual injection contains only 2 mL of hyaluronic acid. This is about half the volume of a normal knee joint’s fluid. Often, the amount of joint fluid in a degenerative knee decreases as time goes by. However, even if the volume of fluid is normal, the concentration of hyaluronic acid in the degenerative joint’s fluid is significantly lower than that of a healthy joint. The additional fluid and thickness (viscosity) provided by the added hyaluronic acid in the degenerative joint helps to act as a cushion or padding during activities.
  • By improving the padding and lubrication in the joint, the goal is to improve function and hopefully slow down the degenerative process in the joint.


 Is this treatment FDA approved?

Currently in the United States, using hyaluronic acid business supplementation is only approved by the FDA to treat degenerative knee joints. Some physicians have injected hyaluronic acid into other joints such as shoulders and hips. While this is allowed by the FDA, it is considered "off-label" and is usually not covered by most insurance companies.

Is this treatment covered by insurance companies?

Most insurance companies do cover the FDA approved injection of hyaluronic acid into degenerative knee joints as long as their medical policy requirements are met.

Is this treatment a permanent solution?

In most cases, viscosupplementation is not a permanent solution. However, for many individuals, this treatment can give many months or years of improved function and decrease pain. Additionally, it can frequently delay surgery for extended periods of time. With improved function, many people are hoping the delay of surgery will allow them to have more options available as treatment technology improves for degenerative joints.

In this video, former U.S. Surgeon General Dr. Vivek Murthy who served under Pres. Obama discusses America's opioid epidemic.  Dr. Murthy states that opiate medications are addictive and are generally not a good solution for chronic pain.

There are several myths surrounding opiates for chronic pain management. Many of these myths deal with both the efficacy and safety of chronic opiates. This short video explains and exposes several of these myths and helps viewers to understand why it is important to use the lowest effective dose of opiates for chronic pain, if they are used at all.

Recent Study Using Spinal Cord Stimulation to Treat Post Herpetic Neuralgia

China Medical University’s Department of Pain Medicine recently published a study entitled ‘Efficacy of Short-Term Spinal Cord Stimulation in Acute/Sub-acute Zoster-Related Pain’ in July 2017. They put this insightful publication together after several months of continuous series of tests to evaluate the effectiveness of short-term spinal cord stimulation in patients with refractory acute/sub-acute zoster-related pain. This study demonstrates the potential of neuromodulation with spinal cord stimulation to achieve relief in refractory acute or subacute pain related to postherpetic neuralgia. It is quite possible that in the future spinal cord stimulation may be a common solution for this very painful condition.

Often, the pain of acute/sub-acute zoster can escalate to a condition known as ‘Postherpetic Neuralgia (PHN).’ This is a refractory condition that impairs the patient’s quality of life may develop following a case of herpes zoster, also known as shingles.

Over the years, doctors have tried many ways to prevent acute and sub-acute herpes zoster-related pain from turning into postherpetic neuralgia, with limited or variable success. Although many studies have been conducted over time, few looked at spinal cord stimulation as a viable remedy for this condition until recently when spinal cord stimulation showed promising results.

In the spinal cord stimulation study, a total of 46 patients with herpes zoster-related pain that had previously undergone the usual therapies without much success underwent short-term spinal cord stimulation. Visual Analogue Scale (VAS), analgesic consumptions among other outcome variables were recorded before and after the stimulation.  69.6% of the test subjects achieved significant improvement in their pain. 39.1% of the patients in the study achieved complete relief of their pain with a VAS score of <2/10. In these test subjects, the duration of the postherpetic neuralgia did not make a significant difference in the amount of relief achieved. Additionally, there were no severe complications reported in the follow-up period. The study did not compare spinal cord stimulator therapy to conventional therapy and did not assess the relief achievable on those patients with only mild to moderate pain.

1. Dong, Dao-Song, Xue Yu, Cheng-Fu Wan, Yan Liu, Lin Zhao, Qi Xi, Wen-Yao Cui, Qiu-Shi Wang, and Tao Song. "Efficacy of Short-Term Spinal Cord Stimulation in Acute/Subacute Zoster-Related Pain: A Retrospective Study." Pain physician 20, no. 5 (2017): E633-E645.

Knee Pain, fitness, healthcare and medicine concept - close up of female hands holding knee

Knee Pain: Causes

There are many possible causes of knee pain. You rely on your knees to support your weight and absorb the force and shock of movement throughout the day. The knee joint is a complex structure consisting of several supporting ligaments, shock absorbing cartilage, lubricating joint fluid, multiple bursa to help ligaments and tendons slide smoothly, a patella (kneecap), the femur, the tibia,  and the fibula. In addition to these joint structures, there are multiple muscles, tendons, nerves, fascia,  and blood vessels that work together to enable this intricately designed joint to function properly. (more…)

People who have or know someone with scoliosis of the spine often have many questions.  Below are some of the most common questions, brief answers, and links to more in depth resources. 

What is Scoliosis of the Spine?

Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty.

Scoliosis - Symptoms and causes - Mayo Clinic

What is the Cause of Scoliosis?

Doctors don't know what causes the most common type of scoliosis — although it appears to involve hereditary factors, because the disorder tends to run in families. Less common types of scoliosis may be caused by neuromuscular conditions, such as cerebral palsy or muscular dystrophy.

Scoliosis - Symptoms and causes - Mayo Clinic

Is Scoliosis Hereditary

Is Scoliosis Hereditary or Genetic? Strong evidence suggests that scoliosis runs in families. Nearly a third of patients with adolescent idiopathic scoliosis have a family history of the condition, and first-degree relatives of scoliosis patients have an 11 percent chance of developing it themselves

Is Scoliosis Hereditary, Genetic or Environmental? - ScoliSMART


Does Idiopathic Scoliosis Occur in Adults?

Scoliosis is defined as a curve of the spine of 10 degrees. Adult scoliosis is broadly defined as a curve in your spine of 10 degrees or greater in a person 18 years of age or older. ... Adult Idiopathic Scoliosis patients have had scoliosis since childhood or as a teenager and have grown into adulthood.

Adult Scoliosis: Conditions & Diagnoses - UCLA Spine Center


Can Scoliosis get worse in Adulthood?

Most cases of scoliosis are mild, involving small curves in the spine that do not get worse. Small curves usually do not cause pain or other problems. Usually a doctor examines the child every 4 to 6 months to watch for any changes. In moderate or severe cases of scoliosis, the curves continue to get worse.

Scoliosis - What Happens When You Have Scoliosis: Healthwise ..


What is scoliosis of the neck?

Scoliosis - a lateral (or sideways) curve of the spine in one or more places - is most frequently seen in children and adolescents. ... Scoliosis can affect the spine in three sections: the cervical (neck), thoracic (chest region), and lumbar (lower back).

Scoliosis in Adults: An Overview - HSS


Can Scoliosis cause pain?

Most of the time scoliosis does not cause pain in children or teens. When back painis present with scoliosis, it may be because the curve in the spine is causing stress and pressure on the spinal discs, nerves, muscles, ligaments, or facet joints. It is not usually caused by the curve itself.

Scoliosis-Symptoms - WebMD


Can scoliosis cause migraine headaches?

Can Scoliosis Cause Headaches? ... Up to 50% of headaches can be attributed to neck problems[1]. Chronic headaches with neck pain usually involve a nerve pressure (subluxation) condition within the neck.

Scoliosis Pain Relief – Scoliosis and Headaches | Hudson Valley ...


Can scoliosis cause pain in the ribs?

These include lung and heart problems, as well as chronic pain in your spine, shoulder blades, and ribs. In regards to scoliosis, most cases are mild. However, severescoliosis can cause back pain and difficulty breathing. ... Your uneven rib cage may leave you feeling twisted around, but have no fear.Apr 7, 2015

Uneven rib cage | Go Ask Alice!


Can sciatica be caused by scoliosis?

While it's possible for scoliosis to cause pain in the sciatic nerve, such cases are unusual. More commonly, patients develop sciatica-like leg pain due to their postural imbalance. Or, in rare instances, the sciatica can even be the underlying cause of the scoliosis.

Is Scoliosis Related to Sciatica Pain? - ScoliSMART


Is scoliosis curable?

Orthopedic surgeons or neurosurgeons are often consulted if surgery is needed. The prognosis for an individual with scoliosis ranges from mainly good to fair, depending on how early the problem is diagnosed and treated. There is no cure for scoliosis, but the symptoms can be reduced.

Scoliosis Symptoms, Treatment & Surgery - MedicineNet


What is a mild case of scoliosis?

Mild scoliosis is a term used to categorize cases of scoliosis that the orthopedic and medical community do not believe require treatment. ... It is also possible for mild scoliosis to cause pain and other health problems. Traditionally mild scoliosis is “treated” with observation.

Mild Scoliosis | CLEAR Scoliosis Institute


What degree of scoliosis requires treatment?

Brace treatment is generally used to prevent scoliosis from getting worse when you have:

  • A curve that is moderate in size (20 to 40 degrees) AND

  • A curve that is progressive (has increased by more than 5 degrees) OR

  • A curve that is over 30 degrees when first diagnosed AND

  • A lot of growing yet to do

Nonsurgical Treatment Options for Scoliosis-OrthoInfo - AAOS



Can you fix scoliosis?

Scoliosis Surgery. Surgery to correct adult scoliosis is an option when nonsurgical treatments do not relieve pain or symptoms. Surgery is also needed for progressive curves or curves causing nerve compression with symptoms such as numbness, weakness, or pain.

Surgical / Non-surgical Adult Scoliosis Treatments - VA, DC, MD


What are the symptoms of scoliosis in adults?

Adult patients may have a variety of symptoms, which can lead to gradual loss of function:

  • Low back pain and stiffness are the 2 most common symptoms.

  • Numbness, cramping, and shooting pain in the legs due to pinched nerves.

  • Fatigue results from strain on the muscles of the lower back and legs.

Adult Idiopathic Scoliosis - Scoliosis Research Society


Can You Reverse Scoliosis with Exercise?

Scoliosis may range from a mild curvature that needs no treatment to a severe abnormality that may require bracing or spinal surgery. Exercises may help in managing or, to some degree, reversing the effects of scoliosis. However, consult with your health care provider for the best way to treat your scoliosis.

Can You Reverse Scoliosis with Exercise? | LIVESTRONG.COM


Can you treat scoliosis without surgery?

Scoliosis Treatment. ... Depending on the degree of curvature and the patient's age, one of three options is generally recommended: do nothing (in cases of mild curvature), wear a scoliosis brace (for mild to moderate curvature when the child is still growing), or undergo scoliosis surgery (in moderate to severe cases).

Natural Scoliosis Care Avoids Braces, Surgery or Wait-and-See


Are there different types of abnormal spine curvature?

There are three main types of spine curvature disorders, including:

  • Lordosis. Also called swayback, the spine of a person with lordosis curves significantly inward at the lower back.

  • Kyphosis. Kyphosis is characterized by an abnormally rounded upper back (more than 50 degrees of curvature).

  • Scoliosis. A person with scoliosis has a sideways curve to their spine. The curve is often S-shaped or C-shaped.

Spine Curvature Disorders: Lordosis, Kyphosis, Scoliosis, and More




Scoliosis treatment, Scoliosis pain, Scoliosis treatments, Scoliosis bracing, Scoliosis brace, Scoliosis exercises, Scoliosis in adults, Scoliosis surgery


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What are the sacroiliac joints?

The sacroiliac joints, also known as the "SI joint" are the two joints on each side of the pelvis that are formed where the sacrum and each one of the iliac bones meets. The sacrum is often called the "tailbone" and the iliac bones are commonly referred to as the "hip bones". However, the portion of the pelvic bones involved with the sacroiliac joints are not part of the actual hip joint.  The general term for the pelvic bones is the "innominate bone". Each one of the innominate bones is actually made up three bones that fuse together as a normal part of human development. The ilium is the bone that your belt sits on and is often commonly called the "hip bone".  The ilium is the part of the pelvis you sit on.  The pubic bone is the lower front portion of the pelvis above and on either side of the genitalia. The sacrum is triangular in shape and is located in the middle line of the lower back below the last lumbar vertebra. Anatomically, the sacrum can be viewed as a modified lumbar vertebra where the spinal canal ends and the last five spinal nerves exit from the spine.  The SI joints function to link the spine to the pelvis. This linkage allows forces, weight, and stress to be transferred between the upper body, pelvis, and legs.

What type of joint is the sacroiliac joint?

The sacroiliac joints are what is known as diarthrodial joints. Diarthrodial joints are joints that have a joint capsule and are lined with hyaline cartilage,  have a synovial membrane, and contain synovial fluid to lubricate the joint. The SI joints are made up of the sacrum and the two innominate bones of the pelvis. Each innominate is formed by the fusion of the three bones of the pelvis. These three bones are the ilium, ischium, and pubic bone.

What are symptoms of SI joint pain?

The presenting symptoms of sacroiliac joint pain can be quite varied. Usually, the pain is below the L5 level in the lumbar spine. Pain is often felt in the pelvis, buttocks, hip, or groin. Sometimes there is a feeling of instability or "giving away" of the low back an area around the sacroiliac joint. Other times the pain can present with more of a neuropathic characteristic with symptoms such as pain, tingling, numbness, and even weakness. These neuropathic symptoms, particularly weakness, should be evaluated by a physician as soon as possible to make sure that the problem is not a herniated disc or other condition that may be causing permanent nerve damage.

People with sacroiliac joint pain also often have trouble sleeping due to the pain. They find themselves having to toss and turn frequently during the night to find a position of comfort. Additionally, prolonged sitting or prolonged standing is difficult for those suffering from SI joint pain. Usually, however, walking helps improve comfort.

What does it feel like when your SI joint is "out"?

The pain felt from inflamed or unstable sacroiliac joints can vary from person-to-person. The pain may only be on one side (unilateral) or it may be on both sides (bilateral). Generally, the pain pattern from sacroiliac joints is axial, staying between the beltline and the knee. It generally is in the lower back, buttocks, groin, and/or thigh. In a significant percentage of cases, however, the pain can extend all the way down to the foot causing sacroiliac joint pain to be confused with pain from a herniated disc.

How do I get my SI joint back in place?

Often, home exercise and stretching can be used to treat sacroiliac joint pain. Prior to resorting to surgical treatment, physical therapy or chiropractic care is usually tried in an effort to correct the problem in a simple of a fashion as possible. The physical therapist or chiropractor can teach you to exercise and stretching techniques to balance the muscles around the SI joint and realign the joint if it is symptomatic. Many patients are able to use these techniques either daily or intermittently as needed to treat their sacroiliac joint.

What causes inflammation of the sacroiliac joints?

Inflammation of the sacroiliac joints is known as sacroiliitis. This can involve one or both of the SI joints. Sacroiliitis is a general term. The specific cause of sacroiliitis can be from a number of possibilities. The most common cause of sacroiliitis is general wear and tear of the joint over time. This is degenerative arthritis also known as osteoarthritis. There is some evidence that the degree of osteoarthritis a person experiences may have a genetic component. However, other factors such as trauma, a long-term heavy strain on the spine, and obesity may accelerate the rate of degenerative arthritis. Another cause of sacroiliitis includes inflammatory conditions such as ankylosing spondylitis or rheumatoid arthritis.

What is in a sacroiliac joint injection?

A diagnostic SI joint injection is used to evaluate and confirm a suspected diagnosis of sacroiliitis/SI joint pain. This is done by anesthetizing (numbing)  the sacroiliac joint with local anesthetics such as lidocaine or bupivacaine. The injection is performed under fluoroscopy (X-ray guidance) for accuracy.

A sacroiliac joint injection is a precision injection performed under fluoroscopic guidance in order to diagnose and/or treat sacroiliac joint pain. A special type of x-ray known as a fluoroscope is used to guide a needle into the joint, inject contrast (dye) for confirmation of needle placement, and then inject local anesthetic and/or anti-inflammatory corticosteroid. Sometimes ultrasound guidance is used instead of x-rays but the x-ray guidance has been shown to be superior in accuracy.

When a sacroiliac joint injection is used for diagnostic purposes, the amount of relief obtained after the injection of local anesthetic is evaluated postoperatively. Opinions vary regarding what degree of relief constitutes a positive result.  Some research advocates relief percentages as low as 50% while the other studies support relief percentages as high as 80 to 100% be used to determine if the pain is actually coming from a sacroiliac joint.

What is minimally invasive sacroiliac joint fusion?

Minimally invasive sacroiliac joint fusion is a relatively new method of stabilizing the SI joints surgically while using much smaller incisions and instruments than in previous techniques. These minimally invasive techniques can be used to treat pain and dysfunction resulting from traumatic disruption of the sacroiliac joints or degenerative sacroiliitis.

What is the recovery time for SI joint fusion?

Recovery from a sacroiliac joint fusion usually takes between two and four weeks. If a fusion is required on only one side instead of two, the recovery process is generally quicker than if both sides require fusion. Patients who have had previous spinal surgery may take longer to heal. Other medical conditions such as diabetes or osteoporosis may slow healing. Additionally, behavioral choices such as smoking can dramatically lengthen the time required for bones to heal. In fact, in other spinal surgeries such as intervertebral fusion, the rate of failed fusion known as "nonunion" can be as much as 10 times higher in smokers than non-smokers.

Si Joint Fusion Success Rate

A recent study evaluated the success rate of minimally invasive sacroiliac joint fusion compared with nonsurgical treatment including other minimally invasive options such as injections and radiofrequency of the nerves on the back of the joints. In this study, it was found that using a 50% reduction as the threshold for diagnosing pain from the SI joint gave equal long-term results in pain relief and functional improvement as using a higher percentage thresholds such as 75%. The authors concluded that using the higher percentage as a diagnostic threshold would not improve the overall outcomes of the minimally invasive fusions but could deny an effective treatment to many individuals who may have gotten substantial long-term relief from the treatment.

In this study, minimally invasive sacroiliac joint fusion reduced pain by 50% or more in 77 to 85% of the subjects treated. Additionally, functional disability was improved and 59.4% to 75% of the subjects treated. As previously stated, the degree of improvement after the surgery was not related to whether a 50% improvement or a 75% improvement diagnostic threshold was used.

What to expect after SI joint fusion

Most patients undergoing minimally invasive sacroiliac joint fusion will remain in the hospital 1 to 2 days.  Icepacks and short-term pain medication may be required in the postoperative period.  Depending on the job the individual has, most people can be back to work within six weeks. Continued improvement may occur for six months to a year after the surgery.


Sacroiliac Joint Dysfunction: SI Joint Pain Treatment - MedicineNet
Sacroiliac Joint Anatomy | SI-BONE
Sacroiliac joint - Physiopedia
Surgery for Sacroiliac Joint Dysfunction - SpineUniverse
Sacroiliac Joint Pain and Inflammation - Arthritis-health
Sacroiliac Joint Dysfunction | Orthopedics & Sports Medicine | Houston ...
Sacroiliac Joint Fusion Surgery Video: iFuse Implant System
Exercises For Sacroiliac Joint Pain - Do-It-Yourself Joint Pain Relief
SI Joint Surgery | The iFuse Implant System | SI-BONE
Sacroiliac (SI) Joint Pain: Symptoms, Causes, and Treatment - WebMD
More items...Symptoms of SI Joint Pain - SI-Bone
Sacroiliac Joint Injection - Spine-Health
SI Joint Fusion Surgery - South Denver Neurosurgery

Reelated Conditions/ Search Terms: Arthritis, Lower Back Pain, Sciatic Nerve, Sciatica Nerves, Spinal Stenosis, Knee Pains, Herniated Disk, Degenerative , Pinched Nerve, Sacroiliac Joint, Pain Management



Lumbar Facet Joint Pain

Lumbar facet pain is a common cause of both acute and chronic pain in the low back. Most people experience low back pain at some time in their life. Lumbar facet (zygoapophyseal joint) pain is the cause of this in many of these cases, particularly as people age. The pain usually comes from degenerating facet joints becoming inflamed. Estimates range that from 16% to 41% of patients with chronic back pain without a herniated disc or "radicular" pain extending below the knee, have pain related to the lumbar facet joints.


Over the years, the diagnosis of this condition has been somewhat of a challenge. Conventional studies such as x-rays, CT scans, and MRIs are often inconclusive. Lab tests are also usually not helpful.


Even physical exam findings, although suggestive of facet syndrome, are not conclusive and have shown very poor reproducibility and correlation with diagnostic blocks.


The way that lumbar facet joint pain is usually diagnosed is by anesthetizing the joints using x-ray guided injections known as medial branch nerve blocks. The medial branch nerves are the tiny nerves that come off of the spinal nerve roots and connect to the lumbar facet joints. These tiny nerves and pain signals back down to the nerve root and then on up to the spinal cord and finally the brain where they are interpreted as painful sensations.


Unfortunately, a single diagnostic block is often not helpful. False positive rates with a single diagnostic block can be as high as 49%. In these situations, this invasive test may be no more of effective or informative than flipping a coin. So, given these findings, how do we diagnose lumbar facet joint pain.


In 2013 a study was published in Pain Physician that that reviewed the current literature evaluating the accuracy of a two-block protocol to more definitively diagnose lumbar facet joint pain.


After reviewing a total of 25 studies, the authors in the study found that there was GOOD EVIDENCE for diagnostic facet joint nerve blocks when using a 75% to 100% pain relief as the criterion standard with the dual blocks. The authors found that there was only FAIR EVIDENCE when using a 50% to 74% pain reduction criterion. Using only a single diagnostic block resulted in limited accuracy whether using 50%-74% or 75%-100%.

What is "Facet Syndrome"?

Facet joint syndrome is spinal pain that originates in the joints on the back side of each of the vertebra. These joints are designed to help stabilize the spine as it moves. There are two such joints at each spinal level. Working in unison the joints assist in making it possible for your back to be more flexible and they support and stabilize the spine as it flexes, extends, and rotates.

What causes facet joint pain?

Causes. Facet joint syndrome can be caused by a combination of aging, pressure overload of the facet joints, injury, and/or trauma. As the lumbar discs degenerate, they wear down and begin to collapse.  This degeneration causes the approximation of the facet joints and more weight and pressure is placed on the joints.

What does facet sclerosis mean?

Facet sclerosis is another term for the degeneration of the joints. It is usually referred to in this way to describe the appearance of the generated joints on x-ray images.

What is facet joint tropism?

Facet joint tropism is a difference in shape or size of the facet on one side of the spine when compared with that on the other side. Facet tropism may also describe differences in angulation of the facet joints. Overall, the word tropism describes an asymmetry of a facet joint on one side of the spine compared with the other. facet tropism can occur at one level or several levels of the spine. This condition is not uncommon.  Estimates of the exact frequency of this condition vary widely. However, most experts agree that the incidence is somewhere around one in six people. Some estimates, however, estimate the incidence of facet tropism as high as 70%. Many experts believe that the presence of asymmetry or tropism in the facets had a spinal level increases the likelihood of irregular wear and degeneration at that level.

What are the symptoms of arthritis in the lower back?

There are several different types of arthritis and arthritis can present in several different ways in the lumbar spine, also known as the low back. The most common type of arthritis is osteoarthritis or arthritis that comes from normal wear and tear over time as part of the normal aging process. This is degenerative arthritis as opposed to inflammatory arthritis such as rheumatoid arthritis. Osteoarthritis usually presents as a goal or sharp pain at and around the science of degeneration. This type of arthritis is often associated with bone spur formation. The degeneration or these bone spurs may cause pressure on a nerve root or other nerve structure. If this occurs, a shooting or burning pain may be felt. In some cases, these degenerative changes can place pressure on the nerve to the point that sensation is lost or weakness occurs. In severe cases, enough pressure can be placed on a nerve or nerves to cause paralysis.

How is facet syndrome treated?

The initial treatment of facet syndrome is usually conservative. This may include rest for a few days to allow a decrease of the inflammation.  Icepack treatments over the facet joints are often helpful. Some people find heat more beneficial if the pain is not due to an acute injury.   With heat and ice, however, care must be taken to avoid burning or frostbite of the skin. Over-the-counter medications such as acetaminophen or NSAID's may be appropriate for individuals without contraindications to these medications. Physical therapy or chiropractic care is often used to decrease pain, strengthen core musculature, and improve range of motion.  Sometimes back braces can give symptomatic relief. However, caution must be used to avoid wearing the back braces too much of the time so as to avoid weakening of the core muscles.  Chiropractic care may be helpful to realign the facets and decrease restrictions in motion. For persistent pain from facet syndrome, physicians often prescribe pain medications such as tramadol or other weak opioids. Interventional pain management options such as facet joint injections or medial branch nerve blocks are often prescribed. Although commonly used, injection of corticosteroid anti-inflammatory medication into the joint space itself has shown only limited efficacy in recent research studies. Blocking the nerve to the facet joints, the medial branch nerves, helps physicians confirm the diagnosis of pain coming from the joints. For cases where the pain is persistent, destruction of these nerves with a radiofrequency neurotomy may provide more extended relief. The nerves usually do grow back over a period of time that may range from six months to two years. If they do grow back and the pain returns, the radiofrequency procedure may be repeated.

Lumbar Spinal Stenosis

What is spinal stenosis of the spine?

Lumbar spinal stenosis is a narrowing of the central spinal canal in the lumbar spine (lower back) or the neuroforamina where the spinal nerves exit the spine.  Narrowing of the central canal is called central spinal stenosis.  Narrowing of the neuroforamina is called foraminal stenosis.  Narrowing in either of these areas can cause pain and/or weakness in the extremities as well as multiple other symptoms.  In more severe cases, permanent nerve damage or paralysis can occur.  Spinal stenosis can put pressure on the nerves traveling through the spinal canal and the neural foramina because of a narrowing of the canal or foramina. The most common sites for spinal stenosis of the lumbar spine in the cervical spine (low back and neck).

What is the cause of lumbar spinal stenosis?

Degenerative disc disease and degeneration of the other structures in and around the spine is the most common cause of lumbar spinal stenosis. Degenerative changes are a normal part of the aging process in the body usually accommodates these changes without a large loss in function and with only mild pain as the years go by. However, in some people, the combination of these changes results in a significant narrowing of the spinal canal or the neuroforaminal openings to a degree that the nerves or the spinal cord are impinged or compressed. When this occurs, the person is said to have lumbar spinal stenosis.

Can spinal stenosis be caused by an injury?

Lumbar spinal stenosis can be caused by trauma or injury to the spine. Such trauma may involve a motor vehicle accident or fall. Other possible injuries may occur when a disc is herniated due to a personal lifting while not using proper technique. Such injuries may result in the nerves or spinal cord being compressed, resulting in lumbar spinal stenosis.

Is Spinal Stenosis bad?

There are several degrees of severity with lumbar spinal stenosis. This severity can range from very mild to very severe. In most cases, the mild to moderate degrees of stenosis caused little if any reduction in overall function. Usually, in these cases, there is little if any pain associated with the narrowing of the spinal canal or neural foramina caused by the stenosis. The person may, however, have pain associated with herniated discs or arthritic degenerative joints. With the more severe cases of spinal stenosis, there may be pain associated with activity and sometimes even at rest. One of the classic symptoms of lumbar spinal stenosis is known as neurogenic claudication. With this condition, the nerves do not get enough blood supply during activities such as walking. Therefore, when the person walks, they begin to have both pain and weakness with extended exertion. However, when they sit down for a few minutes, the problem resolved and they are able to get up and walk for a distance once again. However, when more blood supply is needed during this next bout of activity, the pain and weakness resume. In very severe cases,  a condition known as cauda equina syndrome may occur.   In cauda equina syndrome, nerve damage can occur that may result in incontinence of bowel and/or bladder control as well as possible paralysis. If these symptoms occur, it is a medical emergency that must be treated quickly, usually with surgery, in order to prevent the symptoms from being permanent. Sometimes, however, even with appropriate and timely surgical intervention, the nerve damage can be irreversible.

Can exercise help spinal stenosis?

Doctors often refer people with spinal stenosis to physical therapists or prescribe home exercise programs. Some physical therapy protocols may be beneficial with lumbar spinal stenosis. Although the exercise will not reverse the degeneration, some protocols can help decrease the extent of bulging discs and can help strengthen the core muscles that support the spine. Exercise may be conducted either in the setting of a physical therapy office, with home physical therapy, or with a home exercise program. If exercise brings on pain or other symptoms, the person should not try to "work through the pain". Instead, they should discuss these occurrences with their physician

Can physical therapy cure spinal stenosis?

Physical therapy does not usually "cure" lumbar spinal stenosis. The therapy may help strengthen muscles, improve coordination, improve function, and help relieve some of the pain associated with the more severe cases of lumbar spinal stenosis. Some of the techniques that physical therapist used to help patients with this condition include Williams Flexion Protocol, electrical stimulation, traction, ice, and heat among other physical therapy modalities and treatment protocols.

Is lumbar spinal stenosis curable?

While there is no cure for lumbar spinal stenosis, there are several treatments.  Many if not all of the symptoms associated with lumbar spinal stenosis such as pain and numbness in the legs can be reduced or even eliminated with these treatments. These treatments range from simple home exercise programs to extensive surgical decompression in the more severe cases.

Can you get surgery for spinal stenosis?

There are many surgical options for lumbar spinal stenosis, depending on where the narrowing is occurring and the severity of stenosis. Many of the surgical treatments such as the MILD technique or minimally invasive endoscopic laminectomy techniques can be performed with small incisions and relatively short recovery times. In other cases, more extensive surgical decompression is necessary. Sometimes, there is residual pain that has to be treated as well. This may require medications, further therapy, injections, or neuromodulation with devices such as spinal cord stimulators.

How long does it take to recover from a back operation?

Most people are able to return to a reasonable degree of activity fairly quickly. However, it usually takes several months for the healing in bones to reach maximum strength. It is not uncommon for some patients to take up to a year or more to obtain maximum improvement. While some of the minimally invasive surgeries may require only a few days for a person can return to sedentary activity, more extensive surgeries such as laminectomies and surgical fusions usually require people to be off work for at least 4-6 weeks. The person has a strenuous job, they may be able to return to light-duty after 4-6 weeks but it may take significantly longer for them to be able to return to full duty. Even with successful surgery, some people may not be able to return to their former level of activity, especially if their job required them to do a large amount of heavy lifting, bending, and twisting. For these individuals, it may be necessary to find a job that has lower physical requirements.

How do you prevent spinal stenosis?

Some factors that lead to lumbar spinal stenosis can be prevented but others cannot. Avoiding trauma is the most obvious way to prevent spinal stenosis from occurring. However, there does seem to be a genetic component that current technology cannot prevent. Some of the factors that can help prevent the development or worsening of lumbar spinal stenosis include avoiding tobacco. Use of tobacco products, even smokeless, has been linked to increased back, poor healing, and accelerated degeneration of the spine. Good posture can help prevent degeneration of the lumbar spine to some degree. This is because good posture helps avoid uneven pressures on the various structures of the spine. Regular exercise helps maintain both flexibility and good muscle tone to support the lumbar spine. Finally, maintaining a healthy weight is important since obesity add significantly to the weight burden that the spine has to support year after year. These lifestyle changes can both help prevent and may help reduce the symptoms of lumbar spinal stenosis.
Spinal stenosis - Overview - Mayo Clinic
Lumbar Spinal Stenosis: Learn About Symptoms and Surgery
The Good and Bad News About Spinal Stenosis - Everyday Health
Exercises for Lumbar Spinal Stenosis - Spine-Health
Lumbar Spinal Stenosis | Johns Hopkins Medicine Health Library
Spinal Stenosis Causes | Osteoarthritis, Herniated Disc, Spinal Injury
Lumbar Spinal Stenosis-Prevention - WebMD
Lumbar Spinal Stenosis: Should I Have Surgery? | Michigan Medicine
Physical Therapy for Spinal Stenosis-Topic Overview - WebMD
Spine surgery - discharge: MedlinePlus Medical Encyclopedia

What is a  Pinched  Nerve?

The term “pinched nerve” is used to describe the condition when a nerve is being  compressed by the surrounding tissues

What are some of the symptoms of a pinched nerve?

Some signs and symptoms associated with pinched nerves include changes in sensation or numbness along the distribution of the nerve.

Sometimes a burning pain that may have an aching or sharp quality can be associated with a pinched nerve.

When a nerve is pinched and not functioning properly, you may get the feeling that your foot or hand has fallen asleep.

 What causes a pinched nerve?

There are many causes of nerve compression. For instance, in the case of a herniated disc, the center of the disc is often protruding out into the spinal canal causing compression on a nerve or the spinal cord. In carpal tunnel syndrome,  thickening of ligaments, inflammation of  tendon  sheaths, and/or arthritic changes can cause pressure over the median nerve. Sometimes, repetitive stress is from work, hobbies, or other activities can cause thickening of tissues and pressure on nerves. Obesity is also associated with  increased incidence of nerve compression.

Sometimes inherent differences can lead to increase risk of certain problems. For instance, women tend to have smaller carpal tunnels so they are more prone to get carpal tunnel syndrome than men.

Women tend to also have increased risk of nerve compression during pregnancy because of water retention and weight gain during that time.

Inflammatory processes such as rheumatoid arthritis can cause changes in bones and joints as well as inflammatory changes in surrounding tissue that can compress nerves.

Having conditions like thyroid disease or diabetes can increase the likelihood of having nerve compression.

Sometimes occupational risk or activities can increase the risk of having a pensioner. Examples of this include jobs with highly repetitive movements such as assembly-line work.

Pinched nerve - Symptoms and causes - Mayo Clinic

Pinched Nerves Can Cause Back and Neck Pain - What is a pinched ...

Pinched Nerve: Symptoms, Treatment & How to Fix a Pinched Nerve

Cortisone Injections: What are they?

Cortisone, also known as corticosteroid, shots are injections that may help relieve Inflammation and associated pain in various parts of the body. They're most commonly injected into joints-- such as your ankle, elbow, hip, knee, spine, wrist as well as shoulder. Even inflammation in the small joints of the hands and feet might benefit from corticosteroid shots. When these injections are given, your doctor will often use image guidance like ultrasound or fluoroscopy to make sure that the needle is in the correct position before injecting the medication.

What Kind of Medication is Used?

The medication injected usually includes a local anesthetic like Xylocaine or Sensorcaine along with a corticosteroid such as triamcinolone, Depo-Medrol, or dexamethasone. Corticosteroid injections are usually performed in an office setting if they are in peripheral joints such as the ankle, elbow, hip, knee, or shoulder. Injections in smaller joints such as wrists, ankles, fingers, and toes are also usually performed in an office setting. Corticosteroid injections of deeper structures such as the spine may be performed in a specialized procedure suite in an office or may be performed in a hospital or an ambulatory surgery setting.

What Can I Expect?

In most cases, your doctor will numb the area of the injection prior to injecting the corticosteroid. This is particularly true if the injected steroid is composed of suspended crystals as in the case of Depo-Medrol or triamcinolone. However, if a particle free formulation such as dexamethasone is used, your doctor may be able to use a very thin needle that is much less painful and may not require the discomfort of an injection for local anesthetic.

How Many Steroid Injections Can I Have?

There is usually a limit on the number of corticosteroid injections you can receive in one year because of potential side effects of receiving too much corticosteroid medication. Your doctor can assess the risks and recommend appropriate dosages. However, recent research has indicated that beneficial effects of corticosteroid injections in some parts of the body can be obtained with much lower dosages than we had previously thought.
Some of the conditions that corticosteroid injections can be helpful for include herniated discs, rheumatoid arthritis, tendinitis, bursitis, gout, carpal tunnel syndrome, and plantar fasciitis. In addition to these problems, steroid injections have been used to treat many other inflammatory conditions.

What Are Some of the Risks Associated with Steroid Injections?

Corticosteroid injections, however, are not without risk. Some of the potential side effects or complications of these injections include:

  • Bleeding
  • Infection
  • Steroid flare (temporary flareup in pain at the site of the injection)
  • Thinning or weakening of bone (Osteopenia or Osteoporosis)
  • Color changes in the skin around the site of the injection.
  • Osteonecrosis or death of bone
  • Elevations in blood glucose
  • Temporary decrease in immunity from infection

As a general rule, you shouldn't obtain cortisone injections more than three or four times a year.  The main limitation is the total dose of corticosteroid per year.  Your doctor can advise you on the current recommendations.

The area around the injection site is cleaned up. Your medical professional could additionally apply an anesthetic spray to numb the area where the needle will be placed. In many cases, your doctor could use ultrasound or a kind of X-ray called fluoroscopy to see the needle's progression into the targeted structure-- to assure it in the ideal place.

You'll likely feel some pressure when the needle is inserted. If you have a lot of discomfort, let your physician know.

The medication is then injected. Generally, cortisone shots consist of a corticosteroid medicine to alleviate pain and inflammation gradually and also an anesthetic to supply prompt pain alleviation.

After the cortisone shot.

Some individuals have soreness and also a sensation of warmth of the upper body and also face after a cortisone shot. A cortisone shot might raise your blood sugar levels if you have diabetics issues.

Outcomes of cortisone shots generally depend on the reason for the treatment. Cortisone shots commonly create a short-term flare hurting and inflammation for as much as 2 days after the injection. Afterwards, your pain and also inflammation of the affected joint will likely reduce and the relief could last several months.

References/Additional Resources:

Should You Get a Cortisone Steroid Shot? - Arthritis-health

Cortisone shots - Overview - Mayo Clinic

Q&A: Can Cortisone Injections Ease My Joint Pain? – Health ...


In this video, see the difference between a standard cervical fusion and the Mobi-C artificial disc.

Find out more about this alternative to cervical fusion HERE.


Adam I. Lewis, MD, FAANS ABNS Board Certified Neurosurgery

Spinal Cord Stimulator


At Jackson Neurosurgery Clinic we offer MRI compatible spinal cord stimulation for chronic neck and back pain as well as radiating arm and leg pain.

Dr. Adam Lewis and Dr. John Adams provide a multidisciplinary and comprehensive approach to managing pain.

Dr's Lewis and Adams were the first in the Southeastern United States and one of the first in the U.S. to trial and implant the new Montage pulse generator from Boston Scientific.

Boston Scientific Precision Montage MRI Compatible Spinal Cord Stimulator advances neuromodulation technology with their Illumina 3D Algorithm and Multiwave Platform.

This new system offers multiple advantages and hope to people suffering with chronic pain in the back and extremities.

Boston Scientific describes some of these advantages as follows.


* Full-Body MRI. Multiple Waveforms.
Providing access to Full-Body MRI Scans, Precision Montage delivers Multiple Waveforms, all powered by Illumina 3D. No longer compromise Pain Relief for Full-Body MRI — Precision Montage MRI couples the most advanced programming proven Illumina 3D to provide excellent pain relief and Full-Body MRI.


with Heat-Canceling Technology
The Avista™ MRI Lead is the only lead designed using advanced Heat Canceling Technology for safe access to Full-Body MRI Scans. The layers of the lead were engineered to work together to cancel out the RF waves that cause heat, creating a safe environment for MRI scans. This unique construction was also designed for optimal steering and durability.


Pain is dynamic, and every patient is unique. With the MultiWave Platform, you can offer customized pain relief using Waveforms that are as unique as your patient’s pain. Each waveform can be precisely targeted using our Illumina 3D Algorithm, and delivered through a system that offers your patients safe access to Full-Body MRI scans.

* MR Conditional Statement

The Precision Montage™ MRI SCS System provides safe access to Full-Body MRI Scans only when used with the Avista MRI Leads and exposed to the MRI environment under the specific conditions defined in the ImageReady MRI Full-Body Guidelines for Precision Montage™ MRI Spinal Cord Stimulator System.




It appears that moderate coffee consumption may be healthy after all. In a recent study published in the Annals of Internal Medicine, coffee consumption is associated with an overall reduced risk of death.

The study was published in the August 15, 2017 edition of the Annals of Internal Medicine. It was entitled "Association of Coffee Consumption With Total and Cause-Specific Mortality Among Nonwhite Populations” and its primary funding source was the National Cancer Institute.

The participants included 185,855 individuals from various ethnic descent age 45-75 years old at time of recruitment. The study was a prospective population-based cohort study that was started between 1993 and 1996.

The outcomes measured were total and cause specific mortality (death rate).

During this time period, coffee consumption was associated with lower risk of death in all ethnic populations studied. Native Hawaiians, however, did not reach statistical significance in the lower risk of death. Overall, however, the trend toward a lower risk of death was very significant with a P value <0.001.  The trends between caffeinated and decaffeinated were similar.

The improvement in death rates was observed for patients with several diseases including heart disease, cancer, respiratory disease, stroke, diabetes, and kidney disease. Improved overall risk of death was also noted in individuals who did not report having a chronic disease.

The researchers found that individuals drinking one cup of coffee a day  had a “hazard ratio” for death from all causes that was 9-15% less than non-coffee drinkers. Individuals drinking 2-3 cups of coffee per day had a 14-21% improvement. Those drinking > 4 cups per day showed a 13-22% improvement.

The authors of this study concluded that:

"Higher consumption of coffee was associated with lower risk for death in African-Americans, Japanese Americans, Latinos, and whites."

Park S, Freedman ND, Haiman CA, Le Marchand L, Wilkens LR, Setiawan VW. Association of Coffee Consumption With Total and Cause-Specific Mortality Among Nonwhite Populations. Ann Intern Med. 2017;167:228–235. doi: 10.7326/M16-2472

Sacroiliac Joint Shape Research

A recent study in Pain Physician studied the question regarding whether or not the shape of a person's sacroiliac joint can make a difference as to whether or not they have sacroiliac joint pain.

Sacroiliac Joint Pain

Sacroiliac joint pain is a common problem that accounts for 10-25% of chronic low back pain. However, in patients who have previously had surgery or trauma to the lumbar spine and/or pelvis, the rate can be much higher. Some studies have documented rates of sacroiliac joint pain as high as 75% in patients that have had previous lumbar fusions.

Sacroiliac Joint Pain Diagnosis

Although this problem is quite common, diagnosing it is somewhat of a challenge. Regular studies such as x-rays, CT scans, and MRI scans do not usually show significant findings in the majority of people with sacroiliac joint pain. Physical exam for sacroiliac joint pain is notoriously inconsistent and unreliable for most of the provocation tests. Using a combination of physical exam tests can give a significantly higher likelihood of accurate diagnosis. Even with this, however, the accuracy of the physical exam is only about 80%. The gold standard for diagnosing sacroiliac joint pain is a diagnostic sacroiliac joint injection with local anesthetic. Usually, two injections with different anesthetics are required to rule out placebo effect. Even this injection protocol, however, is not perfect and some studies have questioned the sensitivity and specificity of the dual block diagnostic technique.

SI Joint Pain Treatment

Various treatment options ranging from watchful waiting to physical therapy, joint injection, radiofrequency ablation, and SI joint fusion have been used to try to help those suffering from SI joint pain.

Study Details

This study was a case-control study that compared the shapes of the sacroiliac joints and 223 normal controls and 34 patients with sacroiliac joint (SI) pain syndrome.

The researchers used CT scans with 3-D reconstructions of the joints. They then took the scans and use virtual reality to disarticulate and measure the joints.

Using this technique, they were able to classify the shape of human sacroiliac joints into three different classifications. Type 1 was described as “scone-shaped”. Type 2 was described as (auricle-shaped). Type 3 was described as "crescent-shaped”.

SI Joint Shapes

Analysis of the morphologies of sacroiliac joints revealed that the shape of the sacroiliac joint did not correlate with pain in men. In women, however, there was a significant correlation with the likelihood of SI joint pain and the shape of the joint. The authors found that approximately 32% of women with a type 3 (Crescent-shaped) joint at SI pain. Approximately 17.5% of women with type 2 joints at SI pain. Only 5% of women with type I SI joints had SI joint pain.


The authors concluded that:

"SI joint morphologic variability can be classified into 3 types (type 1, type 2, type 3) based on the relative width of the joint at the axis nutation… Type 3 (crescent) morphology was more highly represented in the SI joint pain population."


A recent study published in Anesthesia Essays and Researches in the January-March 2017 edition compared fluoroscopic guided transforaminal epidural steroid injections to conservative management in patients with chronic lumbar radicular pain.

In this study there were 120 patients. The patients in this study ranged from 18 to 70 years old and were randomly divided into two groups. Each of these patients had back pain for less than one year. They were taking medications such as opioid analgesics, nonsteroidal anti-inflammatory drugs, or neuropathic medications such as Lyrica for low back pain associated with unilateral (one-sided) leg pain, symptoms suggestive of sensory impairment in the affected lamb, and imaging suggestive of spinal stenosis or herniated/degenerated disc, and patients with positive straight leg raise test.

By the end of one month, the straight leg raise test had become negative in 98% of those treated with transforaminal epidural steroid injections compared with only 72% of those treated with conservative care.

In regards to becoming pain free, 93.33% of the transforaminal epidural steroid group was pain-free at one month compared with only 23.33% of the conservative care group at one month. The statistical value of this study is highly significant with a P value <0.0001.

The amount of drug required for pain control was also markedly reduced in the transforaminal study group. The average amount of medication reduction in the transfer in group was 94.33% compared with 72.17% in the conservative care group. Again, the findings were highly statistically significant.

The authors concluded that it is, therefore, a reasonably safe procedure to provide short-term pain relief and allow patients to remain active with much reduced analgesic requirements and its associated systemic side effects.