L5-S1 Herniated Disc

L5-S1 Herniated Disc

The L5–S1 spinal segment can be found just below the beltline. It is the last segment in the lower back that articulates with the sacrum (tailbone). Research has shown that at least 80% of adults will experience pain in the back at one time or another. The disorders of the three most common lumbar segments, L3-L4, l4-l5, and s1 are the main causes of back pain. Two of the most common back pain segments are L4-L5 (or L5-S1)

The Spine is divided into five sections.

  1. The total number of vertebrae in the cervical spine (neck), is seven.
  2. The twelve vertebrae that make up the thoracic (upper and middle back) spine are twelve
  3. The Lumbar spine, lower back, is made up of five vertebrae.
  4. Sacrum, triangular bone, that connects with L5, both pelvises and the coccyx, to form the tailbone. The small triangular-shaped structure of the spine at the bottom is the coccyx.

INTRODUCTION

Low back pain (LBP), which is the most common problem, is a leading cause of disability. Herniated lumbar disc is one of many abnormalities that are associated with LBP. Lumbar discectomy is a procedure that has been performed regularly by neurosurgeons for many decades. Radiculopathy and back discomfort are the most common signs. Incontinence or rectal dysfunction may occur if there is urinary retention. 

Saddle anesthesia should be suspected of CES. However, it is not clear what its pathophysiological mechanisms are. It can be due to direct mechanical compression or Cauda Equina (CE), nerve roots. This is a common condition that can cause work disability. The rare occurrence of sexual and sphincter dysfunction in the CES is due to a prolapsed lumbar lumbar L5–S1 intervertebral Disc, but it has not been thoroughly investigated. This study examines the potential mechanism and outcome of the sexual dysfunction and sphincter dysfunction that can be associated with lumbar disc herniation.

Back Pain and The L5–S1 Spinal Segment

The lower lumbar spinal column is susceptible to injury and wear. A variety of conditions and diseases can impact daily life, including lumbar spine problems.

These are the symptoms and conditions associated with an L5–S1 spinal segment disorder.

  • Leg pain, back pain, and pain in the buttocks are all possible.
  • Numbness, tingling or burning sensations in your buttocks or legs, feet, feet, or toes
  • Problems walking, or inability to stand for a short time
  • Paralysis of one or both legs
  • Bowel and Bladder disorders
  • Sexual dysfunction, including impotence and infertility

The Best L5/S1 Treatment Option

The best way to treat spinal disorders such as L3-L4, L4–L5, L5–S1, and L5–S1 is to be conservative. It is best to avoid any invasive procedures like steroid injections, radiofrequency ablation (RFA), or spine surgery. 

Radiofrequency ablation (or RF ablation) is a minimally-invasive spine surgical procedure. It kills the pain-sensing neuron in your spine. Patients should be discouraged from receiving this treatment, as it can cause degenerative changes to the spine due to nerve damage or soft tissue destabilization.

For back pain due to L3–L4, L4–L5, or L5–S1, you need targeted conservative treatments that treat the affected or injured areas. A combination of chiropractic and physiotherapy is the best treatment for back pain. Pain and disabilities are most common in the lower lumbar segments L3-S1. Slip-discs, arthritis (bone spurs), degenerative discs and arthritis are all common causes of back and leg pain.

L5-S1 Spinal Segment Issues Which Cause Back Pain & Leg Symptoms

Back pain sufferers often experience problems with the L5–S1 segment. These conditions may cause back pain that is caused by the L5–S1 segment.

  • Muscle spasms (in some cases): This is the first sign of backache.
  • Joint problems: Spinal joint misalignment or arthritis can cause back pain. A neglected spinal problem can lead to other serious problems like bone spurs, facet hypertrophy and slipped discs.
  • Pinched nerves: A pinched nerve is the result of slipped discs, bone Spurs, and ligament thickening. This can be seen in Ligamentum Flavum facet hypertrophy or hypertrophy.
  • L5 – S1 Spondylolisthesis: In L5 – S1 Spondylolisthesis, the 5th lumbar section (L5) moves forward relative to the first sacral segments (S1). L5-S1 is the most common location for spondylolisthesis. L5 to S1 is the most common location for spondylolisthesis. L5-S1 can have spondylolisthesis that is either congenital (due to a fracture, spondylolysis), or developmental.
  • Degenerative changes are: Spinal disc degeneration, spinal joint degeneration, or soft tissue degeneration (degenerated muscles, ligaments, and spinal disc slipping) are all leading causes of back pain. Degeneration of your discs or soft tissue may be the cause of back pain.
  • Slipped disc: The term “slipped disc” is used by laypeople to describe bulging discs and herniated discs.
  • Sciatica: A collection of nerves originating from spinal nerves exiting from L4 to S3 is called the sciatic nerve. The L5-S1 section is the major nerve involved in sciatica, or sciatic-like symptoms.
  • L5 to S1 spondylosis: This is a condition that causes excessive weight-bearing or repetitive injuries.
  • Posterior Facet hypertrophy at L5–S1: This is the medical term for the spinal joints. Each segment contains four facets. Spinal joints are formed when the facets of the vertebrae below are connected to the above facets. Facet hypertrophy can be the primary cause of backache.
  • Spinal canal Stenosis L5-S1: When the cord is gone, the spinal canal acts as a tunnel or passageway to the spinal cord. The L1 is the end of the spinal cord. It continues to descend as nerve fibers which look like horse’s tail hairs. Spondylosis and spondylolisthesis are the most common causes for spinal canal shrinkage.
  • Hypertrophy and Ligamentum Flavum at S5-S1: Ligamentum Flavum connects spine bones and provides stability. This ligament is essential for extending and bending movements. Ligamentum Flavum can thin at any segment. The L5–S1 segment does not have as many cases of hypertrophy (or thinning) of Ligamentum Flavum as the L3–L4 and L4–L5 segments.
  • L5-S1 foraminal Stenosis: The openings that allow nerves to exit the spine through. Nerve impingement is caused by shrinkage of the foramen. Foraminal or vertebral foraminal stenosis, also known as foraminal foraminal swelling, is common in the slip disc, spondylolisthesis (hole), facet hypertrophy and hypertrophy Ligamentum Flavum.

You need to seek expert help to heal from L5-S1. Here are some steps to help you with your back pain treatment.

Back Pain from L5-S1 Problems

Two of the most common causes of back pain are L4-L5 (L5-S1) and L5–S1 (L5-S1). The main cause of problems arising from L5–S1 is axial loading (weight-bearing actions). Sitting or standing for long periods of time places enormous stress on L5-S1 segments’ spinal joints and discs. Increased intradiscal pressure is a result of excessive or prolonged weight-bearing.

Indical pressure is measured as mm Hg (millimeters). A healthy intradiscal level is less than 70 mm Hg. An increase in intradiscal pressures above 90 mmHg can cause a decrease of blood flow. An increase in intradiscal pressure also means that nutrients and compounds are not being absorbed into the spinal disc.

The intradiscal pressure, or spine disc pressure, is directly affected by body position and daily activities. These are examples of the average intradiscal pressure at various positions:

  • Supine position: The intradiscal pressure average is 25 mmHg
  • Standing straight: Intradiscal pressure goes up to 100+mm Hg
  • While standing, bend at the waist and let your belly rise to 150+mm Hg.
  • Sitting straight up: The Average Intradiscal Pressure is 200 mmHg
  • Sitting in poor positions: The intradiscal pressure can rise to 250+mm Hg

The most vulnerable spinal segment is the lumbar spine (lower back), which is subject to the adverse effects of higher intradiscal pressures that are associated with prolonged standing or sitting.

L5-S1 Disc Bulge And Disc Herniation Causes, Signs & Symptoms

The most common place for disc bulge, disc herniation (slipped disc) is in the lower back or lumbar spine. L4-L5 are the most common locations for a slipped disc to develop in the lower spine. L5-S1 is second in the list of possible involvement. L3-L4 is the most common site of herniated Lumbar discs.

Degenerative disc disease, which causes spinal disc herniation at L5 and S1, is the most common cause. Spinal disc diseases are all connected to disc degeneration. For L5-S1 to herniate, the disc must have had pre-existing degenerative conditions. Healthy discs will not herniate. Degenerated or damaged discs can lead to a herniated disc L5-S1. These are the most common causes of herniated spinal discs:

  • Prolong sitting
  • Sit in a forward bent position
  • Excessive bending and twisting of the back
  • Improper lifting
  • Slip and fall
  • Injuries

A herniated L5S1 disc could press and impinge nerves or the spinal cord. It can lead to pain, discomfort, and aches in the back, buttocks. It can also cause weakness, tingling and numbness in the legs, legs or knees.

L5-S1 pinched nervous symptoms include weakness, stiffness and numbness. Nerve pain refers to pain that is burning, sharp, or throbbing-like and can travel to the lower extremities, giving patients sciatica-like sensations.

Sciatica is caused by one or more nerves in your cervical spine being compressed, or irritated. You may feel a burning or shooting sensation in your lower back. The pain then moves up your leg and affects the nerve distribution in your feet. Sciatica pain may radiate to the buttocks. Its distribution is dependent on the nerves affected.

L5-S1 Spinal Segment Issues: Back Pain & Leg Symptoms

Low back pain and leg pain are common symptoms of spine problems. However, patients who have severe neck, upper back or mid-back issues and compress their spinal cords may experience weakness and pain in the legs. It is important to get expert help and analysis in order to determine the exact cause of leg discomfort.

If a slipped disc (disc bulge, herniated disc), presses on a nerve, it can cause pain, weakness, or numbness in the area where the nerve travels. The cause of pain felt in the legs and buttocks could be from compression of nerves, an L4–L5 or L5–S1 impingement on spinal nerves, or the compression of the thecal sac.

A bulging or herniated spinal disc can happen at any part of the spine. The neck and lower back are known for bulging, herniated and slipped discs. Slipped discs may occur in the neck at the C4-C5, or C5-C6 segment. Slipped discs are most common in the lower back at the L3–L4, L4–L5, or the L5–S1.

Sciatica-like sensations are common symptoms of back pain caused by herniated discs or slipped discs. They include pain and numbness around the buttocks, leg, foot, toes, and thigh. It can also lead to pain and numbness in your genital area, difficulty with urinating, weakness in the legs, and even a loss of sensation.

Sciatica & The Sciatica-S1 Spinal Segment

Sciatica refers to pain in the back and hips that results from compression of the sciatica nerve, which runs from the lower part of the spine to the lower extremities.

Sciatica is a condition where nerve fibers from sciatica are compressed in the spine, thecal sac or exiting to the spine. Sciatica may also be caused due to congenital abnormalities or excessive muscle tightness. This is a deep muscle found in the buttocks.

Spinal Canal Stenosis – Common Causes of Back Pain

The spinal canal is a tunnel made by the interlocking spine segments that house the spinal cord. The spinal cord is an elongated, cylinder-shaped bundle made up of nerves. It begins at the skull’s base. It then descends into the spinal canal until it reaches the L1 segment or the first lumbar. 

The L1-L2 level of the spinal cord is when the spinal cord becomes a solid rope-like cylindrical to strands like a horse’s tail. (solid part and hair strands). The point at which the rope-like structures transform into hair-like roots or strands is known as cauda Equa.

Cauda Equina Syndrome & Back Pain

Cauda Equina Syndrome is caused by compression and impingement in the nerves in the lower spine (nerves of the spinal canal). Cauda Equina syndrome is most commonly caused by slipped disc, arthritis, hypertrophy and Ligamentum Flavum. These causes compress the spinal cord, spinal sac and nerve roots as they exit from the spinal canal. Cauda Equina Syndrome is a mix of all three.

Cauda equina Syndrome is associated with severe pain in the lower back and lower extremities. This syndrome can lead to paraesthesia, weakness, difficulty in walking and even intestinal and bladder problems in severe cases.

Cauda Equina syndrome symptoms include severe pain in the lower back and legs, paraesthesia, weakness, and difficulty walking in the feet. Cauda equina can also present with other symptoms, such as sexual and reproductive problems, bowel or intestinal issues, bladder disorders, and bladder disorders.

Cauda Equina Syndrome can be caused by most common spinal segments, L4-L5 (S1 and L5-S1). These conditions include slipped discs and thickening of posterior vertebral bodies (spondylosis/arthritis and bone spurs) and hypertrophy at the Ligamentum Flavum.

Anatomy of L5-S1 Spinal Motion Segment

The following structures are typical of this motion segment:

L5 and S1 vertebrae. Different features distinguish the L5 from S1 vertebrae.

  • L5 includes a vertebral body at the front and an arch at back. The arch has 3 bony protrusions. There is a prominent spinous center and two transverse processes on each side. These protrusions act as attachment points to ligaments.
  • The sacral base (also known as S1) is the top and wider end of the triangularly-shaped sacrum. The S1 body consists of a top-most portion with wings-shaped bones on either end, known as the alae. The median ridge is a bony prominence located at the back of S1 vertebra. This ridge has bony openings (foramina), on both the right and left.
  • L5 and the S1 facet joints are joined by articular cartilage lined lumbosacral joint.
  • L5-S1 intervertebral disc. The disc between the vertebral bodies S5 and L5 is made of a gel-like material (nucleus pulposus). It is enclosed by a fibrous ring (annulus fibrosus). This disc acts as a shock absorber and cushion to protect the vertebrae when they move.
  • L5 spinal cord. The L5 spinal neural roots exit the spinal cord through small bony foramina (intervertebral foramina) located on the left and the right sides of the spinal canal. These nerve roots are joined with other nerves and form larger nerves which travel down each leg.
  • The L5 dermatome (or L5 skin area) receives sensations via the L5 spinal nerve and can include parts of the leg, foot and knee.
  • The L5 myotome (a group of muscles controlled and coordinated by the L5 spine nerve) is responsible for leg and foot movement.
  • The L5 – S1 motion segment provides a bony cover for the cauda equina (nerves running down from the spinal cord) and other delicate parts.

Common Problems in L5-S1

The L5 and S1 at the bottom, or vertebral column, are often under excessive biomechanical stress. This can cause more injuries and higher loads. The following are common problems:

  • Disc problems. L5-S1 is the most common level for lower back disc herniation. An disc with a steeper angle will experience greater shear stresses. This can increase the disc’s risk of injury or degeneration.
  • Facet joint pain. Facet joint discomfort can result from wear-and-tear arthritis (osteoarthritis), which is a result of the high load-bearing capacity of the lumbosacral joints.
  • Spondylolysis. Spondylolysis can occur in the L5 vertebra. This is caused by repetitive stress on the bone. It can happen on one side or both. The bone may not break, but become stressed. This is called a “pars stress reaction”.
  • Spondylolisthesis. Spondylolisthesis refers to a condition where the vertebrae slip over S1 if the L5 pars fracture on either side. Spondylolisthesis L5 occurs most often due to repetitive stress to L5’s pars interarticularis. This is most commonly seen in children or adolescents. Trauma is not a common cause of pars fracture.
  • Although rare, malignant tumors like sacral chondromas can develop at the L5–S1 level. This level can also be affected by other problems, such as developmental variations in S1, the fusion of S5 and S1, or extra facet joints between S5-S1.

Common Symptoms and Signs of L5-S1 Stemming

L5-S1 vertebral and disc pain may develop gradually over time or suddenly after an injury. A dull ache, or sharp pain, may be felt in your lower back. Discogenic pain is often worsened when you sit too long, stand in one place, or do repetitive lifting and bending.

Radiculopathy symptoms, or sciatica may be caused by compression or inflammation of the L5/or S1 spinal neural nerve root.

  • Pain is usually described as a sharp, shooting and/or severe sensation in the buttocks and/or toes.
  • Numbness in the feet and/or toes
  • Foot drop is a weakness in the foot or leg muscles.
  • You can also experience a stabbing or aching sensation that is not related to these (dermatomal)areas. Although these symptoms are usually limited to one leg, they can also affect both legs at times.

Cauda Equina syndrome may develop at L5-S1 when there is an injury to the cauda Equina nerves, which descend from your spinal cord. This syndrome is a medical emergency. It typically causes severe pain, weakness or numbness and/or tingling in one or both legs. It is possible to lose bladder and/or bowel control. To preserve leg function and restore bladder and bowel function, the condition must be treated quickly.

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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