Advanced Spine & Pain Interventions, LLC
12389 Crabapple Rd
Alpharetta, GA 30004

 phone 470.299.1998  fax 470.299.1898Patient Referrals  patient portal

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Diagnostic Services

Medical Evaluation and Physical Examination

At ASPI, each new patient will undergo an in-depth consultation with a Medical Doctor, at which time a detailed history and physical exam will be performed. This evaluation will focus on finding the source of the pain in order to establish a working diagnosis, so that a comprehensive treatment plan can be initiated. In most cases, radiographic information (X-rays, MRI's, CT Scans) are crucial in establishing a diagnosis, so patients are encouraged to bring such films to their initial consultation. If no films are available, they may be ordered by the practitioner (See diagnostic Imaging below).

A treatment plan will be devised involving the patient's input. Regular follow-up visits with a provider will be required to determine the ongoing effectiveness of the plan.

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Referral for Diagnostic Imaging or NEUROLOGICAL Studies

At Advanced Spine & Pain Interventions, we offer referrals for Physical Therapy, Diagnostic Imaging, Neurological Studies and Surgical services. Please contact us to find out how to get a referral.

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Brachial Plexus Block

A brachial plexus injury affects the nerves responsible for communication between the spine and the arms, shoulders and hand. This condition occurs as a result of stretched or torn nerves, which is most commonly associated with contact sports. A brachial plexus injury may also be caused by tumors, falls, congenital defects, inflammation or car accidents. Depending on its severity, the symptoms of a brachial plexus injury may vary. Patients with mild brachial plexus injuries may experience weakness and numbness or a burning sensation in their arm, while patients with severe brachial plexus injuries may experience loss of shoulder and elbow control, inability to use their fingers and inability to move or feel their arm.

A brachial plexus block can be performed with only a local anesthetic, although sedation is an option for anxious patients. Once the local anesthetic has taken effect, the skin surrounding the affected area will be cleaned. With the assistance of x-ray and contrast dye, a needle is inserted. Once the needle is situated properly, the medicine is injected. You will be monitored after the procedure is completed. The pain you have been experiencing should be reduced almost immediately, but the length of time it lasts varies from patient to patient.

At Advanced Spine & Pain Interventions, we offer two types of Brachial Plexus Blocks:

  • Axillary - hand, wrist and forearm
  • Interscalene - neck

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Caudal Steroid Injection

A caudal steroid injection is a minimally-invasive procedure for treating leg and lower back pain. Once a local anesthetic has numbed your skin, a small needle will be placed through your tailbone and into the epidural space. Once the needle is properly situated, the medicine will be injected.

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Celiac Plexus Block

A celiac plexus block is a procedure performed to relieve severe abdominal pain by blocking the signals of nerves in the stomach, intestines, liver, pancreas, adrenal glands and other organs around the midsection. The injection will provide a dose of anesthetic to numb the area and produce immediate pain relief as well as a medication such as a corticosteroid or alcohol that will provide much longer-term respite from pain and related symptoms.

A celiac plexus block is generally conducted with the patient lying on his or her stomach. The skin surrounding the affected area will be cleaned. With the assistance of an X-ray and contrast dye, the needle is inserted. Once the needle is situated properly, the medicine is injected. The procedure typically lasts for 30 minutes. You will be monitored after the procedure is completed. The pain you have been experiencing should be reduced almost immediately, but the length of time it lasts varies from patient to patient.

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Cervical Epidural Steroid Injection

Brachial Plexus Block | Caudal Steroid Injection | Celiac Plexus Block | Las Vegas NV | Henderson NV | Summerlin NV The cervical vertebrae are essentially the neck vertebrae. When neck pain is present as a result of a pinched nerve or nerve irritation, often the best solution is a cervical epidural steroid injection. During the procedure, an anti-inflammatory steroid is injected directly into the epidural space, flooding the nerve with the powerful medication. The entire procedure is performed using fluoroscopy guidance, to ensure patient safety and surgical accuracy. You can think of fluoroscopy as a sort of real-time x-ray imaging.

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Cervical Selective Nerve Root Block

A cervical selective nerve root block is an epidural steroid injection used for treating shoulder, upper back, neck, and arm pain. This injection can also determine whether your pain is being caused by disc problems or nerve root inflammation. While MRIs and other imaging tests are helpful in locating the source of pain, they may not be able to identify torn or leaking discs, which can be detected by a cervical selective nerve root block.

A cervical selective nerve root block is performed under local anesthesia; in some cases, an intravenous line may be used as well. Once your skin is numb from the local anesthetic, your doctor will insert a small needle into the epidural space, which protects the spinal cord and its nerves. Fluoroscopy or other imaging technologies may be used to verify that the needle is positioned properly. Once the needle is in the correct place, your epidural space will be injected with an anesthetic and a steroid.

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Discography

Discography, or a discogram, is an injection that helps doctors locate a painful disc before performing lumbar fusion surgery in patients whose pain has not responded to conservative treatments. A discogram may be ordered when other diagnostic injections have failed to pinpoint the source of the pain, which may affect the back, legs, groin or hips.

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Epidural Steroid Injection

Epidural steroid injections, or ESIs, are a minimally invasive treatment that has been used for decades to temporarily relieve low back and leg pain (sciatica). They have been shown to be effective for pain in the neck (cervical) and mid-spine (thoracic) as well. While they do not treat serious underlying spinal conditions, ESIs are often effective in relieving the chronic pain these conditions often cause.

Comprised of cortisone and a local anesthetic or saline solution, ESIs work by reducing inflammation and flushing out particles that cause swelling and pain. Medication is delivered directly to the source of the pain rather than dispersing it throughout the body, as oral painkillers and steroids do. They are injected into the epidural space, the area between the dura (a membrane covering the brain and spinal cord) and the actual cord itself.

We provide epidural steroid injections in the lumbar and thoracic parts of the spine.

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Facet Joint Injections

A facet injection is a minimally invasive treatment option for back pain caused by inflamed facet joints, which may develop from spinal stenosis, sciatica or arthritis, and is characterized by neck, arm, low back or leg pain. Each vertebra has four facet joints that connect it to the vertebra above and below. The injection may also be used for diagnostic purposes.

Facet injections are composed of a combination of long-lasting steroid and a local anesthetic that are injected either into the joint capsule or its surrounding tissue. The steroid reduces inflammation and can relieve pain for a few days to a few years. This treatment can be repeated up to three times a year for those patients who experience successful but short-term pain relief.

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Kyphoplasty

Kyphoplasty is a minimally-invasive procedure to relieve pain from vertebral compression fractures, affecting the bones from which the spinal column is comprised. This procedure is usually performed on patients whose vertebral fractures have occurred as a result of osteoporosis. For best results, kyphoplasty should be performed within two months of the fracture's occurrence.

Kyphoplasty is performed as an outpatient procedure under sedation, although general anesthesia may also be used; therefore, you will need a friend or relative to drive you home afterward. You will be lying facedown for the duration of the procedure, which lasts around an hour. Once the sedative and/or general anesthesia has taken effect, the skin surrounding your spine will be sterilized and shaved, and a tiny cut will be made in the area. With x-ray assistance, an empty needle known as a trocar will be inserted into the spine until its tip is positioned evenly with the fractured vertebra. A balloon is then inserted though the needle and inflated, reverting the bone to its original shape and creating a cavity. The balloon is then removed and orthopedic cement is injected into the area, filling the cavity. Finally, the trocar is removed, pressure is applied to stop bleeding, and a bandage is placed around the skin.

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Lumbar Disc Microsurgery

The lumbar spine refers to the lower area of the spine between the pelvis and thoracic cage. Lumbar disc microsurgery, also known as microdiscectomy, is performed to relieve pressure on nerve roots. It is usually reserved for patients with severe symptoms that do not respond to more conservative treatments and significantly affect the patient's quality of life.

Lumbar disc microsurgery is effective in relieving lower back and leg pain caused by lumbar disc herniation. A herniated disc is a common condition that occurs as a result of gradual wear and tear or an injury to an intervertebral disc, causing it to bulge and break open. Patients with this condition often experience pain, numbness and weakness in the affected area, as well as through the legs.

During lumbar disc microsurgery, an incision is made in the back at the location of the affected disc, and the muscles are lifted away to access the spine. Small surgical instruments and a microscope are inserted into this incision to repair the affected disc using minimally invasive techniques. Once the targeted nerve root is identified, the disc is removed from under the root, and a small portion of the facet joint may be removed as well to relieve pressure on the nerve.

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Lumbar Sympathetic Block

Kyphoplasty | Lumbar Disc Microsurgery | Lumbar Sympathetic Block | Clark County NV | Las Vegas NV | Henderson NV | Summerlin NV The lumbar sympathetic nerves are a small group of nerves that carry pain signals from the lower extremities. A lumbar sympathetic block is a minimally-invasive procedure to determine whether the sympathetic nerves are causing your pain. In some cases, it may even provide you with full pain relief.

A lumbar sympathetic block injection only takes a few minutes, although you will likely remain in our office for an hour; this includes consulting with your doctor before the procedure, positioning for the procedure, and recovery room observation afterwards. During the procedure, you will be lying down on your stomach. Only a local anesthetic is necessary for a lumbar sympathetic block, although sedation is an option for anxious patients. Once the local anesthetic has numbed the skin on your back, you will receive the injection.

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Medial Branch Block

A medial branch block is a minimally-invasive procedure to diagnose and treat neck or back pain. This procedure can determine whether a facet joint-which connects the bones of your spine, providing support as you move-is the source of your pain. Next to the facet joints are the medial branch nerves, which transmit pain signals from these joints to your brain.

Before undergoing a medial branch block, you will be given intravenous medication to help you relax. With the assistance of imaging technologies, a small needle will be inserted near your medial branch nerve. Once it is situated properly, an anesthetic will be injected through it.

The effectiveness of a medial branch block varies depending on your individual condition. Patients whose pain returns after a short period of time may require a different form of treatment if it is confirmed that the facet joint is not the source of the pain.

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Medication Management

Over-the-counter anti-inflammatory medications are often the first treatment utilized to relieve chronic pain. Corticosteroids and stronger prescription medications such as Morphine may also be recommended as an initial treatment. Our doctors try to minimize pharmaceutical treatment by recommending appropriate alternate techniques whenever possible.

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Percutaneous Disc Decompression

Medication Management | PRP Therapy | Radiofrequency Neurotomy | Las Vegas NV | Henderson NV | Summerlin NV  A percutaneous discectomy - also known as "disc decompression" - is a surgical procedure that removes part of an impinged intervertebral disc in order to relieve pain, weakness and numbness throughout the body. It is usually reserved for patients with severe symptoms that do not respond to more conservative treatments, and significantly affect the patient's quality of life. The discectomy procedure is performed under general anesthesia. An incision is made from which the herniated section of the disc is removed using a "decompresser."

 

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Platelet Rich Plasma Therapy (PRP)

PRP therapy is a revolutionary new treatment option that relieves pain associated with musculoskeletal conditions. It has been used on famous athletes such as Tiger Woods and is an accepted form of therapy in pain, orthopedic and sports medicine practices throughout the USA. If you suffer from disabling pain and other treatments have failed this therapy may just be for you! The treatment involves taking a small amount of your own blood and spinning it in a centrifuge in order to separate the platelet rich plasma, which carries the cells that promote repair and healing and then injecting them into the problem area. The procedure is fast and there is no recovery time required.

PRP Treats the Following Conditions:

  • Shoulder: Rotator Cuff Tendinitis or Tear, Rotator Cuff Impingement Syndrome or Bursitis, Bicipital Tendinitis, labrum tears, arthritis, instability
  • Wrist/Hand: DeQuervaine's Tenosynovitis, arthritis, other wrist or finger tendinitis, ligament tears or dysfunction of the fingers
  • Elbow: Medial and lateral epicondylitis (tennis & golfers elbow)
  • Hip: IIliotibial Band Tendinitis (ITB Syndrome), Psoas Tendinitis and bursitis, Greater Trochanteric Bursitis, Hip labrum tears, Piriformis Syndrome, Sacroiliac Joint Dysfunction, arthritis
  • Knee: Patellar Tendinitis, Patellar Femoral Syndrome, chondromalacia patella, partially torn or strained major ligaments of knee (ACL/LCL/MCL), meniscus tears, arthritis, patellar instability
  • Ankle/Foot: Achilles Tendinitis, Peroneal Tendinitis, arthritis, recurrent ankle sprains, other foot or ankle tendinitis

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Radiofrequency Nerve Ablation

The nervous system of the body is the network through which important messages are sent at extremely high speeds. These messages can be vital to the human's survival, but in some cases can be too inflated or erroneous in nature. In these cases, the extra notes transferring through the system can be converted into disproportionate amounts of pain, especially when a nerve cord itself is disturbed. Radiofrequency nerve ablation is used to dull these messages superficially, so they either cease to exist or resemble the relevant amount of pain.

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Radiofrequency Neurotomy

Medication Management | PRP Therapy | Radiofrequency Neurotomy | Las Vegas NV | Henderson NV | Summerlin NV  A radiofrequency neurotomy is a treatment option for facet joint pain that uses heat to interrupt pain signals sent to the brain. It is administered as an injection of heat onto the medial branch nerves, which carry pain signals from the facet joints. The heat creates a lesion that interrupts the signals sent from these nerves and therefore relieves pain.

The pain relief from this procedure generally lasts 9-14 months, although it can last for up to 2 years for some patients. Others may not experience any relief from the procedure. Results are usually felt 2-3 weeks after the neurotomy. This procedure may be repeated if the pain recurs. While a neurotomy destroys nerve signals and the ability to feel certain joints, there is no evidence that this will cause later injury or damage to other joints.

We offer radiofrequency neurotomy treatments for the cervical facet (neck/shoulder), lumbar (lower back), and thoracic facet (upper back) areas of the spine.

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Sacroiliac Joint Steroid Injection

Trigger Point Injections | Sacroiliac Joint Steroid Injection | Las Vegas NV | Henderson NV | Summerlin NVSacroiliac (SI) joint injections help doctors diagnose and relieve lower back pain caused by problems within the sacroiliac joint, which connects the base of the spine (sacrum) to the hip. Steroids, along with a local anesthetic and saline solution, are carefully injected into the SI joint to reduce swelling and pain. As with other spinal blocks, if an SI injection successfully improves discomfort, it may be given up to three times per year.

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Transforaminal Epidural Steroid Injection

A transforaminal injection is a long acting steroid delivered into a nerve root exit in the spine known as a foramen. The injection helps to reduce inflammation and swelling in the spinal cord nerve roots and relieves pain and numbness. A transforaminal injection consists of a small dosage of steroid medication mixed with saline and local anesthesia. The anesthesia numbs the area so the injection often feels like just pinching and pressure.

Immediate pain relief is found because of the injection of anesthesia, but this wears off quickly. Effective relief is usually noticeable by the third day after the injection and can last for several months. This treatment is most successful for patients with pain that radiates through the arms or legs rather than just back or neck pain.

At Advanced Spine & Pain Interventions, we offer transforaminal injections in the cervical, lumbar, and thoracic parts of the spine.

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Trigger Point Injections

Trigger Point Injections | Sacroiliac Joint Steroid Injection | Las Vegas NV | Henderson NV | Summerlin NVTrigger point injections are a treatment option for pain in areas that contain trigger points, or knots of muscle that form when muscles do not relax. These points can also irritate nerves around them and therefore cause pain in other areas of the body. A needle containing a local anesthetic (and sometimes a steroid as well) is inserted into the trigger point to make it inactive and therefore alleviate the pain.

The procedure takes just a few minutes and is done in the doctor's office. It is very safe and has minimal side effects. Trigger point injections not only relieve pain, but also loosen the muscles which are causing the pain to therefore help with the rehabilitation process.

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Spinal Cord Stimulator Trial

Spinal Cord Stimulator Trial | Las Vegas NV | Henderson NV | Summerlin NVA spinal cord stimulator is an electronic device that is implanted in the body to help relieve chronic pain. Also known as a dorsal column stimulator, the device sends low electrical currents through wires placed near the spinal cord to treat pain. It allows patients to control when pain relief is needed or not.

The device does not cure chronic pain, but usually provides a 50% or greater decrease in pain and allows patients to be more active and have less of a need for pain medication. This procedure is usually considered when other solutions, such as surgery, injections and medications, have failed. Before implantation, patients will often be asked to go through a trial period with an external device. The trial will test patients' pain levels and see if they increase with the help of the device.

During the implantation of the permanent device, wires are fed with a needle and positioned on the spinal cord. The actual device is placed dependent on where the pain is. The device can be removed if necessary. The battery of the device must be replaced every 2 to 5 years. Complications rarely occur as the procedure is very safe and minimally invasive. Proper care following the procedure is required and includes limiting movement and avoiding driving for the first few weeks.

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Conditions

Fibromyalgia: A non-life threatening syndrome that affects the muscles and soft tissue. Symptoms include chronic muscle pain, fatigue, sleep problems, and painful tender points or trigger points, which can be relieved through medications, lifestyle changes and stress management. Presently, there is no cure for Fibromyalgia; however the providers at Advanced Spine & Pain Interventions (ASPI) remain up-to-date on the latest treatment for this chronic syndrome; so life does not have to hurt.

Osteoarthritis: Osteoarthritis (OA) is caused by aging joints, injury, and/or obesity. OA symptoms include joint pain and stiffness. Treatment depends on the affected joint, including the hand, wrist, neck, back, knee, and hip, and conservatively, involves medication and exercise. If you are overweight, weight loss may improve OA symptoms. The Providers at ASPI can intervene at any point by providing medications, weight loss management, physical therapy or injections.

Rheumatoid Arthritis: Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Autoimmune diseases are illnesses that occur when the body's tissues are mistakenly attacked by their own immune system. Treatment depends on the affected joint, including the hand, wrist, neck, back, knee, and hip, and conservatively, involves medication and exercise. The providers at ASPI can intervene at any point by providing medications, weight loss management, physical therapy or injections.

Chronic Pelvic Pain: Chronic Pelvic Pain is pain below the navel. It is considered chronic (which means long-lasting) if you have had it for at least 6 months. The type of pain varies from person to person. In some patients, it is a mild ache that comes and goes. In others, the pain is so steady and severe that it makes it hard to sleep, work, or enjoy life.If your doctor can find what's causing the pain, treating the cause may make the pain go away. If no cause is found, the providers at ASPI can help you find ways to ease the pain and get back your quality of life.

Interstitial Cystitis: Interstitial cystitis is a chronic inflammation of the bladder that causes chronic pain and discomfort. Symptoms often include a sense of urgency and increased frequency of urination. Interstitial cystitis causes mild to severe pain in the bladder and surrounding pelvic area. In about half the cases of interstitial cystitis, the symptoms go away spontaneously. In nearly all instances, though, they return after an average of about eight months.Because there is no cure for interstitial cystitis, the goal of treatment is to relieve symptoms. Not everyone with IC responds the same way to the same treatment. What works for one person may not work for another. The providers at ASPI have a variety of treatment options if you have failed or are not a candidate for surgery or Botox injections. 

Crohn's Disease: Crohn's disease is a chronic inflammatory disease of the digestive tract. Symptoms include abdominal pain and diarrhea, sometimes bloody, and weight loss. Crohn's treatment consists of lifestyle changes, such as exercise and a healthy diet, as well as over-the-counter anti-diarrhetics and prescription anti-inflammatory medication. Presently, there is no cure for Crohn's Disease; however, the Providers at Advanced Spine & Pain Interventions (ASPI) remain up-to-date on the latest treatment for this chronic syndrome; so life does not have to hurt.

Ulcerative Colitis: Ulcerative Colitisis a disease that causes inflammation and sores (ulcers) in the lining of the large intestine (colon). It usually affects the lower section (sigmoid colon) and the rectum. But it can affect the entire colon. In general, the more of the colon that's affected, the worse the symptoms will be. The disease can affect people of any age. But most people who have it are diagnosed before the age of 30. Experts aren't sure what causes it. Presently, the cure for Ulcerative Colitis is removal of the colon; however, if you are not a candidate for surgery the Providers at Advanced Spine & Pain Interventions (ASPI) remain up-to-date on the latest treatment for this chronic syndrome; so life does not have to hurt.

Peripheral Neuropathy:  Peripheral Neuropathy refers to the conditions that result when nerves that carry messages to and from the brain and spinal cord from and to the rest of the body are damaged or diseased. The most common symptoms of peripheral neuropathy include: Tingling, Numbness, Loss of sensation in the arms and legs, and/or a burning sensation in the feet or hands. There are many causes for peripheral neuropathy, including Diabetes or Trauma. Once the nerve is damaged, it is very rarely reversible; however, the Providers at Advanced Spine & Pain Interventions (ASPI) remain up-to-date on the latest treatment for this chronic syndrome; so life does not have to hurt.

Migraines: Migraines and other types of headaches, such as tension headache and sinus headache, are painful. Migraine symptoms include a pounding headache, nausea, vomiting, and light sensitivity. The symptoms are treated with anti-nausea drugs and abortive or preventive medications; however if these options are not helpful or long lasting, the providers at ASPI are experts in Botox injections for responsive migraines.

Pancreatitis: Chronic pancreatitis can be difficult to treat. Doctors will try to relieve the patient's pain and improve the nutrition problems. Patients are generally given pancreatic enzymes or insulin. A low-fat diet may also help. Surgery may help relieve abdominal pain, restore drainage of pancreatic enzymes or hormones, treat chronic pancreatitis caused by blockage of the pancreatic duct, or reduce the frequency of attacks. If these are not an option for you or treatment has failed, the providers offer minimally, invasive blocks to provide relief from severe pain, often, lasting 6 months to one year.

Post-Operative Pain: Effective postoperative pain control is an essential component of the care of the surgical patient. The advantages of effective postoperative pain management include patient comfort and therefore satisfaction, earlier mobilization, fewer pulmonary and cardiac complications, a reduced risk of deep vein thrombosis, faster recovery with less likelihood of the development of neuropathic pain, and reduced cost of care. The providers at ASPI can work closely with your surgeon to consult in your post-operative pain management.