Herniated Cervical Disc MRI

Herniated Cervical Disc MRI

Stress testing of the cervical spine reveals increased pressure to the spine when it is in an upright position. It also includes flexion and extension views (looking upward and downward). When a patient lies down during traditional supine MRI, the stress on the discs is minimal. It may show a slight disc bulge or nothing at all. The disc material is compressed when the table is tilted vertically. This causes the disc material to protrude or herniate, pinching the spinal cord, and causing pain.

In flexion, you look downwards to increase pressure on the disc. This can cause spinal cord compression and herniation growth. Many patients report feeling more pain or numbness at the fingertips. Supine images often fail to show disc herniation and spinal cord compression. MRIs taken in weight bearing or flexion/extension reveal the source of the patient’s pain.

The Stress Test MRI is used to help doctors understand and diagnose positional symptoms. Although patients may feel relief when they lie down, pain, numbness and weakness often increase when the patient is in an upright or weight-bearing posture.

Diagnostic, weight bearing images can show pinched nerves and injured discs. These images may be able to explain the patient’s symptoms in a way that is not possible with traditional supine imaging. Traditional supine MRIs may miss up to 30% of spinal injuries. Ask for a Stress Test MRI if you feel more pain or numbness while standing or sitting. This is your MRI – do not lie down.

Overview

A herniated disc is when the gel-like core of a spinal disc bursts through the tough outer wall. This is similar to how jelly doughnut fillings are squeezed out. When the disc material touches or presses on a spinal nerve, it can cause pain in the neck or arms as well as tingling and numbness. The first steps to recovery include rest, pain medication and spinal injections. Most people feel better within six weeks. They can then return to their normal activities. Surgery may be necessary if symptoms persist.

Anatomy of the Discs

The spine is composed of 24 bones, called vertebrae. The cervical (neck) portion of your spine supports your head weight (approximately 10 lbs) and allows for you to flex your head from side to side and 180 degrees. The cervical vertebrae are numbered from C1 through C7. The discs are shock absorbers that prevent the vertebrae rubbing together. The annulus is the outer ring of a disc. It is made up of fibrous bands that connect between each vertebra’s bodies. The nucleus, a center of gel-filled material in each disc, is located at the middle of each disc. A pair of spinal nerves branch out from your spine at each level. Your spinal cord and spinal nerves function as a “telephone” that allows messages or impulses to travel back-and-forth between your brain, body, and spinal cord to control sensation and movement.

What is a herniated cervical disc?

When the gel-like core of your disc bursts through the disc’s tough disc wall (annulus), it is called a herniated disc. Your spinal nerves are affected by the gel material, which can cause a chemical irritation. The pressure from the herniated disc causes spinal nerve inflammation and swelling, which can cause pain. The herniation will shrink over time and you might experience some or all of the relief that you are seeking. Most cases of neck or arm pain will resolve within 6 weeks.

Normal disc and herniated disc. The nucleus gel material, which is made up of gel and other substances, escapes from the annulus disc and compresses spinal nerves.

A herniated disc can be described using different terms. A bulging disc (also known as protrusion) is when the disc annulus is not damaged but forms an outpouching which can press against nerves. True herniated disc, also known as calming-fluid (or slipped disc), occurs when the disc annulus cracks/ruptures, allowing the gel-filled middle to escape. Sometimes, the herniation can be so severe that a fragment is formed. This means that the disc has been completely removed from the spine.

What are the signs?

The symptoms of a herniated disc can vary depending on where it is located and how you feel about pain. A herniated cervical disc can cause pain radiating down your arm and into your hand. There may be pain near or on your shoulder blades, as well as neck pain when you turn your head or bend your neck. Muscle spasms can occur when muscles tighten and become uncontrollable. Sometimes, the pain can be accompanied by numbness or tingling in your arm. Also, muscle weakness may occur in your handgrip, triceps and biceps.

It is possible that you felt pain the first time you woke up. This could be due to a traumatic event or injury. Some patients find relief by elevating their arm behind their heads, as this relieves pressure on their nerves.

What are the causes of this?

Injuries and improper lifting can cause disc bulging or herniation, or they can happen spontaneously. Aging is an important factor. Your discs become more fragile and dry as you age. The disc’s tough outer fibrous wall may become weaker. A tear in the disc’s outer wall may cause the gel-like nucleus to bulge or burst, causing nerve pain. Early disc degeneration can be caused by genetics, smoking, as well as a variety of occupational or recreational activities.

Who are the affected?

People in their 30s and 40s are most likely to have herniated discs. However, older people and those in middle age are more susceptible to the condition if they engage in strenuous exercise. The neck is home to only 8% of herniated discs.

What is the process of diagnosing a condition?

Consult your family doctor if you feel pain. To understand your symptoms and any previous injuries or conditions, your doctor will conduct a comprehensive medical history. The doctor will also determine if there are any lifestyle issues that may be causing the pain. The doctor will then perform a physical exam to identify the cause of the pain, and check for weakness or numbness.

One or more of these imaging studies may be ordered by your doctor:

Magnetic Resonance Imaging (MRI), a noninvasive scan that uses a magnetic field in combination with radiofrequency waves, gives a detailed view to the soft tissues of the spine. Contrary to X-rays, nerves and discs can be clearly seen. The dye (contrast agent), may be injected into your bloodstream. An MRI will detect the disc that is damaged and any nerve compression. An MRI can detect bone overgrowth, spinal cord tumors or abscesses.

Myelogram, a specialized Xray in which dye is injected through a spinal tap into the spinal canal, is called a myelogram. The images are then recorded by an X-ray fluoroscope. A myelogram is made with a dye that appears white on X-rays. This allows the doctor to see the canal and spinal cord in detail. Myelograms may show pinched nerves due to a herniated disc, bony growth, spinal cord tumors or spinal abscesses. This test may be followed by a CT scan.

The non-invasive CT scan uses an Xray beam and a computer, to create two-dimensional images of the spine. You may be injected with a dye or contrast agent. This test can be used to confirm which disc has been damaged.

EMG (Electromyography) and NCS (Nerve Conduction Studies): EMG (Electromyography) and NCS (Nerve Conduction Studies) measure the electrical activity in your nerves. The results of the electrodes or small needles are placed into your muscles and recorded by a special machine. A herniated disc puts pressure on the nerve root and the nerve can’t supply normal movement and feeling to the muscle. These tests can detect nerve damage or muscle weakness.

X-rays look at the bony vertebrae of your spine. They can show your doctor if they are too close together, arthritic changes or bone spurs. This test cannot diagnose a herniated disc.

Diagnosis of Cervical Radiculopathy Using a Herniated Disc

After reviewing the patient’s medical history and conducting a physical exam, cervical radiculopathy can usually be diagnosed from a herniated disc. To confirm the diagnosis of cervical radiculopathy, the doctor may use one or more provocative diagnostic tests, such as Spurling’s. The test involves the patient being asked to bend or twist their head towards the painful side in order to see if additional pressure can temporarily or permanently trigger the symptoms.

Advanced diagnostics are available if more information is required to confirm the diagnosis. This would most commonly include an MRI scan. It uses a strong magnet that images the cervical spine to show whether a disc has moved onto a nerve root. A CT scan with myelogram, which is dye injected into the spine to view soft tissues, could be used to image the cervical spine if a patient is unable or unwilling to undergo an MRI.

What are the available treatments?

The first step in recovery is conservative nonsurgical treatment. This may include medication and rest, physical therapy, home exercises and hydrotherapy. A majority of arm pain patients with a herniated disc will feel relief within six weeks. They can then return to their normal activities. Your doctor may recommend surgery if you are unable to respond to conservative treatment, or if your symptoms worsen.

Non-surgical treatments

  • Self-care: Most cases of a herniated disc will resolve within two days. Your recovery will be made easier by limiting your activities, using heat therapy and taking over-the-counter medications.
  • Medication: Your doctor might prescribe medication, including nonsteroidal anti-inflammatory drugs (NSAIDs), pain relievers, and steroids. For muscle spasms, muscle relaxers may be prescribed.
  • Aspirin, naproxen, Alleve, Naprosyn, ibuprofen, Motrin, Nuprin and Advil, as well as celecoxib (Celebrex) are nonsteroidal antiinflammatory drugs (NSAIDs). These drugs reduce inflammation and pain.
  • Acetaminophen (Tylenol) can be used to relieve pain, but they don’t have as many anti-inflammatory properties as NSAIDs. Analgesics and NSAIDs can cause stomach ulcers, as well as problems with the kidneys and liver.
  • To control spasms, muscle relaxants such as methocarbamol or Robaxin, carisoprodol(Soma), and cyclobenzaprine/Flexeril may be prescribed.
  • To reduce nerve inflammation and swelling, steroids may be prescribed. They can be taken orally (a Medrol dose packet) in a tapering dose over a 5-day period. It provides pain relief almost immediately within 24 hours.
  • Steroid injections: This procedure is performed under x-ray fluoroscopy. It involves injecting steroids and a numbing drug into the epidural area of the spine. To reduce nerve swelling and inflammation, the medicine is administered directly to the area. Although epidural injections can provide temporary relief for approximately 50% of patients, the effects are usually temporary. To achieve full effects, repeat injections may be necessary. The duration of pain relief can vary, and may last for weeks or even years. Injections can be used in conjunction with physical therapy or home exercise programs.
  • Physical therapy: This therapy helps you get back to your full activity and prevents injury. Physical therapists will help you with proper posture, lifting and walking, as well as strengthening and stretching your neck, shoulder and arm muscles. You’ll be encouraged to stretch your spine and increase flexibility by them. Strengthening and exercise are important elements of your treatment. They should be a part of your daily fitness.
  • Holistic therapies: Acupressure, yoga and nutrition / diet modifications, meditation, biofeedback, and acupuncture are all useful for managing pain and improving overall health.

Surgical treatments

Surgery may be considered if symptoms persist or are not resolved with conservative treatment. Planning surgery takes into account factors such as age, duration of the problem, medical history, past neck surgeries, and the expected outcome.

Anterior (front of neck) is the most common method for cervical disc surgery. If you need decompression due to other conditions, such as stenosis, a posteriori (from your back) approach might be possible.

  • Anterior cervical discectomy and fusion (ACDF): A small incision is made in the neck. To expose the bony disc and vertebrae, the neck muscles, vessels, and nerves are removed. The nerve-pressing portion of the ruptured disc is removed. The herniated material can be removed and the disc space can be filled with bone grafts or cages to form a fusion. Fusion refers to the joining of two or more bones. The graft will eventually fuse to the vertebrae above and below, forming one solid piece. To provide stability and possibly improve the fusion rate, metal plates and screws can be used.
  • Anterior discectomy: A moveable device mimicking a disc’s natural movement is inserted into the injured joint space. Fusion eliminates motion while an artificial disc preserves it. They are made of metal and plastic and look similar to knee and hip joint implants. The outcomes for artificial disc are similar to ACDF (the gold-standard), but cervical disc replacement preserves motion, and may avoid adjacent level disease. However, this hypothesis is still a possibility and has not been proven.
  • Microendoscopic discectomy is minimally invasive. The surgeon makes a small incision at the back of your neck. To enlarge the tunnel from the vertebra, small tubes called dilators are used. To expose the nerve root or disc, a portion of the bone must be removed. To remove the disc, the surgeon can use either an endoscope (or a microscope). This method causes less muscle damage than traditional discectomy.
  • Posterior cervical discectomy: A surgeon makes a small incision at the back of your neck. The spinal muscles are removed to reach the damaged disc. To reach the nerve root, and the disc space, a section of the bony ar is removed. It is important to remove the portion of the damaged disc that is compressing a spinal nerve. To prevent further pinching, the spaces where the nerve roots exit from the spine are often enlarged.

Clinical trials

Clinical trials are research studies that test new therapies, such as diagnostics and procedures, on people to determine if they work and if they are safe. To improve medical care, research is ongoing. You can find information about current clinical trials on the Internet, including details such as eligibility, protocol and locations. The National Institutes of Health, private industry, and pharmaceutical companies can sponsor studies.

Recovery and Prevention

8 out of 10 people experience back pain at some point in their lives. Usually, it resolves in 6 weeks. Regular activity, a positive mental attitude and prompt return to work are important aspects of recovery. It is best for patients to be able to return to a modified or limited duty if your normal job is not possible. You can get prescriptions from your physician for this activity for a limited time.

Prevention is the key to avoiding recurrence.

  • Proper lifting techniques
  • Proper posture is important when sitting, standing, moving and sleeping.
  • A good exercise program is needed to strengthen the abdominal muscles and prevent injury.
  • A well-designed work space
  • Healthy weight and lean body mass
  • Positive attitude and stress management
  • No smoking

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Kevin Pauza, M.D.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Travis Foxx, M.D. - Premier Anesthesiology & Pain

Kevin Pauza, M.D. - Turtle Creek Surgery Center

Prior to attending Penn State University, Dr. Pauza earned his undergraduate degree from Lehigh University, and furthered his training with a Surgical and Medical Internship at Columbia University College of Physicians and Surgeons. He continued his specialty training at the University of Pennsylvania, followed by an Interventional Spine Fellowship. In addition to his research, philanthropic, and clinical endeavors, Dr. Pauza remains a motivated educator. He established a Spine Fellowship program and continues training physicians from around the world. He heads international committees responsible for establishing standards and educating surgical and non-surgical physicians.

After helping hundreds of patients who failed to experience relief after spine surgery, it became evident to Dr. Pauza that current methods needed to change. This motivated him to seek better ways to help patients, by thinking outside the box.

Dr. Pauza is the first physician in history to pursue FDA approval for using biologics to treat the spine. Millions of patients will benefit from his development of minimally invasive treatments for degenerative disc disease and other more common and serious disorders of the spine.

SPECIALTY

  • Disc Biologics
  • Interventional Spine

EDUCATION & DEGREES

  • Fellowship: Interventional Spine, University of Pennsylvania
  • Residency: PM&R, University of Pennsylvania
  • Internship: Surgery & Medicine, Columbia University College of Physicians and Surgeons
  • Medical Doctorate: Pennsylvania State University College of Medicine
  • Bachelor of Arts: Biology, Lehigh University
  • Bachelor of Arts: Psychology, Lehigh University

CERTIFICATIONS & LICENSES

  • Texas State Medical and Surgical License
  • New York State Medical and Surgical License
  • Florida State Medical and Surgical License

HONORS

  • Lehigh University Four-year Academic Scholarship
  • Magna Cum Laude, Lehigh University
  • Lehigh University President’s Award
  • Lehigh University Tower Society
  • Distinguished Alumnus, Penn State University (selected from 500,000 Penn State alumni)
  • North American Spine Society, Outstanding Paper of the Year, 2003
  • President-Elect, International Spine Intervention Society
  • Founding Partner, Texas Spine and Joint Hospital
  • Commencement Speaker: Penn State University College of Medicine
  • Advisory Board, AMA
    Keynote Speaker, Harvard Pain Center Commencement
  • Founding Chairman, Standards Committee, International Spine Intervention Society
  • Chairman, Spine Committee, Amercian Academy of Physical Medicine & Rehabilitation
  • Appointed Spine Advisor, Japanese Prime Minister
  • Appointed Spine Advisor, Allied Royal Families

EXPERIENCE

  • Founding Partner & Principal, Texas Spine & Joint Hospital

Brandon Tolman, D.O. - Nashville Spine Institute

Boris Terebuh, M.D. - Regenerative Spine & Joint Center

Boris Terebuh, MD specializes in providing personalized nonsurgical solutions for spine problems that interfere with the function patients desire and the independence they deserve. Dr. Terebuh completed his Physical Medicine & Rehabilitation residency training at The Ohio State University in 1997 and has been in solo practice in Ohio since 2001 because he is committed to providing accessible, individualized and attentive care to his patients. His regenerative approach to solving spine problems enhances the body’s natural ability to heal itself. His guiding principle is integrity – doing what is right for patients in a conscientious manner with the motivation of helping them become fully functional, independent and satisfied. Dr. Terebuh is a very unique Medical Doctor because he has earned seven Board Certifications in the field of musculoskeletal medicine and nonsurgical spine care. Boris Terebuh, MD is delighted to be a Discseel® provider because this revolutionary new technology aligns perfectly with his preferred regenerative treatment approach and patient care philosophy. Dr. Terebuh is also grateful to Discseel® developer, Kevin Pauza, MD, for all the years of diligent and meticulous research to create this innovative, paradigm-shifting intervention, which will certainly spare countless individuals the prospect of avoidable spine surgical procedures.

Thierry Bonnabesse, M.D. - Champlain Spine and Pain Management

Gregory Lutz, M.D. - Regenerative Sportscare Institute

Dr. Gregory Lutz is the Founder and Medical Director of the Regenerative SportsCare Institute (RSI). In addition, he currently serves as Physiatrist-In-Chief Emeritus at Hospital for Special Surgery (HSS) and a Professor of Clinical Rehabilitation Medicine at Weill Medical College of Cornell University. Dr. Lutz is one of the world’s leading experts in the field of regenerative interventional orthopedic medicine, appearing annually on Castle Connolly’s and New York Magazine’s “Top Doctors” lists.

Janet Pearl, M.D. - The Boston Stem Cell Center

Dr. Janet Pearl has been in practice since 1999 and is the Medical Director of The Boston Stem Cell Center. She is also the Medical Director of  Complete Spine and Pain Care  an interventional integrated Pain Management practice, both located in Framingham, Massachusetts. Dr. Pearl is Triple Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology and has over 20 years experience in doing these procedures.

Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Pain Management Fellowship program.

After graduating from Harvard College with an A.B. in Applied Mathematics with Economics, Dr. Pearl received a M.Sc. in Health Planning and Financing at the London School of Hygiene and Tropical Medicine. She then received her M.D. from the Columbia College of Physicians and Surgeons, where she represented the Medical School as a senator in the Columbia University Senate.

Watch Dr Pearl give an introduction to The Boston Stem Cell Center

Dr. Pearl completed her internship in Internal Medicine at New England Deaconess Hospital, her residency in Anesthesiology at the Massachusetts General Hospital, and her fellowship in Pain Management at the Brigham and Women’s Hospital. Dr. Pearl was the first resident ever to serve on the Accreditation Council for Graduate Medical Education (ACGME)’s Residency Review Committee for Anesthesiology. She is a Joseph Collins Scholar and a Rotary Scholar and was awarded the AMA/Glaxo Welcome and AMA/Burroughs Welcome Resident Leadership Awards.

From 2004 to 2010, Dr. Pearl served on the University of Massachusetts Board of Trustees. While there she chaired the Committee on Science, Technology and Research, was a member of the Committee on Academic and Student Affairs and the Governance Committee and also served as Vice Chair of the Advancement Committee, and as a member of the Committee on Athletics.

Dr. Pearl is Board Certified in Regenerative Medicine, Pain Medicine and Anesthesiology with the American Board of Regenerative Medicine and the American Board of Anesthesiologists.

Memberships:

  • The American Pain Society;
  • The Massachusetts Medical Society;
  • The Massachusetts Society of Anesthesiologists;
  • The Massachusetts Society of Interventional Pain Physicians;
  • The American Society of Anesthesiologists;
  • The American Society of International Pain Physicians;
  • The American Institute of Ultrasound in Medicine; and,
  • The American Board of Regenerative Medicine.

PUBLIC SERVICE:

  • Member, Massachusetts Department of Industrial Accidents, Health Care Services Board 
  • Member of the Association of Harvard College Class Secretaries and Treasurers
  • Past Member of the Board of Directors of the Harvard Alumni Association
  • Former Member of the Board of Trustees University of Massachusetts. (10/2010 – 10/2014) 

Mark Reecer, M.D. - Fort Wayne Physical Medicine

Dr. Mark Reecer is board certified in Physical Medicine & Rehabilitation and Pain Management. He has over 20 years of work comp experience, and he routinely provides Independent Medical Examinations (IMEs) for the Indiana Workers’ Compensation Board. Dr. Reecer has lectured extensively and has authored multiple publications that promote his specialty and the use of treatment modalities to eliminate pain, improve function and avoid surgery.

Dmitry Buyanov, M.D. - IV Infusion Treatment Center

Dr. Buyanov is originally from Kiev, Ukraine. He received his training in Anesthesiology and his Interventional Pain Management Post-Doctoral at Penn State Medical Center, PA. Dr. Buyanov moved to San Antonio in 2003 at which time he was part of a multi-specialty group before he founded Premier Pain Consultants in 2004. His practice has over 5000 active patients in his practice. Dr. Buyanov treats his patients in a cost-effective manner although giving them the best care with interventional pain treatments/procedure to help each patient improve their quality of life. Dr. Buyanov strongly believes in an individualized and multidisciplinary approach to pain management, he believes in the Buddhist saying: “pain is inevitable but suffering is optional”. He works closely with the area internists, physical therapists, chiropractors, psychiatrists, neurologists, and spine surgeons to insure that each patient has the most optimal individualized treatment plan. Dr. Buyanov enjoys spending his spare time with his children.

Desmond Hussey, M.D. - NASA Neuroscience and Spine Associates. P.L

Dr. Hussey earned his undergraduate degree from Dartmouth College, and proceeded to earn his Medical Degree from The University of Miami School of Medicine. He then attended Northwestern University Internal Medicine Program, followed by a Neurology Residency Program at Emory University. Dr. Hussey continued his specialty training at John Hopkins University pain clinic. A member of The Spinal Injection Society and The American Academy of Neurology and Psychiatry.

Haley Burke, M.D. - Colorado Rehabilitation and Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Maxim Moradian, M.D. - Interventional Spine Care & Orthopedic Regenerative Experts

Dr. Moradian is triple-board certified in Physical Medicine and Rehabilitation (PM&R), Sports Medicine and Pain Management. Dr. Moradian’s clinical practice is devoted to the comprehensive care of spine, joint, muscle, tendon, ligament, and peripheral nerve disorders. He is proficient in performing advanced, minimally-invasive procedures under fluoroscopic and/or ultrasound guidance in the entire spine. Dr. Moradian performs electrodiagnostic testing (EMG/NCS) for the accurate diagnosis of muscle and/or nerve disorders. He has a special interest in regenerative medicine, sports concussions, neuromuscular ultrasound, medical education, and clinical research. His true passion is to treat his patients like his family and friends.

Wendi Lundquist, D.O. - Active Life Physical Medicine & Pain Center

Dr. Lundquist is the Medical Director and founder of Active Life Physical Medicine & Pain Center, Innovative Surgery Center, and Regena Spa. She is dual board certified in Physical Medicine and Rehabilitation along with Pain Management and a diplomat with the American Board of Pain Medicine. She completed her training at Loyola University in Chicago, Illinois in July of 2005. During her time there, she served as Chief Resident and was involved in several research projects. Prior to, she completed medical school at Midwestern University at the Arizona College of Osteopathic Medicine campus in Glendale, Arizona and internship at Doctors Hospital in Massillon, Ohio. She also has a Bachelor of Science in Biology and minor in Chemistry from the University of New Mexico in Albuquerque. She has a special interest in sports medicine, pain and spine. With 17 years experience, she has great enthusiasm towards regenerative medicine.

Yasuyuki Nonaka, M.D. - Nonaka Lumbago Clinic

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Haley Burke, M.D. - Colorado Rehabilitation & Occupational Medicine

Dr. Burke is board-certified in both Interventional Pain Management and Neurology and has completed an accredited Pain Fellowship with the Department of Anesthesiology at MD Anderson Cancer Center, one of the nation’s most prestigious hospitals. Dr. Burke completed her residency in Neurology at the University of Colorado, where she received the department’s ‘Excellence in Teaching’ award during her year as Chief Resident. Her Doctor of Medicine degree was completed at the University of Texas Health Science Center, where she was elected to the ‘Gold Humanism Honor Society.’

Matthias H. Wiederholz, M.D. - Performance Pain and Sports Medicine

Founding Partner, Triple Board Certified – Physical Medicine & Rehabilitation; Sports Medicine; Anti-Aging, Regenerative & Functional Medicine

Dr. Matthias H. Wiederholz is cofounder of Performance Spine & Sports Medicine, LLC. He is a fellowship-trained interventional pain physician whose clinical interests include: Interventional Pain Management, Sports Medicine, Musculoskeletal Medicine, Minimally-Invasive Spine Surgery, Non-Surgical Orthopedics, and Anti-Aging / Functional Medicine.

He received his specialty training in Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston, Texas where he served as chief resident. He completed fellowship training in Interventional Pain Management in Marietta, Georgia. He is board-certified in Physical Medicine & Rehabilitation and Sports Medicine. He also received advanced fellowship training through the American Academy of Anti-Aging Medicine and is board-certified in Anti-Aging, Regenerative & Functional Medicine.

Dr. Wiederholz performs a myriad of interventional pain procedures including, but not limited to the following: epidural steroid injections, facet joint injections, radiofrequency ablation, sacroiliac joint injections, discography, percutaneous disc decompression, epidural lysis of adhesions spinal cord stimulator implants, and minimally-invasive discectomies. Endoscopic spine surgery is a very unique and valuable tool in his armamentarium and makes Dr. Wiederholz one of the most specialized physicians in the field of Pain Medicine.

Dr. Wiederholz uses musculoskeletal ultrasound in the diagnosis of musculoskeletal injuries. He incorporates ultrasound for precise injection therapy including cortisone injections, prolotherapy, and PRP (platelet rich plasma). This technology is also utilized to perform the Tenex procedure, a percutaneous procedure for treating chronic tendon pain (tennis elbow, rotator cuff, plantar fasciitis, etc).

Dr. Wiederholz is the fellowship director for the sports and spine fellowship at Performance Spine & Sports Medicine. Dr. Wiederholz holds an affiliation with Capital Health System and JFK Johnson Rehabilitation Institute.

Being advanced fellowship trained in Anti-Aging, Regenerative & Functional Medicine means that Dr. Wiederholz has the most advanced training in Anti-Aging Medicine available. He is a leading expert in Bio-Identical Hormone Restoration and helps patients achieve wellness through nutrition, lifestyle, and hormone therapies.

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Michael Wolff, M.D. - Southwest Spine & Sports