Posts for tag: neck
Overview of Whiplash
Causes and Risk Factors for Whiplash
Signs and Symtoms of Whiplash
Steroids for Sciatica: More Trouble Than They're Worth
By Deborah Pate, DC, DACBR
Use of epidural steroid injections has increased dramatically in recent years, despite the fact that studies have failed to demonstrate evidence this procedure is clinically helpful (while other studies suggest it may actually be dangerous). Considering that lack of evidence – not to mention the terrible 2012 outbreak of fungal meningitis / infections caused by contaminated vials used for epidural corticosteroid injections – it is prudent at least to take a critical look at this procedure as it relates to sciatica or pain affecting the sciatic nerve, which extends from the lower back down the back of each leg.
Small Relief, Big Potential Side Effects
In a recent meta-analysis of 23 randomized trials involving more than 2,000 patients in which epidural steroid injections were compared with placebo for sciatica, epidural steroid injections produced small, statistically insignificant short-term improvements in leg pain and disability (but not less back pain) compared to placebo. This improvement also was only over a short period of time – two weeks to three months. Beyond 12 months, there was no significant difference between groups.
Besides infection, there are other side effects associated with epidural steroid injections: bleeding, nerve damage and dural puncture. Then there are side effects associated with the steroid medication, which include the following: a transient decrease in immunity, high blood sugar, stomach ulcers, cataracts and increased risk of fracture.
This last complication is certainly not emphasized in clinical circles. Therapeutic steroids may reduce pain, however the use of steroid injections seem to promote deterioration of skeletal quality, which is not surprising since other forms of steroid medication have long been associated with osteoporosis.
A retrospective study published in the Journal of Bone and Joint Surgery looked at lumbar epidural steroid injection (LESI), and the potential impact on bone fragility and vertebral fractures (spinal fractures). Researchers identified a total of 50,345 patients who had medical diagnosis codes involving the spine; within that group, a total of 3,415 patients had received at least one LESI.
Three thousand patients were randomly selected from the 3,415 injected population and 3,000 additional patients were selected from the non-injected group as a control group. There was no significant difference between the injected and non-injected groups with respect to age, sex, race, hyperthyroidism or corticosteroid use.
When incidence of vertebral fractures was assessed, researchers discovered that an increasing number of injections was associated with an increasing likelihood of fractures, and each successive injection increased the risk of spinal fracture by 21 percent. Based on this evidence, LESIs clearly exacerbate skeletal fragility. They promote deterioration of skeletal quality similar to the use of exogenous steroids, which is the leading cause of secondary osteoporosis. In fact, the rate of vertebral fracture following epidural steroid injections may be underestimated.
Both European and American guidelines, based on systemic reviews, conclude that epidural corticosteroid injections may offer temporary relief of sciatica, but do not reduce the rate of subsequent surgery. This conclusion is based on multiple randomized trials comparing epidural steroid injections with placebo injections, and monitoring of subsequent surgery rates. Facet joint injections with corticosteroids seem no more effective than saline injections.
Rising Costs, Limited Benefits
Despite the limited benefits of epidural injections, Medicare claims show a 271 percent increase during a recent seven-year interval. Earlier Medicare claims analyses also demonstrated rapid increases in spinal injection rates. For patients with axial back pain without sciatica, there is no evidence of benefit from spinal injections; however, many injections given to patients in the Medicare population seem to be for axial back pain alone.
Charges per injection have risen 100 percent during the past decade (after inflation), and the combination of increasing rates and charges has resulted in a 629 percent increase in fees for spinal injections. Yet during this time, the Medicare population increased by only 12 percent.
It all begs the question: Why such a huge increase in the use of a procedure that has limited benefit?
Talk to your doctor of chiropractic for more information on sciatica and nondrug alternatives to your pain.
Deborah Pate, DC, DACBR, is a San Diego chiropractor specializing in radiological assessment of the spine and musculoskeletal system. In fact, she was the first chiropractor accepted into a fellowship in osteoradiology at the University of California at San Diego. Contact her with questions and comments regarding this article at email@example.com .
As we get older, age-related spinal degeneration becomes more common, which is one of the reasons why cervical stenosis most often appears in people over the age of 50. Cervical stenosis is a chronic condition in which the spinal canal in the region of the neck becomes increasingly narrower, causing the nerves that run through the spinal cord to become compressed, leading to cervical myelopathy, which involves a range of symptoms such as pain, tingling, numbness and weakness in the arms, and sometimes in the legs as well.
Normal everyday wear and tear on the spine begins to make its effects more known the older we get. The vertebral disks that cushion the spine begin to lose fluid and become less flexible. Small tears can occur in the discs, causing them to bulge into the area of the spinal canal. In addition, the bones of the vertebra itself may begin to break down, and in response to this the body tries to build bone on the site of the damage, creating bone spurs (osteophytes) that may also impinge on the area of the spinal canal.
Another condition that can arise as we age is the calcification of our ligaments. This causes them to harden and thicken, and if it involves the ligaments in the spine, this can also create pressure on the nerves that run through the spinal canal. Other possible causes are spondylolisthesis (where one vertebra slips out over the one below it), arthritis (both rheumatoid arthritis and osteoarthritis can be risk factors for cervical stenosis), tumors, trauma due to displacement of the discs and bone fragments from fractures that fall into the area of the spinal canal. Cervical stenosis that shows up in young people is generally due to a genetic defect that causes the development of a narrow spinal canal.
Mild cases of cervical stenosis often cause little or no pain and can be treated with non-invasive methods such as chiropractic care, physical therapy and non-steroidal anti-inflammatory medications such as acetaminophen or ibuprofen. Your chiropractor can recommend exercises and stretches that will help to decompress the spinal canal and can use spinal manipulation to help realign misaligned vertebrae or apply traction to increase the space between the vertebral discs. In severe cases your chiropractor can refer you to a qualified neurosurgeon.
Corticosteroid injections are sometimes used to reduce inflammation and relieve pain, but these should not be used for a prolonged period of time, and its success is limited. If surgery is required, the surgeon will aim to create more space in the spinal canal so as to take the pressure off the nerves. This most usually involves a laminectomy, where a portion of the spine (the lamina) is removed to create more space for the nerves.
The New Way to Treat Herniated Discs Without Surgery
By Dr. James D. Edwards
If you’re suffering from a herniated disc and chiropractic adjustmentsor therapy have not yielded sufficient benefit, you should ask your doctor if you might be a candidate for spinal decompression therapy.
What is spinal decompression therapy?
It’s a nonsurgical, traction-based treatment for herniated or bulging discs in the neck and low back. Anyone who has back, neck, arm or leg pain caused by a degenerated or damaged disc may be helped by spinal decompression therapy.
Specific conditions that may be helped by this therapeutic procedure include herniated or bulging discs, spinal stenosis, sciatica, facet syndrome, spondylosis or even failed spinal surgery.
Many patients, some with magnetic resonance imaging (MRI)-documented disc herniations, have achieved “good” to “excellent” results after spinal decompression therapy.
The computerized traction head on the decompression table or machine is the key to the therapy’s effectiveness. The preprogrammed patterns for ramping up and down the amount of axial distraction eliminate muscle guarding and permit decompression to occur at the disc level. This creates a negative pressure within the disc, allowing the protruded or herniated portion to be pulled back within the normal confines of the disc, which permits healing to occur.
Your specific treatment plan will be determined by the doctor after your examination. Based on research and my clinical experience, the best results are achieved with 20 sessions over a six-week period. To reduce inflammation and assist the healing process, supporting structures sometimes are treated with passive therapies (ice/heat/muscle stimulation), chiropractic adjustments (when indicated) and/or active rehabilitation in order to strengthen the spinal musculature.
There are many spinal decompression systems in use today, most of which work equally well. The cost for 20 sessions can range from $1,000 to $5,000 or more. While this may seem like a lot, it is very reasonable, considering the cost and potential adverse outcomes associated with spine surgery.
Spinal decompression therapy has saved many people from spinal surgery. If you are suffering from a degenerated or herniated disc, I encourage you to explore safe and effective spinal decompression therapy before risking surgery. The rationale for treating a herniated disc without resorting to surgery has research support on its side: According to a recent study in the Journal of the American Medical Association,surgery is no more effective than non-invasive treatments, including chiropractic care, for patients with lumbar disc herniation causing sciatica.
Ask your doctor for more information about spinal decompression and if you might be a candidate. If your doctor does not yet offer spinal decompression therapy, they can help refer you to someone who does.
What Does It Mean?
Not familiar with some of the terminology in this article? Don’t worry: Here’s a brief explanation of what these terms mean in relation to your spine.
Anulus Fibrosus: The tough outer ring of a vertebral disc; it encases the nucleus pulposus (see description below) within the disc.
Facet Syndrome: An irritation of one or more of the joints on the back of the spinal vertebrae, which comprise the spinal column.
Herniated Disc: Displacement of the center of a vertebral disc through a crack in the outer layer. Disc herniation can put pressure on spinal nerves and cause pain.
Muscle Guarding: Muscle spasming, often in response to a painful stimulus.
Nucleus Pulposus: A gel-like substance within each intervertebral disc, surrounded by the anulus fibrosus.
Sciatica: Pain in the lower back, buttocks, hips, or adjacent anatomical structures, frequently attributable to spinal dysfunction.
Spinal Stenosis: Narrowing of the spine at one or more of three locations: in the center of the spine, where nerves branch from the spine, or in the space between vertebrae. This puts pressure on spinal nerves and can cause pain.
Spondylosis: Otherwise known as spinal arthritis, spondylosis is a degenerative condition in which spinal discs weaken, particularly with age.
James D. Edwards, DC, a graduate of Logan College of Chiropractic in St. Louis, Mo, has been in practice for more than 30 years.