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Dorsal Root Ganglion (DRG) Stimulation

Dorsal Root Ganglion (DRG) Stimulation

 

What Is DRG stimulation?

What is the mechanism of DRG stimulation?

What is a DRG stimulation system made up of?

Risks Associated with DRG stimulation

How is a DRG stimulator inserted?

How DRG stimulation work?

Indications for getting a DRG stimulator

Reviews of our Patients got DRG stimulator implanted

 

What Is DRG stimulation?

DRG or dorsal root ganglion is also known as posterior root ganglion is a bundle of sensory nerve cell bodies within the epidural space. The dorsal root ganglion carries sensory neural signals from the peripheral nervous system to the central nervous system, which includes the spinal cord  It is an easily accessible structure in the spine that plays a key role in the development and management of chronic neuropathic pain

Injury or irritation of the dorsal root ganglion can lead to intractable symptoms of neuropathic pain that may or may not respond to typical treatments. This can lead to additional complications in the form of impairment in functioning for the individual spinal cord stimulation.

Applying stimulation to the DRG allows treating specific areas of the body with pain hence targeting specific focal area. Easy accessibility of DRG  makes it a perfect target for treating chronic neuropathic pain that is not treated with traditional spinal cord stimulation, such as the hand, chest, abdomen, foot, knee or groin pains.

What is the mechanism of DRG stimulation?

Dorsal root ganglion stimulation works by blocking the transmission of pain. As every sensation passes through dorsal root ganglion, the signal of pain to the spinal cord and brain is interrupted. Stimulating the nerve bundles with low-intensity electrical impulses is also believed to reduce pain by replacing the sensation with a pleasant tingling sensation, known as paresthesia.

What is a DRG stimulation system made up of?

The system consists of three components:

Electrodes: These are a straight insulated wire with a curve on the tip to fit around the DRG. There are four electrical contacts near the tip to deliver the electrical pulses. The wire is passed into the spine through a large hollow needle. Up to four wires can be connected to one IPG so up to four DRGs can be stimulated, each with its own wire.

An implantable pulse generator (IPG): It is a small box that contains a battery and circuitry to produce the stimulus current:. If the electrode is being put in the lower back (e.g. for leg pain) the IPG is usually implanted under the skin of the abdomen (tummy). If the electrode is being put in the spine in the neck (e.g. for arm pain) the IPG may be implanted under the skin below the collar bone.

Programmer: It is a handheld  device that is given to the patient to adjust the stimulator to control pain.

Risks associated with DRG stimulation

As with every surgical procedure, there are risks involved with dorsal root ganglion neuromodulation. Though very little is known about the consequences of injecting pain relieving medication within the dorsal root ganglion or the spinal cord, neuromodulation of the neural tissue within this area is believed to be safe and completely reversible. The procedure itself for implanting the device is regarded as safe and conducted in such a way as to avoid inflammation or additional pain to the individual. In fact, many may return to normal activities of daily function within several days.

Risks associated with the condition are considered to be mild in nature and generally include minor bleeding at the site of the injections, infection, neural injury, and local anesthetic systemic toxicity. Individuals may also have a reaction to the medication used during the procedure.

How is a DRG stimulator inserted?

The procedure is carried under local anesthesia. When the skin has been numbed, a needle is passed into the space near the DRG and the electrical lead is fed through it and guided into place using Xrays.

Since the patient is awake, the effect of stimulation can be tested via the lead straight away. If the patient feels the tingling sensation, the procedure is completed by making a small incision around 3 cm nearby to allow placement of an implantable pulse generator under the skin and connecting the lead to it. If the test stimulation doesn’t give a definitive effect on the patient’s pain, a temporary extension wire is attached to the lead which is then brought out through the skin so that it can be tested for a few days using an external stimulator, before deciding whether the system is working well enough to complete.

How DRG stimulation Works?

DRG Stimulation is a more advanced and refined version of traditional spinal cord stimulation. Instead of positioning the leads over the posterior aspect of the spinal cord, smaller and more precise leads are placed over the dorsal root ganglion itself. Specifically, it is placed on the ganglia residing in the lumbar and sacral regions of the spine. This allows for greater and more targeted control of pain in the lower limbs.

-Largest study to date concerning lower limb pain associated with CRPS (ACCURATE Study), patients reported that the DRG Stimulator gave them significantly greater pain relief than SCS

-No changes in paresthesia intensity (pins and needles sensation) when changing body position as compared to SCS
-A more precise and targeted area of administration i.e. no feeling of electrical stimulation outside their area of pain

Indications for getting a DRG stimulator:

Dorsal root ganglion is now being preferred over spinal cord stimulation. Patients trialed with DRG stimulation have a greatly improved chance of success with much better pain relief.

In addition to CRPS, DRG stimulation can also treat:

  •  Discogenic pain due to degenerative disc disease
  •  Post-herpetic neuralgia
  •  Phantom limb pain
  •  Groin pain after a hernia repair (post-herniorrhaphy neuralgia)
  •  Lumbar radiculopathy
  •  Foot pain
  •  Neuropathic pain due to peripheral neuropathy
  •  Neuropathic chest wall pain
  •  Lumbar stenosis
  •  Chronic postsurgical pain

 

Reviews from our patient that got DRG stimulator

Conclusion

Dorsal root ganglion stimulation is a procedure for providing relief from symptoms of chronic pain resulting from a neural injury. This interventional approach is regarded as a relatively safe and effective procedure, with a low risk for side effects. The dorsal root ganglion is considered an ideal target for delivering pain relief because of a more targeted approach. Also dorsal root ganglion requires less neuronal stimulation to alter pain hence the devices for this treatment can work for a long time.

Another benefit of dorsal root ganglion stimulation is that the dorsal root ganglion lacks the protective capsular membrane that is found on other peripheral nerve fascicles. It has a permeable connective tissue, making it an ideal target for the application of neuromodulation.

The Food & Drug Administration (FDA) just granted approval to DRG Stimulation for use within the U.S. as of February 2016 for the treatment of CRPS.  Currently, the only device capable of DRG Stimulation is called the Axium which is available. Our site in Fort Lauderdale is the first site in Florida to implant the DRG stimulator.

 

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Superion® Interspinous Spacer (ISS)

What is Superion® Interspinous Spacer (ISS)?

How does it work?

When is it used? 

What will it accomplish?

When should it not be used?

Benefits of Superion device

 

What is Superion® Interspinous Spacer (ISS)?

The Superion® InterSpinous Spacer (Superion Spacer) is a small H-shaped spinal implant system for the treatment of moderate lumbar spinal stenosis implant. The device fits between two adjacent bones (spinous processes) in the lower back. This limits movement (extension) at the level where the device is placed. The Superion Spacer is made of titanium alloy.

Features of the Superion System:

  • One piece, expandable implant
  • Minimally invasive midline approach
  • Motion preserving
  • Tissue sparing and fully reversible

FIRST IN FLORIDA: Vertiflex Superion Interspinous Spacer Tx for Lumbar Spinal Stenosis

If standing or walking causes pain,weakness or fatigue in the legs, you’re probably suffering from lumber spinal stenosis or LSS. As you stand or walk, the lumbar curvature becomes more pronounced, the spinal nerve more crowded, and the back and legs more painful.
The aim of the Superion spacer is simply to hold the spine in the same open and neutral position as when sitting.
You are a candidate for this simple outpatient procedure if the following are true:
1) you suffer from neurogenic claudication from spinal stenosis: increased pain and tiredness in the buttocks or legs with walking that is relieved with sitting.
2) you have 2 or fewer levels of severe stenosis in the spine
3) the main level is not at the L5-S1 level
4) you want to avoid back surgery

How does it work?

The Superion® ISS system is designed to deliver the implant through a single small incision in the patient’s back. The procedure can be performed under local anesthesia on an outpatient basis and closed with a single suture. Spinal stenosis is a narrowing of the passageways in the spine. When the spinal cord and nerve roots get pinched or compressed during extension of the spine due to the narrowed passageways, this can cause pain, numbness, tingling ,weakness in the leg(s) or legs and back. The device is designed to limit extension of the spinal level to relieve these symptoms.

When is it used? 

The Superion Spacer treats patients who suffer from pain, numbness, cramping in their buttock, groin, or legs with or without back pain. The Superion Spacer is used in patients who have difficulty with daily physical activities and who experience relief in flexion from their symptoms.

Spinal stenosis symptoms are often characterized as:

  • Developing slowly over time, or slow onset
  • Coming and going, as opposed to continuous pain
  • Occurring during certain activities (such as walking)
  • Feeling relieved by rest (sitting or lying down).

The symptoms of lumbar stenosis generally develop slowly over time and symptoms may come and go. Lumbar stenosis symptoms may include:

  • Leg pain
  • Leg pain with walking (claudication)
  • Tingling, weakness or numbness that radiates from the lower back into the buttocks and legs.

Many people have evidence of spinal stenosis on X-rays, but may not have signs or symptoms. When symptoms do occur, they often start gradually and worsen over time. Symptoms vary, depending on the location of the stenosis:

  • In the neck (cervical spine).Cervical stenosis can cause numbness, weakness or tingling in a leg, foot, arm or hand. Tingling in the hand is the most common symptom. Nerves to the bladder or bowel may be affected, leading to incontinence.
  • In the lower back (lumbar spine).Compressed nerves in your lumbar spine can cause pain or cramping in your legs when you stand for long periods of time or when you walk. The discomfort usually eases when you bend forward or sit down.

What will it accomplish?

The device should help relieve the symptoms of moderate lumbar spinal stenosis by blocking extension of the affected spinal level.

When should it not be used?

Patients should avoid having surgery with the Superion Spacer if they are experiencing any of the following conditions:

 

Benefits of Superion device:

  • This surgery helps relieve pressure on your spinal nerves.
  • The Superion implant is designed to keep your spine still so when you stand upright the nerves in your back will not be pinched or cause pain.
  • The Superion implant is intended to allow you to continue to move your back more than with a fusion surgery. With the Superion implant in place, you should not need to bend forward to relieve your pain.

Video Testimonial for Superion® Interspinous Spacer (ISS)

 

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Dr McRoberts proudly introduces the scientist who invented Nevro Spinal Cord Stimulator

 

Dr.McRoberts takes the privilege of introducing the scientist who worked tirelessly for 10 years to create the High Frequency SCS.  He gave happiness to his patients by giving them a ray of hope during their pain and agony. The success rate of this device is insurmountable. Dr.W.Porter McRoberts is the first Interventional Physiatrist to use Nevro in South Florida. Nevro SCS is innovative evidence-based neuromodulation platform for the treatment of chronic pain.

About Nevro SCS

https://www.youtube.com/watch?v=qc9slfMrTh0

https://www.youtube.com/watch?v=lKI0wQbUL_Q

https://www.youtube.com/watch?v=mSJOIlcJRqA

https://www.youtube.com/watch?v=BQgXzyPtmcc

Nevro Patients Feedback

More HF10 therapy testimonials from real patients

I FELT NORMAL

“My thought was that the Nevro® stimulator was going to work the same [as the traditional spinal cord stimulator I had previously]. But after I switched to the Nevro system, I was speechless because I didn’t feel anything. I thought, ‘it is not working, maybe there is something wrong’ because there was no paresthesia. It really took me off guard. There was no pain and there was no paresthesia. And the fact that I felt normal. It felt like I did before I ever hurt my back. I know this sounds a little dramatic, but [undergoing a trial period with the Senza® System] really has changed my life. It has changed my outlook on my pain. It lets you feel normal.”

– U.S. Study Patient1

I DIDN’T FEEL ANYTHING EXCEPT RELIEF

“I just completed my Nevro® SCS trial and for me … I had wonderful results. I had good strong relief in my back pain. Now in comparing it to the conventional [SCS] system, which I had in my spine for 5 years, it was like night and day. The conventional system used a system of tingling, which began to hurt me in the end. With this new system, there is nothing. I didn’t feel anything except relief. There is no noise, no sensations. I just had relief from my back pain. I knew that it was going to improve my lifestyle.”

– U.K. Study Patient2

IT JUST CHANGED MY LIFE COMPLETELY FOR THE BETTER

“I’ve had back pain for just over 20 years now. I’ve had 4 surgeries and untold epidurals. It’s a lot really. I’ve had 2 spinal cord stimulators fitted. The first one was a conventional spinal cord stimulator, which really didn’t do much for me. I had some relief in the legs, but it gave me a tingling sensation while it was on, which is quite off-putting. The second spinal cord stimulator was from a company called Nevro. I’ve had it for just over 6 months now. And it has done the job really well with no tingling. I can now do things that people take for granted that I was never able to do. Simple things like taking the dog for a walk or picking my kids up from school. It just changed my life completely for the better.”

– U.K. Study Patient2

NOW I CONTROL THE PAIN

“Before the operation, the majority of my life I spent in bed. I was doing everything in bed, only getting up to use the bathroom and even that was agonizing. So I was very unhappy. For years, I visited many hospitals in this country [U.K.] and in other countries looking for help to deal with the pain. After the [Nevro] operation, the pain is gone. Before it was a different story, the pain controlled my life. Now I control the pain.”

– U.K. Study Patient2

About Nevro

At Nevro, we believe true innovation transforms more lives. Nevro explored beyond traditional SCS frequencies in search of better therapeutic outcomes. Combining high frequency at 10 kHz with a unique waveform and a specific treatment algorithm resulted in HF10 therapy: A paresthesia free treatment proven to provide superior pain relief to more patients.

Clinical Evidence

Randomized, controlled trial compared HF10 therapy with traditional SCS: 10 U.S. centers, 241 enrolled, 198 randomized, 171 implanted.

Demonstrated superiority at all primary and secondary endpoints vs traditional SCS
(12-month follow-up)

Novel 10-kHz High-frequency Therapy (HF10 Therapy) Is Superior to Traditional Low-frequency Spinal Cord Stimulation for the Treatment of Chronic Back and Leg Pain: The SENZA-RCT Randomized Controlled Trial

Leonardo Kapural, M.D., Ph.D.Cong Yu, M.D.Matthew W. Doust, M.D.;Bradford E. Gliner, M.S.Ricardo Vallejo, M.D., Ph.D.B. Todd Sitzman, M.D., M.P.H.Kasra Amirdelfan, M.D.Donna M. Morgan, M.D.Lora L. Brown, M.D.;Thomas L. Yearwood, M.D., Ph.D.Richard Bundschu, M.D.Allen W. Burton, M.D.Thomas Yang, M.D.Ramsin Benyamin, M.D.Abram H. Burgher, M.D.

COMPARATIVE, FEASIBILITY

5 centers, 24 patients trialed with both traditional SCS and HF10 therapy.

Demonstrated safety and efficacy in humans (acute follow-up)

88% of patients preferred high-frequency SCS

Novel spinal cord stimulation parameters in patients with predominant back pain.

Tiede J1, Brown LGekht GVallejo RYearwood TMorgan D.

 

PROSPECTIVE, LONG-TERM

2 centers, 72 patients implanted

Demonstrated long-term safety and efficacy for both back pain and leg pain
(24-month follow-up)

Sustained Effectiveness of 10 kHz High-Frequency Spinal Cord Stimulation for Patients with Chronic, Low Back Pain: 24-Month Results of a Prospective Multicenter Study

Adnan Al-Kaisy, MD,*1 Jean-Pierre Van Buyten, MD,†1 Iris Smet, MD,† Stefano Palmisani, MD,* David Pang, MD,* and Thomas Smith, MD*

Neuromodulation has been used for decades to treat chronic pain. Yet despite its widespread adoption, limited published, prospective, long-term evidence about the efficacy of traditional spinal cord stimulation (SCS) existed. Nevro understands the critical importance of clinical evidence in today’s environment and has produced world class evidence to advance SCS therapy. No other company has committed so fully to establishing clinical evidence of the safety and efficacy of SCS treatment and no other SCS technology has the wealth of clinical study data to back its technology.

HF10 Therapy proven to provide patients superior relief without paresthesia.

The only spinal cord stimulation therapy approved to deliver pain relief without paresthesia.

8 out of 10 people who try Hf10 therapy have significant relief of back pain and leg pain.

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How Vertiflex Superion Beats The Competition

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First in Florida: Superion Interspinous Spacer for Lumbar Spinal Stenosis

This is the incision size for the Superion spacer. First in Florida: Superion Interspinous Spacer for Lumbar Spinal StenosisFirst in Florida: Superion Interspinous Spacer for Lumbar Spinal StenosisIMG 2942
This is the incision size for the Superion spacer.

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Achilles Tendinitis

Achilles Tendinitis

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No brain, No pain!

No brain, No pain!

The above post is reprinted from materials provided by Manchester UniversityNote: Materials may be edited for content and length.

Scientists at The University of Manchester have shown for the first time that the numbers of opiate receptors in the brain increases to combat severe pain in arthritis sufferers.

Chronic pain — pain which lasts for more than six months — is a real problem for many people with approximately 46% of the UK population estimated to suffer from it (comprising 20% of consultations in general practice). However, some people seem to cope better than others with pain, and knowing more about how these coping mechanisms work might help to develop new ways of treating this distressing symptom.

It has been known for a long time that we have receptors in our brains that respond to natural painkilling opiates such as endorphins, but the researchers in Manchester have now shown that these receptors increase in number to help cope with long-term, severe pain.

By applying heat to the skin using a laser stimulator, Dr Christopher Brown and his colleagues showed that the more opiate receptors there are in the brain, the higher the ability to withstand the pain.

The study used Positron Emission Tomography (PET) imaging on 17 patients with arthritis and nine healthy controls to show the spread of the opioid receptors.

This suggests that the increase in opiate receptors in the brain is an adaptive response to chronic pain, allowing people to deal with it more easily.

Dr Brown said: “As far as we are aware, this is the first time that these changes have been associated with increased resilience to pain and shown to be adaptive.

“Although the mechanisms of these adaptive changes are unknown, if we can understand how we can enhance them, we may find ways of naturally increasing resilience to pain without the side effects associated with many pain killing drugs.”

Professor Anthony Jones is the director of the Manchester Pain Consortium which is focused on improving the understanding and treatment of chronic pain. He said: “This is very exciting because it changes the way we think about chronic pain.

“There is generally a rather negative and fatalistic view of chronic pain. This study shows that although the group as a whole are more physiologically vulnerable, the whole pain system is very flexible and that individuals can adaptively upregulate their resilience to pain.

“It may be that some simple interventions can further enhance this natural process, and designing smart molecules or simple non-drug interventions to do a similar thing is potentially attractive.”

Val Derbyshire, a patient with arthritis said: “As a patient who suffers chronic pain from osteoarthritis, I am extremely interested in this research. I feel I have developed coping mechanisms to deal with my pain over the years, yet still have to take opioid medication to relieve my symptoms.

“The fact that this medication has to be increased from time to time concerns me greatly, due to the addictive nature of these drugs. The notion of enhancing the natural opiates in the brain, such as endorphins, as a response to pain, seems to me to be infinitely preferable to long term medication with opiate drugs.

“Anything that can reduce reliance on strong medication must be worth pursuing.”

Professor of Cognitive Neuroscience at the University, Wael El-Deredy said: “Receptor imaging is challenging and requires the co-ordination of a large team to collect and analyse the images. We are very lucky to have this technique in Manchester. There are very few places in the world where this study could have been done.”

The paper, ‘Striatal opioid receptor availability is related to acute and chronic pain perception in arthritis: Does opioid adaptation increase resilience to chronic pain?’, featured in the journal Pain, published by Wolters Kluwer.


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fascinating articles

fascinating articles

Understanding pain requires understanding what pain MEANS to a person.

Our fund of knowledge is rapidly changing.

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Ultrasound Guided Injections

Ultrasound Guided Injections

Ultrasound guidance is revolutionizing pain medicine.

We are rapidly doing more procedures with this real-time video imaging tool.

Ultrasound Guided InjectionsUltrasound Guided InjectionsF3

 

Ultrasound is the newest method of image guidance, allowing the physician to see in real time the soft tissue of the body.

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IHOP DR MCROBERT POTTER

Education: Procedures

a. Neuromodulation

university/

i. University

1. 1 https://www.youtube.com/watch?v=UNZLlsJlExU

2. 2 https://www.youtube.com/watch?v=dMN1Wx8rfqE

3. 3 https://www.youtube.com/watch?v=a6sCefrCX2k

4. 4 https://www.youtube.com/watch?v=kB-iph6jWcI

5. 5 https://www.youtube.com/watch?v=GiYaCg5sdKM

b. Biologic Regenerative Medicine for Pain

ii. High Frequency- Nevro Senza HF-10 SCS

iii. Dorsal Root Ganglion (DRG) Stimulation SCS

iv. Traditional (Tonic) SCS Stimulation

v. Novel Waveforms (Burst, Chaos, Pink Noise, High Density) SCS

vi. Hybrid Stimulation SCS+PNS

vii. Peripheral Nerve Stimulation PNS

viii. Intro to Nevro SCS

i. Bone Marrow Aspirate (BMA)

ii. Platelet Rich Plasma Injection (PRP)

c. Facet Joint Nerve Block and Ablation

d. Genicular Nerve Ablation

e. Sacral Nerve Ablation

f. Intrathecal Pump Implant

g. Totalis Micro Invasive Laminotomy for Spinal Stenosis

h. MILD Micro Invasive Lumbar Decompression for Spinal Stenosis

i. Vertiflex Superion Interspinous Spacer

j. Facet Joint Cyst Rupture

k. Epidural Injections

i. “BONC” Bolus Only No Continuous

i. Transforaminal Steroid Injections

ii. PRP Epidural Injections

iii. Cervical “SAFE” approach Transforaminal

l. Sacroilliac Joint Injections

m. Discography

n. MRIs

o. How to Prepare for your visit

p. Role of Physical Therapy in Pain Management

2. Education: Syndromes

a. Sacroilliac Joint

b. Cervical Spine Anatomy

c. Thoracic Spine Anatomy

d. Lumbar Spine Anatomy

e. Degenerative Disc Disease

f. Facet Join Syndromes

g. Opioids

3. Testimonials

i. Discogram

i. Vertebral Discs

Education: Procedures

a. Neuromodulation

university/

i. University

1. 1 https://www.youtube.com/watch?v=UNZLlsJlExU

2. 2 https://www.youtube.com/watch?v=dMN1Wx8rfqE

3. 3 https://www.youtube.com/watch?v=a6sCefrCX2k

4. 4 https://www.youtube.com/watch?v=kB-iph6jWcI

5. 5 https://www.youtube.com/watch?v=GiYaCg5sdKM

b. Biologic Regenerative Medicine for Pain

ii. High Frequency- Nevro Senza HF-10 SCS

iii. Dorsal Root Ganglion (DRG) Stimulation SCS

iv. Traditional (Tonic) SCS Stimulation

v. Novel Waveforms (Burst, Chaos, Pink Noise, High Density) SCS

vi. Hybrid Stimulation SCS+PNS

vii. Peripheral Nerve Stimulation PNS

viii. Intro to Nevro SCS

i. Bone Marrow Aspirate (BMA)

ii. Platelet Rich Plasma Injection (PRP)

c. Facet Joint Nerve Block and Ablation

d. Genicular Nerve Ablation

e. Sacral Nerve Ablation

f. Intrathecal Pump Implant

g. Totalis Micro Invasive Laminotomy for Spinal Stenosis

h. MILD Micro Invasive Lumbar Decompression for Spinal Stenosis

i. Vertiflex Superion Interspinous Spacer

j. Facet Joint Cyst Rupture

k. Epidural Injections

i. “BONC” Bolus Only No Continuous

i. Transforaminal Steroid Injections

ii. PRP Epidural Injections

iii. Cervical “SAFE” approach Transforaminal

l. Sacroilliac Joint Injections

m. Discography

n. MRIs

o. How to Prepare for your visit

p. Role of Physical Therapy in Pain Management

2. Education: Syndromes

a. Sacroilliac Joint

b. Cervical Spine Anatomy

c. Thoracic Spine Anatomy

d. Lumbar Spine Anatomy

e. Degenerative Disc Disease

f. Facet Join Syndromes

g. Opioids

3. Testimonials

i. Discogram

i. Vertebral Discs

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