READ FIRST: How to Use the Information In the Neck Pain / Cervical Spine Category

Cervical Discogram - Test Report

Cervical Discogram Report

I was told not to drink any fluids or eat any food for 2 hours prior to my procedure. I took this advice seriously as I didn’t want to get nausea or throw up with needles stuck in my Neck.

Arrival at the Imaging Center

I arrived at the outpatient scan center, filled out the typical mountain of paperwork and releases.  Here sign this… blah blah.  Who can really read and understand all that fine print when they are in pain?  My advice is to research Discograms BEFORE you have yours so you know what to expect.

After the paperwork shuffle was completed I was seated in the lobby and waited about a half hour until I was called back.  I changed into the standard hospital scrubs - a gown that opens in the back and a pair of the pants.  I then was taken into the operating theater where I was given an IV.

Preparation for the Cervical Discogram

I received 1gm of an inter venous antibiotic, and placed into position on the table under the fluoroscopic arm.  I was also hooked up to a machine to monitor my blood pressure.  The Radiologist that did my procedure made sure a full 45 minutes passed before he began (This is a precaution to prevent infection and possible Discitis).  During that time he took time to explain to me the procedure and the risks and answered my questions.

My main question was about swallowing during the procedure.  Having needles protruding to the center of your cervical spine and swallowing seemed like it was a potential problem, but it’s not. He told me it was okay, but at certain points during the test he would tell me not to.  I didn’t know if I would be able to talk with needles in my neck, but it was no problem. I also asked about the gauge of the needles.  He told me they would be 25 gauge needles.  I had read some Doctors use 22 gauge needles (Lower the gauge the thicker the needle), and sometimes used the 22 gauge to the disc, the slipped a thinner 25 gauge inside the thicker needle.  He said there was no reason to do this.

The worst part of the 45 minute ordeal prior to beginning the test was the alcohol based scrub that was pretty powerful!  The smell was a bit overwhelming so they placed oxygen in my nostrils to help.  They topped off the Alcohol based prep, with another thick yellow gooey prep.  And for the record, this is very hard to wash off… you have to just let the last bit wear off after a few showers.

The Actual Cervical Discogram Begins

After all the preparation it was time for the Doctor to begin testing my discs. I was given a small amount of Versed (Midazolam) through my IV drip and off we went. The Doctor said he would be testing 4 levels between C4 and C7. For those of you who are new to this the level tested is named after the LOWER Vertebra… so the disc material between C3/4 would be called the C4 disc.  You have 7 Cervical Vertebrae but only 2 Discs because C1/2 is a bone in bone joint.  Anyways… moving on with the test experience.

The Doctor did not tell me the levels he was testing (So I would not be biased in my responses). And I could not tell what level he was working on. With the first needle puncture he said (This is going to feel like a bee sting… and it kind of did), then he would push the needle in slowly to the disc.  He used just enough anesthetic to make the procedure unpleasant, but bearable.  When the point of the needle arrived on the edge of the disc, he would tell me then he would push the needle in and tell me as he was injecting.

I should mention that just before each injection I could hear the Fluoroscopic arm move into position.  For those of you who don’t know the Fluoroscope takes X-Ray images in rapid succession so the Doctor can see EXACTLY where he is placing the needles.

He asked me to describe the pain on a scale of 1-10, tell him the location of the pain, and if this was typical of my “normal” pain or different from my “normal” pain.  Then he would withdraw the needle.  At the next level he said “bee sting” and then repeated the process until all 4 levels were complete.

I was told the test would take about half an hour, and that is probably pretty accurate.  It’s hard to keep track of time when you have Versad flowing through your veins.

Your personal pain tolerance will no doubt be different than mine.  I have had many IV’s and Needle procedures so this was pretty commonplace for me.  Yes it hurt!  But it is really not much worse than having dental work done (Okay it’s worse then regular dental, but not much worse than a root canal and it takes less time for the actual test than a root canal!).  The needles hurt most going in, then only for a few seconds during the active injection of the contrast agent.  Not all my discs caused pain… 3 of 4 were painful.  Only 2 of 4 above the “5″ Threshold on a scale of 1 to 10.  What was surprising was the disc that hurt the most was NOT the one I expected to hurt the most. I know this because after the test I asked the Doctor which disc it was that caused the most pain.

On to the CT SCAN

Immediately following the completion of the Cervical Discogram I was wheeled into another room and placed in the CT Scanner.  I’ve had CT Scans before and they are pretty easy.  Because they needed to scan my C6/7 level and I have broad shoulders (Plus my neck was in mild spasm from all the needling) I asked for the straps to help pull my arms down.

The CT Scan was a breeze and only took a few minutes.  Unlike MRI’s CT Scanners are basically open so you don’t need to worry if you are claustrophobic. The Downside to CT Scans is RADIATION.  And they blast you with a pretty high amount.  Be sure to ask your Doctor BEFORE the test about the precautions they use to minimize your exposure.  You want the least amount of radiation possible.

After the CT was complete I asked to talk to the Doctor because I had some questions about followup pain and I was pretty sore.  He offered to give me an injection of pain medication (I declined because I was pretty much doped up from the Meds I had from the IV).  But he did write me a script for a few pills to get me through the next couple of days and told me to be sure to call in to the Scan Center or to my Doctor if I got a fever or felt ill.

I never went to a recovery area, and no one really came to check on me. I waited seated on the side of a bed for about half hour to talk to the Doctor and then got dressed and went home.  Total elapsed time start to finish in the Scan Center was about 3 hours.

And while I felt okay, later on that night I was pretty sore.  I am about 36 hours post procedure at the time of this writing and pretty close to my normal all day everyday chronic pain self.

About the Cervical Discogram Test

Is the risk worth the benefit?  Maybe.  It depends on your own condition and a whole host of other factors.  Most Doctors will not order a Discogram unless they are seriously considering surgery.  The point of the test is to correlate Discogenic Pain to your regular pain.  If your discs are not causing your pain then surgery may not be a good answer for you.  It’s more complicated than that, but that’s the theory anyway. Sometimes the evidence on MRI is so overwhelming that the test is simply not needed.  Other times patients have pain that is just not explained until they have the test. Discograms are subjective test, but can be valuable.  They are also quite expensive!

That’s it… another test another day.

Cervical Discograms are a Diagnostic Test and do NOT treat pain.

Considering the Cost of Cervical Fusion vs. Disc Replacement

Artificial Cervical Disc Surgery Cheaper Than Fusion

– Kevin McKeever
HealthDay
Posted: 2008-04-28 19:05:04

Note: This article was funded by ADR Manufacturer Medtronic, maker of the FDA Approved prestige Cervical Artificial Disc. The real cost of surgery is not just in the upfront expenses.

MONDAY, April 28 (HealthDay News) — Treating cervical degenerative disc disease by surgically implanting an artificial vertebrae onto one’s spine may cost more initially than a traditional disc fusion operation, but it saves the patient almost $6,000 within two years, according to a new study.

The cost savings is primarily from the patient’s ability to return to work sooner after surgery and his or her need for fewer follow-up procedures.

The study — which was funded by Medtronic, the maker of the artificial cervical disc — was expected to be presented April 29 at the annual meeting of the American Association of Neurological Surgeons, in Chicago.

More than 200,000 procedures are performed each year in the United States to relieve compression on the spinal cord or nerve roots. The most common involves spinal fusion surgery to unify two or more vertebrae in an effort to strengthen the spine and alleviate chronic neck pain.

A year ago, the U.S. Food and Drug Administration approved the use of the first, and to date only, artificial cervical disc in certain cervical spine surgeries. Medtronic’s PRESTIGE disc is a stainless-steel device with a ball-in-trough design, held in place with bone screws.

Researchers conducting a cost-benefit analysis on 541 patients who received either the artificial cervical disc (arthroplasty) or fusion surgery found arthroplasty saved the patient an average of $5,988 over two years following the surgery.

The cost of initial surgery, secondary procedures and medical devices per patient and the average initial procedure cost were both higher for arthroplasty patients than for fusion patients; however, the artificial disc recipients saved long-term, because they needed fewer secondary procedures and returned to work following surgery an average of 38 days sooner than fusion patients.

The return to work alone yielded a gain in work productivity of $6,368, the report said.

“From a societal perspective, the economic benefits associated with these outcomes may offset the increased device costs associated with arthroplasty therapy,” said study presenter Dr. Vincent C. Traynelis, of the University of Iowa, in a prepared statement.

Motion Preservation Surgery of the Spine: Advanced Techniques and Controversies: Expert Consult: Online and Print

Motion Preservation Surgery Text Book

by James J. Yue (Author), Rudolph Bertagnoli (Author), Paul C. McAfee (Author), Howard S. An (Author)

Book Link: Motion Preservation Surgery

This is the most authoritative text available at the time of this writing (August 2008).

* Publisher: Elsevier Health Sciences
* Pub. Date: June 2008

Product Description

New motion-preserving devices are revolutionizing spine surgery but the learning curve for these operations is steep, and great attention must be given to patient and device selection and the perfect execution of each procedure. Only one reference spells out exactly how to perform these new techniques and its peerless author team, comprised of key investigators involved in the devices’ actual clinical trials, is uniquely qualified to help you get the best results! These global leaders in this area discuss the advantages and disadvantages of the full range of non-fusion technologies and present the step-by-step, richly illustrated operative guidance you need to achieve optimal outcomes! 3 hours of surgical video on DVD demonstrate how to perform key procedures, and access to the complete contents of the book online enables you to reference it conveniently from any computer.

* Select the best device and approach for each patient!
* cervical total disc arthroplasty
* lumbar total disc arthroplasty
* lumbar partial disc replacement: nucleus replacement
* lumbar posterior dynamic stabilization: pedicle screw based
* lumbar posterior dynamic stabilization: interspinous based
* lumbar facet replacement
* Produce optimal outcomes with detailed advice on
* advantages and disadvantages of each option
* indications and contraindications
* patient selection
* interpretation of imaging studies
* surgical anatomy and biomechanics
* surgical techniques
* tips and pearls
* See how to perform each technique, thanks to
* step-by-step, full-color illustrations
* more than 3 hours of surgical videos on DVD, narrated by the experts!
* Access to the complete contents of the book online lets you perform rapid searches, follow links to Medline and PubMed abstracts, and more.

Heterotopic Ossification in Total Cervical Artificial Disc Replacement.

Cervical Spine
Spine. 31(24):2802-2806, November 15, 2006.
Mehren, Christoph MD *; Suchomel, Petr MD, PhD +; Grochulla, Frank MD *; Barsa, Pavel MD +; Sourkova, Petra MD +; Hradil, Jan MD +; Korge, Andreas MD *; Mayer, H Michael MD, PhD *

Abstract:
Study Design. Prospective clinical study enrolled in 2 centers (Munich and Liberec) as part of a prospective European multicenter study with ProDisc C (Synthes Inc., Paoli, PA).

Objectives. The first goal of the study was to evaluate the rate of heterotopic ossifications identified with plain radiograph following total cervical disc replacement (TCDR). The second goal was to show whether segmental motion can be preserved, and whether TCDR can provide improvement of the patient’s ability to perform activities of daily living as well as a decrease of pain.

Summary of Background Data. Only a few reports about the radiologic outcome after TCDR are published so far. Heterotopic ossification is a well-known phenomenon after total hip arthroplasty. The rate of heterotopic ossification following TCDR is unclear.

Methods. The radiographs of 54 patients (in total, 77 implanted prostheses) were analyzed 1 year after TCDR with a ProDisc C prosthesis. We classified the heterotopic ossification in 5 grades according to a recently published classification system for lumbar total disc replacement. For clinical parameters, the visual analog scale and the Neck Disability Index were evaluated preoperatively and 1 year postoperatively. The Student t test and Wilcoxon test were used for statistical analysis.

Results. In 26 treated segments (33.8%), no heterotopic ossification was detectable. Grade 1 ossifications were present in 6 levels (7.8%). A total of 30 segments (39.0%) showed grade 2 ossifications. Heterotopic ossifications that led to restrictions of the range of motion were present in 8 cases (10.4%). One year postoperatively, 7 cases (9.1%) had a spontaneous fusion of the treated segment. The clinical parameters improved significantly and were similar to previous reports about TCDR.

Conclusions. Only 33.8% of the patients did not show any signs of heterotopic ossification, and the rate of spontaneous fusion after TCDR 1 year after surgery was unexpectedly high. There were 49.4% of the patients with grade 2-3 ossification, which lets us suspect an even higher rate of spontaneous fusion after long-term follow-ups. Motion preservation after TCDR is only guaranteed if spontaneous fusion can be prevented. Thus, mobility of the implanted segments needs to be further studied.

(C) 2006 Lippincott Williams & Wilkins, Inc.

Magnetic Resonance Imaging Clarity of the Bryan(R), Prodisc-C(R), Prestige LP(R), and PCM(R) Cervical Arthroplasty Devices.

Diagnostics
Spine. 32(6):673-680, March 15, 2007.
Sekhon, Lali H. S. MBBS, PhD, FRACS *; Duggal, Neil MD, FRCS(C) +; Lynch, James J. MD, FRSC I *; Haid, Regis W. MD ++; Heller, John G. MD [S]; Riew, K Daniel MD [//]; Seex, Kevin MBBS, FRACS, FRCS [P]; Anderson, Paul A. MD **

Abstract:
Study Design. Prospective, randomized, controlled and double-blinded study on imaging of artificial discs.

Objective. The purpose of this study is to compare postoperative imaging characteristics of the 4 currently available cervical arthroplasty devices at the level of implantation and at adjacent levels.

Summary of Background Data. Cervical arthroplasty is being performed increasingly frequently for degenerative disc disease and, in most cases, with frank neural compression. Unlike lumbar arthroplasty, performed mainly for axial back pain, decompression of neural elements may need to be confirmed with postoperative imaging after cervical arthroplasty.

Methods. Preoperative and postoperative magnetic resonance imaging scans of 20 patients who had undergone cervical arthroplasty were assessed for imaging quality. Five cases each of the Bryan(R) (Medtronic Sofamor Danek, Memphis, TN), Prodisc-C(R) (Synthes Spine, Paoli, PA), Prestige LP(R) (Medtronic Sofamor Danek), and PCM(R) devices (Cervitech, Rockaway, NJ) were analyzed. Six blinded spinal surgeons scored twice sagittal and axial T2-weighted images using the Jarvik 4-point scale. Statistical analysis was performed comparing quality before surgery and after disc implantation at the operated and adjacent levels and between implant types.

Results. Moderate intraobserver and interobserver reliability was noted. Preoperative images of patients in all implant groups had high-quality images at operative and adjacent levels. The Bryan(R) and Prestige LP(R) devices allowed satisfactory visualization of the canal, exit foramina, cord, and adjacent levels after arthroplasty. Visualization was significantly impaired in all PCM(R) and Prodisc-C(R) cases at the operated level in both the spinal canal and neural foramina. At the adjacent levels, image quality was statistically poorer in the PCM(R) and Prodisc-C(R) than those of Prestige LP(R) or Bryan(R).

Conclusions. Postoperative visualization of neural structures and adjacent levels after cervical arthroplasty is variable among current available devices. Devices containing nontitanium metals (cobalt-chrome-molybdenum alloys in the PCM(R) and Prodisc-C(R)) prevent accurate postoperative assessment with magnetic resonance imaging at the surgical and adjacent levels. Titanium devices, with or without polyethylene (Bryan(R) disc or Prestige LP(R)), allow for satisfactory monitoring of the adjacent and operated levels. This information is crucial for any surgeon who wishes to assess adequacy of neural decompression and where monitoring of adjacent levels is desired.

(C) 2007 Lippincott Williams & Wilkins, Inc.

Multiple-Level Arthroplasty With PCM Disc May Be as Effective as Single-Level Replacement

Note: This article was originally published in 2005, and is based on a Study done in Brazil. The device used was the PCM from Cervitech.

April 20, 2005 (New Orleans) — With two-year follow-up data on just under 100 patients, it appears that multiple-level arthroplasty with the Porous Coated Motion (PCM) cervical disc is as effective at reducing pain and preserving spine function as single-level arthroplasty with the device, the lead investigator reports.

Luiz Pimenta, MD, a neurosurgeon at the Clinica Mattos Pimenta in Sao Paolo, Brazil, presented the data here at the American Association of Neurological Surgeons annual meeting on behalf of the multiple centers participating in the PCM study. Dr. Pimenta has served as a consultant to PCM’s developer and manufacturer, Cervitech, Inc.

That company is based in the U.K. and the U.S., with headquarters in Rockaway, New Jersey.

According to Cervitech, the PCM disc is designed to allow “translational motion in an arc consistent with the natural motion of the cervical spine segment.” The disc has an ultra-high molecular weight polyethylene bearing surface attached to the lower endplate. Both of the endplates are made of cobalt chrome.

In the trial presented by Dr. Pimenta, 41 patients had a single-level replacement, 34 patients had a two-level replacement, eight had three-level replacement, and four had four-level replacement.

For single-level replacement patients, mean scores for the neck disability index (NDI) and the visual analog scale (VAS) score decreased by 38.7% and 38.6%, respectively, compared with 65% and 61.4% for the bilevel group. For the multiple-level replacement patients, the NDI decreased by 95.3% and the VAS by 86.6%.

Dr. Pimenta also reported on Odom scores at two years. Almost 13% of single-level replacement patients had excellent Odom scores compared with 16.3% of bilevel patients and 20.8% of multiple-level replacement patients.

In patients with multiple-level replacements, the clinical outcomes were generally better, and range of motion was much improved also, said Dr. Pimenta. Clinical studies of single-level arthroplasty might be underestimating the true benefit of the procedure, he said, but added that a large-scale randomized study was necessary.

Edward Benzel, MD, director of spinal disorders at the Cleveland Clinic Foundation in Ohio, said it appeared that the PCM disc is helping to establish and maintain lordosis. Fusion, he said, is well known for leading to decreased range of motion and degenerative changes at adjacent levels.

With the PCM disc study, it seemed that restoration of sagittal alignment was a key to the success seen with the multiple-level replacement patients, Dr. Benzel said. The maintenance of sagittal alignment may, in fact, be one of the most important variables, he said.

Total disc arthroplasty is likely to be much more costly than fusion, but “if there is greater quality, we may be willing to accept a greater cost,” Dr. Benzel said. He called the PCM disc study a “seminal work.” I am republishing here because it is one of the few articles explaining the potential benefits of Cervical ADR at multiple levels.

AANS 2005 Annual Meeting: Abstract 755. April 19, 2005.

Reviewed by Gary D. Vogin, MD

Dangers of Relying Solely on X-Ray for Diagnosis of Cervical Disc Problems

Case Report Acute Cervical Disc Lesions

A 6′6″ tall basketball playing student was involved in a fracas with gate crashers at his sister’s birthday party and was severely beaten up by six soldiers. He subsequently suffered neck and arm pain and was seen at a hospital on several occasions and told that because his pain neck x-rays were normal there was no dramatic lesion. He presented two years later unable to continue playing basketball because of an insidiously evil and spastic paraparesis and evidence of bilateral C7 root lesions.

Myelography revealed a severe traumatic C6/7 disc lesion which required surgery. The root pain was relieved, but recovery from the cord damage was incomplete. This case exemplifies once again the dangers of accepting that normal x-rays indicate there is no abnormality.

Where a neck injury occurs in a patient who already has an abnormal neck due to cervical spondylosis. In such patients sudden flexion or extension of the neck following a simple trip or rear end collision in a car they produce acute root symptoms or even a cute cord damage. Usually the root symptoms are bilateral may affect multiple routes and the accompanying cord damage may cause an acute tetraparesis. The potential seriousness of even minor traumatic events affecting the cervical spine in this way in patients with severe pre-existing spondylosis must be recognized.

Source: Neurological Differential Diagnosis By John Patten

5 Painful Facts You Need to Know

By Robert Roy Britt, LiveScience Managing Editor
http://www.livescience.com/health/080725-pain-facts.html

5 Painful Facts You Need to Know

First off, let’s set the record straight: Pain is normal. About 75 million U.S. residents endure chronic or recurrent pain. Migraines plague 25 million of us. One in six suffer arthritis.

The global pain industry peddles more than $50 billion in drugs a year. Yet for chronic pain sufferers, over-the-counter pills are typically little help, while morphine and other narcotics can be addictive sedatives.

An overview study published last month in the Journal of General Internal Medicine looked at multiple studies of pain and found “researchers don’t yet know how to determine which [treatment] is best for individual patients.” From studies of drugs to surgeries and alternative medicines, “We have found that there are huge gaps in our knowledge base,” said Dr. Matthew J. Bair, assistant professor of medicine at the Indiana University School of Medicine.

So what is pain and why do so many suffer so long?

Pain is felt when electrical signals are sent from nerve endings to your brain, which in turn can release painkillers called endorphins and generate reactions that range from instant and physical to long-term and emotional. Beyond that, scientific understanding gets painfully fuzzy.

Here’s what’s known:

Fact 1 - Scientist Don’t Understand Pain

When you’re in pain, you know it. But if scientists could fully grasp how pain works and why, they might be able to help you more. The American Academy of Pain Medicine defines pain as “an unpleasant sensation and emotional response to that sensation.” Some pain is the result of an obvious injury. Other times, it is caused by damaged nerves that are not so easy to pinpoint. “Pain is complex and defies our ability to establish a clear definition,” says Kathryn Weiner, director of the American Academy of Pain Management. “Pain is far more than neural transmission and sensory transduction. Pain is a complex mixture of emotions, culture, experience, spirit and sensation.”

Fact 2 - Chronic Pain Shrinks Brains

If you have chronic pain, you know how demoralizing and debilitating it can be, physically and mentally. It can prevent you from doing things and make you irritable for reasons nobody else understands. But that’s only half the story. People with chronic backaches have brains as much as 11 percent smaller than those of non-sufferers, scientists reported in 2004. They don’t know why. “It is possible it’s just the stress of having to live with the condition,” said study leader A. Vania Apkarian of Northwestern University. “The neurons become overactive or tired of the activity.”

Fact 3 - Migraines and Sex Go Together

It may not eliminate the phrase “Not tonight, honey …” but a 2006 study found that migraine sufferers had levels of sexual desire 20 percent higher than those suffering from tension headaches. The finding suggests sexual desire and migraines might be influenced by the same brain chemical, and getting a better handle on the link could lead to better treatments, at least for the pain portion of the equation.

Fact 4 - Women Feel More Pain

Any man who has watched a woman having a baby without using drugs would swear that women can tolerate anything. But the truth is, guys, it hurts more than you can imagine. Women have more nerve receptors than men. As an example, women have 34 nerve fibers per square centimeter of facial skin, while men average just 17. And in a 2005 study, women were found to report more pain throughout their lifetimes and, compared to men, they feel pain in more areas of their body and for longer durations.

Fact 5 - Some Animals Don’t Feel Our Pain

Animal research could offer clues to eventually relieve human suffering. Take the naked mole rat, a hairless and nearly blind subterranean creature. A study this year found it feels neither the pain of acid nor the sting of chili peppers. If researchers can figure out why, they might be on the road to new sorts of painkilling therapies for humans. In 2006, scientists found a pathway for the transmission of chronic pain in rats that they hope will translate into better understanding of human chronic pain. Lobsters feel no pain, even when boiled, scientists said in a 2005 report that is just one more salvo in a long-running debate.

What You Can Do

Meanwhile, exercise is a useful remedy for many types of chronic pain.

In an Italian study detailed in the May issue of the journal Cephalalgia, office workers did relaxation and posture exercises every two to three hours. Over an eight-month period, they kept diaries, which were then compared to those of a control group that did not change habits. In the end, the group that exercised reported that headaches and neck and shoulder pain decreased by more than 40 per cent, and their use of painkillers was cut in half.

“Physical activity is actually a natural pain reliever for most people suffering from arthritis,” concludes another study published in the Arthritis Care and Research journal in April. “Even minor lifestyle changes like taking a 10-minute walk three times a day can reduce the impact of arthritis on a person’s daily activities and help to prevent developing more painful arthritis,” said Dr. Patience White, chief public health officer of the Arthritis Foundation. “Physical activity can actually reduce pain naturally and decrease dependence on pain medications.”

A Doctor that Specializes in Pain Management is a Physiatrist!

A Physiatrist (Pain Management Doctor) is the specialist to help you with non-surgical “conservative” treatments to reduce pain. These Doctors use many injection therapies and do no “cure” pain, they only treat it. Do not confuse Physiatrist with a Psychiatrist or Psychologist who treat mental disorders - not pain.

5 Pain Treatment Methods for Spinal Related Pain

About these Spinal Pain Treatment Modalities

Treatments I list on this page are those I have not investigated throughly. I have not tried these treatments, some mainstream, some alternative. I list them only so that those of you who are visiting the site may have additional access to possible therapies. it’s hard to say I’ve tried everything when there are so many therapies “Out there”. The real problem is not every therapy works for every person. So with that being said I give you this list.

Intrathecal Drug Delivery (Pain Pumps) - This is heavy duty, you do not want this… only the very worst cases may need this treatment.

Spinal Chord Stimulator -Surgically implanted pain treatment devices similar to Intrathecal except they deliver low voltage electrical stimulation instead of drugs.

Radiofrequency and Pulse Radiofrequency - Electromagnetic energy is delivered via a needle to treat nerves for pain.

Phoresis - High frequency sound waves are used to push a steroid medication through the skin. Lontophoresis uses a small machine to produce a mild electrical charge to carry the medicine through the skin.

Spinal Chord Stimulator -Surgically implanted paint

Therapeutic Ultrasound - I’m still learning about how this works. I’ve had both hot and cold Therapeutic Ultrasound and the hot felt great, but I don’t know the side effects if applied improperly. Most of the mainstream medical community would agree there is not real evidence to support this treatment.

Exercise - Exercise Therapies - Yoga - Tai Chi

General Exercise

The body is designed for movement and movement aids healing, just don’t over do it! You have to remember there is no blood flow to the discs so if you do not move, the spinal fluid does not move!

Your road to recovery will be much slower or non-existent without some form of gentle to moderate exercise. I’ve had Doctors tell me for Cervical Problems not to swim, but others have said it’s good. I like to swim and while I don’t do anything specific for very long, I believe just the buoyancy provided such incredible relief there are immense benefits in aqua therapy even if all you do is walk through the water. This allows me to relax and stretch and move around and it feels great.

Yoga

The benefits of movement and stretching can not be understated unless directly contradicted by your condition. Give yoga a try I’m still working on my personal yoga experience and I think the benefits are making my pursuit worthwhile.

Beautiful Yoga Movements

Yoga is for everyone. I show you this video to show how incredible movement of the Human Form can be. You do not have to be flexible to start Yoga. The whole point is you are working towards your own goals at your own pace. If you never are able to touch your toes, that’s fine. That’s not the point. The point is to get your body moving and stretching with gentle, relaxing, and peaceful movements.

Tai Chi

Gentle movements and motions many have touted to have brought about relief from spinal pain throughout the back and neck. I have not been to an instructed class on Tai Chi, but from what I’ve read I would like to start.

Tai Chi Fundamentals for Taiji Beginners

Sympathetic Nerve Blocks

Sympathetic Nerve Blocks - Peripheral Nerves consist of two systems: sensory-somatic nervous system and the autonomic nervous system. All of the spinal nerves are “mixed”; that is, they contain both sensory and motor neurons. All our conscious awareness of the external environment and all our motor activity to cope with it operate through the sensory-somatic division of the PNS.

Only your Physician will be able to determine if this will benefit you should read about it and bring it to their attention. Many doctors want to believe their patients are uneducated morons, others will listen intently if you give them the opportunity. Physicians are busy people and often overlook the possible causes of pain in that they get so narrowly focused in their own little specialties. You may need a referral to a specialist to diagnose a cause or condition that would be best treated with a Nerve Block.

Please see additional posts on Nerve Blocks such as the Occipital Nerve Blocks for Cervogenic Headache.

Nucleoplasty

A minimally invasive procedure for disc Herniations involving radio wave therapy delivered via a needle to dissolve the disc herniation reducing pressure on the disc and the irritated nerves.

Learn more about the use of Nucleoplasty for Spinal Surgery.

TCM Traditional Chinese Medicine and Ayurvedic Medicine

Ayurvedic Medicine

A whole different world of treatment opportunities to vast to cover in a single post. Start with this link for information on Ayurvedic Medicine

TCM Traditional Chinese

Another system of Medicine that has been around for thousands of years, but today typically falls into the realm of “Alternative Medicine” in the eyes of westerners. I would encourage you to at least investigate the basics of Traditional Chinese Medicine.

I have been to a Chinese Medicine Doctor for acupuncture, and I have taken some Chinese Herbs, but beyond that I know little about the practice.

You may find treatmentd in either or both practices that work effectively for your pain problems.

Occipital Nerve Blocks for Cervicogenic Headaches

Cervicogenic Headaches

The cervical spine and associated muscular support of the head interwoven with vessels and nerve supply in the head and upper extremities, compose a complex structure with many sites for the generation of pain. A reduction in the space in which nerves pa ss through or lie can result in pain and loss of function. If the pressure is acute, pain is more likely to occur. Loss of function is generally the result of more prolonged and continuous pressure.

The sites of nerve compression in the neck are the intervertebral foramina, the spinal canal, the interscalene space and the course of the occipital nerves through the trapezius muscle at the base of the skull. Impairment or free movement at the joints, discs or ligaments may lead to irritation of sensitive structures of the joints and soft tissue of the neck. Reflex muscle spasms resulting from this irritation can produce continuous tension on the periosteal insertion of muscles. It is common for head and neck pain to originate with stress on the cervical musculature. Tension headaches are the result of sustained muscle contraction which produces both irritation at muscle insertion points and ischemic pain of the muscle itself.

Irritation of the cervical nerve roots at any point from their origin of the spinal cord to their paths to the occipital muscles can result in pain referred to the head and neck or upper extremity. Common sources of such irritation are the degenerative changes associated with osteophytes. As the degenerative process progresses, the spinal canal decreases in all diameters causing pressure on the long ascending and descending tracts as well as the cervical nerve roots. The most frequent complaint of the patient with cervical spondylosis is cervical, occipital or atypical facial pain due to irritation of the C2, C3 and C4 nerve roots. The continued irritation of these roots as they exit from the intervertebral foramina produce an inflammatory response i n the root with secondary edema.

As the greater and lesser occipital nerves pierce the trapezius at the base of the skull they are subject to pressure by cervical muscles and spasm. The result, an occipital neuralgia, produces further cervical spasms leading to a reflex perpetuation of occipital pain. Carcinoma and tumor invasion of the cervical spine and soft tissues of the neck may cause destruction as well as encroachment in cervical nerve roots or invasion of branches of the cervical plexus. These malignant forms of cervicogenic headache will not be discussed.

Treatment

The purpose of this discussion is to describe those injection techniques that have been found useful in the treatment of muscle tension and cervicogenic headaches. These procedures include: trigger point injections, occipital nerve blocks, anesthetic blocks of the cervical nerve C2-C5, facet joint blocks at C2, C3 and cervical epidural steroid injections.

Occipital Nerve Blocks

To understand how a blockade of the occipital nerve is efficacious in the treatment of headache, a review of the anatomy will be presented. The greater and lesser occipital nerves are sensory nerve which enter into the second, and to some extent the thir d cervical segments. The nerves enter the spinal cord via the Tract of Lissauer to terminate in the substantia gelatenosa of the upper cervical cord where they synapse. The infratentorial intracranial structures are innervated by the upper three cervical nerves. Sensory cutaneous distribution in the occipital nerve is over the back of the head anteriorly to the borders of the innervation of the first division of the trigeminal nerve. The C2 component is a more medial band extending form the superior nuch al line to this boundary. C1, when present, innervates an overlapping area more posteriorly. The greater occipital nerve passes over the superior nuchal line midway between the mastoid process on the occipital protuberance just lateral to the insertion of the nuchal ligaments. The lesser occipital protuberance is just lateal to the insertion of the nuchal ligaments. The lesser occipital nerve passes laterally to the greater occipital nerve over the nuchal ridge.

The greater occipital nerve runs transversely and then turns at right angles to run posteriorly. It then emerges through the aperture above the aponeurotic sling between the trapezius and the sternomastoid. This fact renders untenable any speculation t hat it may be compressed by spasm in the trapezius. Similarly, the nerve is not vulnerable to bony compression between the posterior arch of the atlas and the lamina of the axis. How the occipital nerve becomes sensitive to the diverse headache condition described is still a matter of speculation.

Occipital nerve blockade has been used for the treatment of diverse headaches for decades. The most effective position for greater occipital blockade is sitting or lateral decubitus with the chin flexed upon the chest. A short 25 gauge needle is inserted through the skin at the level of the superior nuchal line so as to develop a wall of local anesthetic surrounding the posterior occipital artery. The procedure should be done under strict aseptic conditions. The artery is commonly found approximately one-third of the distance between the external occipital protuberance and the mastoid process on the superior nuchal line. Injection of 3-5 ml of local anesthetic in this area with or without depo-corticosteroids will produce satisfactory anesthesia. Due to the superficial nature of this block complications are infrequent but may include hematoma, infection and paresthesia. Occipital nerve blockade will local anesthetic may also be used as a prognostic tool to determine if rhizotomy is warranted in refr actory cases. Occipital rhizotomy may be performed surgically or using a cryoprobe.

To learn more and read the complete article please visit Dr. Lichten’s Website.

Cryoanalgesia - Cryoneuroablation - Cryoneurolysis,

Basic Description of Cryoanalgesia

Cryoanalgesia is a pain-relieving technique which uses cold to treat nerve pain. It’s been around for centuries, and in its crudest form, uses ice to numb nerves. The more sophisticated, current type of cryoanalgesia uses a needle-like probe to deliver very, very cold sensation and thereby incapacitate nerves.

Detailed Description of Cryoanalgesia

Cryoneuroablation, also known as cryoanalgesia or cryoneurolysis, is a specialized technique for providing long-term pain relief in interventional pain management settings. Modern cryoanalgesia traces its roots to Cooper et al who developed in 1961, a device that used liquid nitrogen in a hollow tube that was insulated at the tip and achieved a temperature of - 190 degrees C. Lloyd et al proposed that cryoanalgesia was superior to other methods of peripheral nerve destruction, including alcohol neurolysis, phenol neurolysis, or surgical lesions.

The application of cold to tissues creates a conduction block, similar to the effect of local anesthetics. Long-term pain relief from nerve freezing occurs because ice crystals create vascular damage to the vasonervorum, which produces severe endoneural edema. Cryoanalgesia disrupts the nerve structure and creates wallerian degeneration, but leaves the myelin sheath and endoneurium intact.

Clinical applications of cryoanalgesia extend from its use in craniofacial pain secondary to trigeminal neuralgia, posterior auricular neuralgia, and glossopharyngeal neuralgia; chest wall pain with multiple conditions including post-thoracotomy neuromas, persistent pain after rib fractures, and post herpetic neuralgia in thoracic distribution; abdominal and pelvic pain secondary to ilioinguinal, iliohypogastric, genitofemoral, subgastric neuralgia; pudendal neuralgia; low back pain and lower extremity pain secondary to lumbar facet joint pathology, pseudosciatica, pain involving intraspinous ligament or supragluteal nerve, sacroiliac joint pain, cluneal neuralgia, obturator neuritis, and various types of peripheral neuropathy; and upper extremity pain secondary to suprascapular neuritis and other conditions of peripheral neuritis.

Stress

Practical Advice for Dealing with Stress

This is for real! Avoid the drugs. Deal with your issues head on. LET GO! The Dali Lama (I am not a follower, but appreciate his wisdom) has said Follow the three R’s: Respect for self, Respect for others, Responsibility for all. Love what you do and do what you love is another quote that will set you free from the burdens of stress.

When you get down go outside on a clear night away from city lights and just look at all the stars. You are part of the universe! You’re place is here and now and one day you will advance to someplace special based on your actions. When everything you do in life becomes more about you than those around you it’s time for self reflection.

Life is about giving! Once you have experienced the joy of a selfless act (And you can define a selfless act by doing something for someone and telling no one) you’ll be hooked. Don’t ask why me, ask why not me? You have the capacity to suffer; you’ll get through this! You may have no other options at this point in time. Nothing is static; everything changes.

Make everyday as good as you can. Don’t be afraid to cry - each tear is a drop of stress leaving your body! Focus on the positive, the beautiful, the enriching while you continue to educate yourself to various treatments. This is not a pep talk. These principals work.

People will forget what you do, people will forget what you say, but people will never forget the way you make them feel!

The past is over, each new day brings new opportunity and new challenges. Only you can determine your future by the decisions you make today. Once you are well do not forget the plight of those still suffering!

Faith and Spirituality

We Are All Spiritual Beings

Regardless of your religion at a molecular level we are all atoms, beings that are electro chemical. Faith, energy, our brains, mood, stress, all play a role in healing. When we are emotionally stable and emotionally healthy we feel better, and we can heal faster.

Practice your religion, follow your faith; if you pray - then pray, if you meditate - then meditate. You will find some interesting information by searching online for “Violet Flame”, “Archangel St. Michael”, “Archangel St. Germaine”, “Buddhism”, “Higher Self”, etc. Find a doctrine that makes sense to you and explore. At the very least you will educate yourself to the fact that we as human beings are not alone.

What matters is you find your core belief system, you then practice it. Keep an open mind as there is much to be learned from all religions. And the “right” religions is merely the one you believe.

Minimally Invasive Endoscopic Surgery

Minimally Invasive Endoscopic Surgery is any surgical procedure done with an Endoscope and a minimal incision. Unfortunately the definition varies, and an Endoscopic procedure can end up in a full incision depending on the procedure and needs of the patient.

As far as this applies to Spinal Procedures it’s main meaning is to remove only the offending portion of a disc through a small (Until it’s stuck in you!) needle like tube (Endoscope). The remaining portion of the disc is left intact. Search the NET for “Jho Proceedure” or Dr. Jho’s No Fusion Microforaminotomy for detailed information. Dr. Jho is one of many surgeons using Endoscopic Techniques, but I refer you to him as he explains a lot of the procedures.

Endoscopic Laser Spine Surgery (aka PLDD Percutaneous Laser Disc Decompression) A laser is threaded within a needle to the center of your disc then activated, the result is the water is evaporated out of the disc (the disc also contains fat) resulting in immediate shrinkage or resorption of the disc material and in practice for the right candidates this should reduce pressure on the nerves the disc was aggravating. Note this only works for the “right” candidates. You should note that this stops the pain for many, but it does not “fix” the disc. Once the pain is gone you must take dietary, postural, and lifestyle changes to ensure you do not cause further injury to your spine. Once the water is gone your disc is basically degenerated. You can read more about it at Dr. Daniel S.J. Choy Laser Spine Center. This link is not an endorsement, it’s a reference. I do not know Dr. Choy.

Note: While Minimally Invasive Endoscopic Surgery may seem the best “Answer” at first, it really doesn’t mean anything. What matters is patient selection, your condition, and whether an Endoscopic approach is your best treatment option. A Surgeon should always choose the best procedure for you, and to approach the procedure from the least invasive method which accomplishes the objectives.

Facet Joint Blocks

Graphic Image of a Facet Joint

A Facet Joint is a joint between two adjacent vertebrae. Each vertebra is connected at the intervertebral disk in the front and the two facet joints in the back. Facet Joints are the bony masses connected to the vertebrae in the image above. Facet Joints are prone to wear and tear as our spines degenerate, so as the Intervertebral Discs degenerate so do the Facet Joints (once the cartilage is gone).

A “Block” can be done to determine if this is the source of your pain. If this is the case then the nerves can be “burned” giving up to a year of temporary relief. Osteoarthritis (meaning bone inflammation) as a diagnosis if often really Facet Joint Pain. You will still need to fix your diet and posture, but this could help if the Facet Joint is truly the source of your pain. This is a minimally invasive procedure involving needles and outpatient surgery and in the Cervical Spine is usually done under Fluoroscopic Guidance.

Spinal Traction

Traction is a gentle consistent pressure that is applied to “Pull” the spine segments apart gently reducing pressure on the discs and adjacent materials. Traction can be performed manually by a trained medical professional or through the use of a traction device or machine.

I have used both an over the door ratcheting system (Neck Pro) and a Pronex inflatable system (Much Preferred). Unfortunately little relief in my case. I’ve read how this has helped many; however those with fused vertebrae should not attempt this modality as it can weaken or pull apart the fusion site.

My recommendation for anyone considering traction is to purchase an “Inversion Table” which I write about in a separate post Titled “Inversion Therapy”. Inversion is a very gentle method of traction that involves the entire spine. You simply lie on a table and invert (Tip upside down) a few degrees at a time. You do NOT have to hang completely upside down to enjoy benefits. In fact many people feel tremendous benefits from inverting only a few degrees.

Hydro Therapy - Aqautic Therapy for Pain Relief and Exercise

Benefits of Hydro Therapy

Hydro Therapy is simply the use of warm water to help us relax or exercise or both. Hot Tubs, Swimming Pools, Therapy Pools, and even your Home Bathtub can serve as appropriate vehicles for this purpose. Today’s “Hot Tub” contains dozens of jets that can feel wonderful and allow us to release muscle tension and relax. You may have a high end “Whirlpool Tub” or built in Home Spa. Larger bodies of warm water allow us to move from relaxation into exercise, stretching and strengthening. So while passive relaxation has it’s benefit, if you can, try and find a warm water pool large enough to exercise in. Ideally the pool will be no deeper than mid chest level to the bottom of your neck (48″ to 52″) is just about right.

If a pool is too deep it can be dangerous should you become ill. If a pool is too shallow you won’t receive the full benefits of flotation and buoyancy. Water allows us to exercise without stressing the joints. As muscles relax and the forces of gravity are lessened we can enjoy stretching that would not otherwise be possible. An ideal temperature for exercise is 84 to 90 degrees. Much warmer and you’ll become uncomfortable with your movements and begin to sweat a lot. For just relaxation 100 to 102 degrees is wonderful. When the water temperature drops below body temperature and we are not moving it becomes uncomfortable, and water over 104 degrees is very dangerous to our bodies. In fact if your water temperature is above body temperature you should limit your sessions to 20 minutes. Water 104 degrees and higher for periods longer than 20 minutes can damage your internal organs.

Warm water can really help to reduce your stress levels. Often Hydro Therapy is combined with aroma therapy and music to complete the relaxation. It’s hard not to just relax when the pressure is taken off your injury. It’s like an anti-gravity experience where we become weightless.

Some Spas contain special “Neck jets” or “Lumbar jets” that just melt (at least temporarily) away your pain. The warm water dilates the blood vessels promoting healing, and a 20 minute session will help you fall asleep faster

Caveats: You’re skin is an organ and will absorb chemicals in water so ask your dealer about the least chemical solution to keeping the water pure and clean. Tubs will make you sweat and release toxins in the water so be sure to keep your Spa’s water clean. Do not exceed 20 minutes in water over 104 degrees (The limit at which you can set the Spa’s) as your internal proteins will start to cook! If the water feels too hot turn it down, anything over body temperature will make you sweat. Ask your Physician about Hydro Therapy for your condition. Hydro Therapy will not “cure” your condition, but it can go a long ways to making your pain more tolerable and will aid in your recovery most of the time. If prescribed by your Physician you may be able to deduct the expense of a Hydro Therapy Solution from your personal taxes.

Note: Not everyone is comfortable in water. Some people never learn to swim as youngsters, this is okay. That’s why we recommend to find a pool that is not too deep. Find a partner to go with you. Swimming and splashing is fun! Enjoy yourself.

Tips on Purchasing a Hot Tub

There are so many brands available and Hot Tub dealers come and go. Find a local dealer that has been in business a long time with an established track record. The tub is important, but even more important is the warranty and service for that warranty. Tubs require maintenance, you’ll need a source for chemicals. Pumps break, control panels break. Just like purchasing an automobile - think about the “Total Cost of Ownership” not just the up front cost. Be sure to “Wet Test” the tub before you buy! Wet testing is essential, because the tubs feel completely different with and without water. Wet testing means taking your swimsuit to the dealer and sitting in the tub for 10 or 15 minutes. Make sure you can control the jets, make sure the jets are not so powerful that they blow you out of your seat. Try all the seat positions to be sure they are comfortable to your body.

Massage Thereapy Treatments for Back and Neck Pain

Note: See Also My Post on Myofascial Release

Different Types of Massage Treatments

• Deep Tissue - Targets deep layers of muscles and connective tissue
• Rolfing - A specific form of deep tissue work
• Trigger Point Therapy - Addresses Adhesions in the muscles
• Swedish - most common, long smooth strokes and kneading, circular motions
• Shiatsu - Finger pressure on acupuncture meridians
• Thai
• Many many more

My point in this post is not to cover every single variation of massage, but to point out there are treatments that may address your specific problem areas.

Therapies like Deep Tissue Massage are designed for relieving muscle contraction and reducing pain. Not all massage therapists are alike, some do not understand how to do this properly - this is a form of medical massage, as opposed to just a relaxing massage to reduce stress. All massage work has benefits. Try several different modalities and see what works best for you. Be careful of the oils the therapist uses - I like grapeseed oil.- as some oils contain fragrances and are toxic to the chemically sensitive. You’re skin will absorb these chemicals.

The only downside to massage treatments is cost. I would go everyday if I could afford the expense, or better yet I’d have the therapist stop by my home. Give massage a try, it’s great!

Video About Massage Treatments

UltraSound for Pain

High frequency sound waves are directed to the sore area causing the body tissues (molecules) to vibrate. This changes to heat in the deeper tissues helping to flush the area and bring in a new supply of nutrient and oxygen rich blood. I’ve had this treatment and it feels wonderful, but the effects did not last for very long.

I have uncovered very little evidence to suggest Ultrasound is an effective treatment for spinal pain. All I can tell you is when I had Heated Ultrasound and it really loosened up my muscles which felt great. I had Ultrasound at another facility with a cold gel and it did nothing. So I believe it was the heat that made me feel better.

Ergonomics - Maintain Your Posture Maintain Your Health

Are You Ready for a Rude Awakening

If you have Spinal Problems (Neck or Back) you have bad posture! Have someone video tape you sitting on the sofa, working on your computer, eating dinner, just the everyday activities you do all day long! Then watch that video and you’ll be amazed at how you slump, move, sit, etc.

Correcting bad postural habits will stop and may even reverse spinal problems. But the battle is difficult if your furniture is not designed with Ergonomics in mind. Most sofas, beds, chairs, etc. are NOT designed for proper posture. So the more you use the non-ergonomic disaster the more your spine has to compensate, and the more difficult it will be to ever recover proper posture and live pain free.

Videos to Introduce You to Ergonomics

This video is primarly about lifting properly

Selecting Ergonomic Office Furniture

Ergonomics Matter!

You can do every kind of therapy and/or treatment but if you continue on with old poor postural habits and non-ergonomic furniture, you’ll just fall into the same old trap that ruined your spine in the first place.

Ergonomics is simply a term to describe making your environment “spine friendly”. You simply can not underestimate the importance of keeping your spine in correct posture through the use of ergonomic furniture and office equipment. How many hours a day do you spend sitting or sleeping? During these times it is essential that you provide your spine the optimal correct support so it can heal, and to prevent further injury.

Use a lumbar pillow on your chairs or better yet purchase truly ergonomic chairs. A cervical injury will be made worse if you do not correct your lumbar posture (the spine and body work as a whole!). Steelcase™ Humanscale™, Bodybilt™ all build truly ergonomic office chairs; while the $200 OfficeMax chairs that claim to be ergonomic are NOT ergonomic at all! Sit in a well designed chair and you will immediately “feel” the difference.

If you are a computer user a LCD flat panel and invest in a moveable monitor arm. If you are a laptop user you should do this and hook your laptop up to the larger monitor and monitor arm. Make sure you take breaks from your chair every 20 minutes to stretch and change position. You need to move your spine and shift those discs!

Make sure you have a good bed. Avoid the Tempurpedic™ or Memory Foam Mattresses (The toxins emitted from these materials are very unhealthy). It’s all marketing hype. Buy real cotton or invest in a Talay Latex (Natural Rubber) mattress. Royal Pedic in Los Angeles makes outstanding beds (but they are expensive) and offers excellent information on their website about natural bedding materials. Yes some of you will have Latex allergies and will need all cotton mattresses, but otherwise Talay Latex is wonderful!

Purchase the proper back supports for you Car, Truck, or RV seats (It’s cheaper than purchasing new seats) It’s your health. Fix your posture or continue to pay the price. Yes it can be expensive to buy all these things, but can you afford not too? What is the true price of pain? How much is your health worth?

Acupuncture