Spine Care – PushAsRx Athletic Training Centers El Paso, TX https://www.pushasrx.com Chiropractic Science & Functional Fitness Thu, 06 Aug 2020 02:01:00 +0000 en-US hourly 1 https://wordpress.org/?v=5.4.2 https://i2.wp.com/www.pushasrx.com/wp-content/uploads/2019/06/IMG_8806_500_x_500.png?fit=32%2C32&ssl=1 Spine Care – PushAsRx Athletic Training Centers El Paso, TX https://www.pushasrx.com 32 32 111105572 Treatment Options for Spinal Compression Fractures https://www.pushasrx.com/spinal-compression-fracture/ Thu, 06 Aug 2020 02:01:00 +0000 https://www.pushasrx.com/?p=25859 11860 Vista Del Sol, Ste. 128 Treatment Options for Spinal Compression Fractures

Minimally invasive surgical procedures can be used to treat spinal compression fractures. These procedures are utilized to reduce severe pain, stabilize the fracture itself, and restore lost height or shape of the broken vertebral body. These procedures are known as: Balloon kyphoplasty Vertebroplasty Vertebral body augmentation A vertebral compression fracture is a type of spinal […]

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11860 Vista Del Sol, Ste. 128 Treatment Options for Spinal Compression Fractures Minimally invasive surgical procedures can be used to treat spinal compression fractures. These procedures are utilized to reduce severe pain, stabilize the fracture itself, and restore lost height or shape of the broken vertebral body. These procedures are known as:
  • Balloon kyphoplasty
  • Vertebroplasty
  • Vertebral body augmentation
A vertebral compression fracture is a type of spinal fracture that can be caused by osteoporosis. This is a metabolic disease that weakens bone density and increases the risk of fracture/s in the spine, wrist, and hip. Osteopenia and osteoporosis affect millions, according to the National Osteoporosis Foundation. If left untreated, it can progress without an individual knowing and painlessly until the bone/s fracture. A vertebral compression fracture is more frequent than hip fractures and can lead to extended disability.  
Vertebral Fracture Diagnosis Imaging Studies | El Paso, TX Chiropractor
 

Vertebroplasty

Vertebroplasty is a minimally invasive treatment done through the skin for painful vertebral compression fractures. It also helps with strengthening the surrounding vertebral bodies also at risk of fracturing. Orthopedic bone cement is injected into the fractured vertebral body.

How is it performed?

Under general anesthesia, a specialized needle for bone is slowly inserted through the soft tissues of the back towards the vertebral compression fracture. The surgeon sees the position of the needle at all times through a real-time x-ray. Once reached a small amount of orthopedic bone cement, called polymethylmethacrylate, is injected into the vertebral body. Polymethylmethacrylate is a medical-grade bone cement that’ss been used for years for various orthopedic procedures. The cement can sometimes be combined with an antibiotic to reduce the risk of infection along with a powder that has barium or tantalum. This allows it to be seen on the x-ray. The cement is a thick paste that hardens quickly. The fractured body is injected on the right and left sides, the midline of the back. After a few hours, the patient is up and moving. Most go home on the same day.  
11860 Vista Del Sol, Ste. 128 Treatment Options for Spinal Compression Fractures
 

Balloon kyphoplasty

Balloon Kyphoplasty is another newer minimally invasive surgery for vertebral compression fractures that can be associated with osteoporosis. Kyphoplasty utilizes a balloon that expands the compressed bone to help restore lost vertebral height while creating a space where bone cement is injected. Kyphoplasty stabilizes fractures, restores lost vertebral height, and reduces deformities.

How it is performed?

Balloon kyphoplasty is performed under local or general anesthesia. Using real-time x-ray two small incisions are made, and a probe is inserted into the vertebral body space. The bone is drilled and balloon/s, called a bone tamp is a pump that is inserted on each side.  
11860 Vista Del Sol, Ste. 128 Treatment Options for Spinal Compression Fractures
 
These balloons are inflated with contrast medium so the surgeon can see on the real-time x-ray until each balloon expands to the correct height, and then are taken out. The balloon is used to create a space for the bone cement and helps expand the compressed vertebral body bone. The cement binds and stabilizes the fracture. The cement provides:
  • Strength
  • Stability
  • Hardens rapidly
  • Restores height
  • Relieves pain

Vertebral augmentation implant

A vertebral augmentation implant is different from vertebroplasty and kyphoplasty. This minimally invasive procedure for middle and lower back spinal compression fractures utilizes a flexible loop spring style spinal implant. It is performed under local or general anesthesia. A real-time x-ray is used to visualize the spinal anatomy and guide the placement of the device. The implant is delivered through a small incision. Once the implant is in place, the bone cement is injected, and the implant is removed.  
 

Potential benefits include:

  • Reduction of new fractures above or below the existing fracture
  • Improves the spine’s angle
  • Reduced spinal deformity
  • Reduces bone cement leakage
  • Reduces the amount of bone cement

Benefits of all

Vertebral compression fractures and the limited abilities of traditional surgical options led to the refinement of these surgical systems. Each procedure provides options, as to how the treatment helps relieve pain, reduce and stabilize fractures, reduce spinal deformity, and stop the progressive worsening of untreated osteoporosis.

Added benefits:

  • Surgical time is minimal
  • Local or general anesthesia is all that is needed
  • Hospital stay is a day or only a few hours
  • Patients can quickly return to normal activities
  • No bracing required
A spine surgeon will explain the purpose and aims of the recommended procedure, including the benefits and risks to help make an informed decision.

Reduce Body Pain and Increase Performance with Functional Foot Orthotics

 
 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

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%%title%% %%excerpt%% chiropractic,compression,fracture,health,options,spinal,treatment,wellness,spinal compression fracture Vertebral Fracture Diagnosis Imaging Studies | El Paso, TX Chiropractor 11860 Vista Del Sol, Ste. 128 Treatment Options for Spinal Compression Fractures 11860 Vista Del Sol, Ste. 128 Treatment Options for Spinal Compression Fractures 25859
Thoracic Spine – Middle Back Basics https://www.pushasrx.com/thoracic-spine-middle-back-basics/ Tue, 04 Aug 2020 01:48:29 +0000 https://www.pushasrx.com/?p=25832 11860 Vista Del Sol, Ste. 128 Thoracic Spine - Middle Back Basics

The thoracic spine known as the middle back starts below the cervical or neck spine at around the level of the shoulders. It continues down to the first level of the low back or lumbar spine. There are twelve vertebrae, numbered T1-T12 top to bottom, and it is these vertebrae that make up the thoracic […]

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11860 Vista Del Sol, Ste. 128 Thoracic Spine - Middle Back Basics The thoracic spine known as the middle back starts below the cervical or neck spine at around the level of the shoulders. It continues down to the first level of the low back or lumbar spine. There are twelve vertebrae, numbered T1-T12 top to bottom, and it is these vertebrae that make up the thoracic spine. When seen from the side, a normal forward curve can be seen.  
11860 Vista Del Sol, Ste. 128 Thoracic Spine - Middle Back Basics
 
The ribs are attached to the thoracic spine’s vertebrae making this region of the spine strong and stable. However, this area has less range-of-motion than the neck region. Because of its location, the thoracic spine deals less with injury/s than other areas of the spine. But it is the most common area for fractures from osteoporosis. Scoliosis and abnormal kyphosis are also thoracic spine disorders.  
 
Getting to know the body’s spine and how it functions can help individuals have a better and thorough understanding of possible causes to upper and middle back pain, a doctor’s diagnosis, and the reasons for how simple lifestyle changes/choices can keep the middle back, as well as, the rest of the spine healthy.

Thoracic Support

The thoracic spine gives support to the torso, chest and provides an attachment point for each of the rib bones, minus the two at the bottom. The vertebral bodies are rounded with bony arches that project from the back of each and form a hollow protective space for the spinal cord. Facet joints are paired at the back of each and allow for limited movement.  
spinal arthritis el paso tx.

Intervertebral Discs

There is a fibrous pad called an intervertebral disc that is held in place by the endplates between each level’s upper and lower vertebral bodies. Each disc acts like a spacer creating disc height/space between the upper and lower vertebrae. This space opens nerve passageways called a foramen or neural foramina at both sides. Nerve roots branch off the spinal cord and exit the canal through the neural foramina.

Soft Support Structures Limited Movement/s

The entire spinal column consists of:
  • Ligaments
  • Tendons
  • Muscles
These soft tissues attach to the bones, the discs, and work together to stabilize the midback when resting and when in motion. Ligaments are the strong bands of tissue that connect/protect the vertebrae, discs, provide stability, and help with excessive movement. Muscles hold the body upright and allow spinal flexion which is bending forward, extension bending backward, and rotation twisting from side to side. And the tendons are fibrous tissues that attach the muscle/s to the bone.

Nerves Role

The twelve pairs of nerve rootlets that branch off the cord through the neural foramen are to supply and generate sensation/feeling along with function/movement to the body. These nerves provide nutrients to the midback and chest area and relay signals between the brain and major organs, including:
  • Lungs
  • Heart
  • Liver
  • Small intestine

Spinal Disorders

  • Osteoporosis raises the chances of a thoracic fracture. A vertebral compression fracture can cause one or more bodies of bone to flatten or become wedge-shaped creating spinal cord/nerve compression. Sudden and severe back pain can be associated with vertebral compression fractures.
  • Scoliosis is an abnormal side to side curvature of the spine and is well known to develop in the thoracic spine causing deformity.
  • Abnormal kyphosis means the forward curvature has become extreme. The appearance of a kyphotic deformity can be seen as a hump.
11860 Vista Del Sol, Ste. 128 Thoracic Spine - Middle Back Basics
 

Types of kyphosis:

  • Congenital or appearing at birth
  • Posture related
  • Scheuermann’s disease
  • Metastatic cancer where it travels from the chest, or lung causing spinal tumor/s that can develop and potentially lead to structural deterioration
  • Thoracic disc herniations are not common because of the middle back’s strength and stability created by the ribcage.

Spine Maintenance

Talk with your doctor, chiropractor, spine specialist about stretches and exercises that will work for your specific situation to strengthen the core, and middle back musculature. This will help significantly with injury prevention during flexion, extension, and rotation.
  • Pay attention to posture
  • Learn to use proper body mechanics
  • Quit smoking/vaping
  • Healthy diet
  • Learn about the risks for osteoporosis and talk with your doctor about a preventive bone maintenance plan.

Back Pain Therapy

 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

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%%title%% %%sep%% PUSH as Rx %%excerpt%% back,chiropractic,fracture,health,mid,motion,pain,relief,ribs,spine,thoracic,wellness,middle back 11860 Vista Del Sol, Ste. 128 Thoracic Spine - Middle Back Basics spinal arthritis el paso tx. 11860 Vista Del Sol, Ste. 128 Thoracic Spine - Middle Back Basics 25832
Spinal Tumors https://www.pushasrx.com/spinal-tumors/ Thu, 30 Jul 2020 01:54:20 +0000 https://www.pushasrx.com/?p=25812 11860 Vista Del Sol, Ste. 128 Spinal Tumors

A spinal tumor is an abnormal mass of tissue either inside the spine or outside. It is also called a neoplasm meaning a new abnormal growth. They can develop in the bone, spread to other parts of the spine, or outside the spine, like the lungs and chest. Tumor cells can multiply slowly or very […]

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11860 Vista Del Sol, Ste. 128 Spinal Tumors A spinal tumor is an abnormal mass of tissue either inside the spine or outside. It is also called a neoplasm meaning a new abnormal growth. They can develop in the bone, spread to other parts of the spine, or outside the spine, like the lungs and chest. Tumor cells can multiply slowly or very rapidly. Tumors are either cancerous or non-cancerous. They can develop anywhere in the spine:
  • Cervical – neck
  • Thoracic – mid-back
  • Lumbar – low-back
  • Sacral – sacrum
It is not uncommon for spinal tumors to develop out of a tumor from the individual’s breast, lung, kidney, prostate, or another area of the body that has spread out.  
11860 Vista Del Sol, Ste. 128 Spinal Tumors
 

Symptoms

Whether cancerous or not, spinal tumors can cause a variety of symptoms, including:
  • Pain not related to an injury or physical activity.
  • Pain in the back or neck that presents suddenly, quickly worsens, especially at night. This can be an indicator of a spinal tumor.
  • Pain that radiates to other parts of the body, like the arms, hands, legs, and feet.
  • The pain continues even when resting.
  • Muscle weakness or loss of sensation, especially in the legs, arms, or chest.
  • Difficulty walking
  • Abnormal curvature of the spine not from poor posture
  • Paralysis
  • Loss of bladder or bowel control
  • Lowered sensitivity to heat and cold
An individual could have a dominating symptom/s or a combination.

Causes

As previously mentioned these tumors can originally develop in another part of the body and then metastasize to the spine. These types of tumors are secondary tumors. Research scientists are still trying to figure out what exactly causes primary tumors that originate in the spine. One theory believes genetics plays a role.  
 

Early diagnosis

The most common symptom of a spinal tumor is pain. Examinations and diagnostic tests will be conducted both physical and neurological. A doctor or specialist needs to see and evaluate the spine. This is essential in diagnosing a potential tumor. A doctor could also order:
  • CT scan
  • MRI
  • PET scan – Positron Emission Tomography
  • Myelogram if there are symptoms of spinal cord compression
If the imaging reveals a tumor, a biopsy could be performed. A sample of tissue will be examined under a microscope to see if the tumor is cancerous or not. If the tumor is cancerous, the biopsy will show the type of cancer and determine the stage of the disease. Depending on the tumor type and location, other tests/procedures could be recommended.

Treatment

There are many factors that go into creating an optimal treatment plan. This includes whether the tumor is cancerous or not, size, location, and symptoms. Types of treatment:
  • Observe and wait as small non-cancerous tumors that are not growing or impinging/pinching other spinal structures could only need to be monitored for changes.
  • Surgery
  • Radiation treatment
  • Stereotactic radiosurgery works by delivering a high dose of radiation specifically targeted at the tumor
  • Chemotherapy

Chronic Body Pain Rehabilitation

 
 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

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Spinal Tumors | PushAsRx Athletic Training Centers El Paso, TX %%excerpt%% abnormal,cervical,chiropractic,growth,health,lumbar,neoplasm,sacral,spinal,thoracic,tumors,wellness,spinal tumors 11860 Vista Del Sol, Ste. 128 Spinal Tumors 25812
Spinal Hardware Removal When Broken or Infected https://www.pushasrx.com/spinal-hardware-removal/ Tue, 28 Jul 2020 02:02:41 +0000 https://www.pushasrx.com/?p=25781 11860 Vista Del Sol, Ste. 128 Spinal Hardware Removal When Broken or Infected

Different spinal surgical procedures use various types of spinal hardware to stabilize the spine. When this hardware breaks or gets infected sometimes it could have to be removed. The reason for this spinal hardware, whether from injury, disease, or a condition, that area of the spine needs added support other than the bone, collagen, ligaments, […]

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11860 Vista Del Sol, Ste. 128 Spinal Hardware Removal When Broken or Infected Different spinal surgical procedures use various types of spinal hardware to stabilize the spine. When this hardware breaks or gets infected sometimes it could have to be removed. The reason for this spinal hardware, whether from injury, disease, or a condition, that area of the spine needs added support other than the bone, collagen, ligaments, and other tissues. Surgeons utilize this hardware to:
  • Stabilize the spine
  • Correct deformities
  • Regain motion
  • Height restoration
  • Pain relief
  • Help heal another area of the spine
The hardware ranges from rods, plates, cages, wires, spacers, etc. There are many types and are employed in various operations. Many spine procedures involve some type of hardware. A surgeon relies on this spinal hardware to complete procedures involving realignment of the spine or spinal fusion. Many patients undergo spine surgery without complications, however, some have problems with the hardware. The most common issues are the hardware loosening, breaking, or the development of an infection. Unfortunately, when this happens it can mean that another surgical procedure may be necessary to remove the hardware/device.  
11860 Vista Del Sol, Ste. 128 Spinal Hardware Removal When Broken or Infected
 

Spinal Instrumentation

All of these pieces of equipment are designed to remain in the body permanently. The hardware can be made from stainless steel, titanium, and titanium alloy. Spinal fusion is common, involves hardware, and could be necessary to help/correct:
  • Spinal deformity/s
  • Degenerative condition/s
  • Heal fractures
  • Other issues causing back pain
The procedure involves the surgeon grafting bone between two vertebrae. Then the hardware is used to hold those vertebrae together. This eliminates motion between them. This is how the vertebrae fuse into a single bone, which reduces or eliminates the pain. Like with any surgical procedure complications can include hardware failure.  
 

Spinal Hardware Removal Reasons

If the hardware loosens, gets infected, or the patient can feel some of the hardware under the skin a surgeon will likely recommend removal. Intense, excessive pain is often a symptom of a loose screw and other hardware complications. If the hardware is protruding under the skin the patient could feel a bump that could cause pain when touched. Loose hardware could irritate the surrounding tissues and nerves, resulting in the patient feeling pain or hearing a grating, crackling, or popping sound. Loosened instrumentation can be caused by the bones of the spine not healing or fusing correctly. The hardware can also shift and break from the bones not healing properly. Other reasons for hardware failure shortly after surgery.
  • Lifting heavy objects
  • Participation in high-impact activities
  • Trauma from accident, slip, fall, etc.
  • Health conditions especially osteoporosis and osteopenia can increase the risk of the instrumentation loosening, breaking, and shifting.
Quite uncommon but some patients develop infections right after or weeks following the surgery. When the hardware gets infected the patient could feel pain along with the site of the incision draining, and fever. Key indicators around the incision site are:
  • Chills
  • Redness
  • Swelling
  • Tenderness
Sometimes there are allergic reactions to the hardware itself. However, this has decreased significantly in recent years. This was common with stainless steel before the use of titanium.  
11860 Vista Del Sol, Ste. 128 Spinal Hardware Removal When Broken or Infected
 

How The Removal Is Done

This type of removal surgery is typically not considered an emergency unless the nerves or spinal cord are at risk of being injured/damaged. The exact procedure depends on the individual’s specific situation and case. However, it will be easier than the first surgery. Removal is typically nowhere near the extensiveness of the initial instrumentation placement. Before the procedure, the surgeon will advise preparation tips, just as with the original surgery. To optimize recovery, patients should ensure they are in the best possible health that they can be. This means no smoking, light exercise, and even breathing exercises for optimal lung function. Patients should not begin any new medication regimen prior to the surgery and should ensure all medications are known to the surgical team. The procedure will go in through the original incision and remove any scar tissue around the hardware. Depending on the situation the hardware could be reinserted or left out entirely.

Post Removal

Hospital stay depends on the individual situation. Some patients go home the same day and some have to wait. If there was an infection it more than likely means an extended hospital stay to make sure the infection is gone and has not spread elsewhere. The healthcare team will give directions just as with the original surgery which can include detailed instructions on:
  • Sitting
  • Sleeping
  • Showering
  • Taking meds
  • Sex
Recovery from hardware removal depends on the extent of the surgery. Contact the surgical team if experience new or unusual symptoms after the procedure, including fever, pain beyond the surgical soreness, numbness, weakness, tingling, and for problems/issues around the incision area, like bleeding, redness, swelling, and draining.

Bottom Line

Spinal hardware helps the spine heal, and ultimately reduces or eliminates the back pain improving quality of life. Instrumentation and devices can be defective, causing them to break, loosen, etc and need to be replaced. It’s just in this case the replacement has to take place in and around the spine. A doctor will assess the damage and decide if removal surgery is necessary, which will prevent further problems.
 

18 Wheeler Accident Chiropractic Rehab

 
 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

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%%title%% %%excerpt%% broken,chiropractic,hardware,health,infected,plates,removal,rods,screws,spine,surgery,wellness,wires,spinal hardware 11860 Vista Del Sol, Ste. 128 Spinal Hardware Removal When Broken or Infected 11860 Vista Del Sol, Ste. 128 Spinal Hardware Removal When Broken or Infected 25781
Regenerative Epigenetics & Dietary Changes | El Paso, Tx (2020) https://www.pushasrx.com/regenerative-epigenetics-dietary-changes-el-paso-tx-2020/ Thu, 16 Jul 2020 23:09:55 +0000 https://www.pushasrx.com/regenerative-epigenetics-dietary-changes-el-paso-tx-2020/

PODCAST: Dr. Alex Jimenez and Kenna Vaughn introduce Sonja Schoonenberg to discuss epigenetics and nutrition. Our diet can affect our gene expression. Therefore, eating unhealthy foods can ultimately increase our predisposition to develop a variety of health issues, such as diabetes, stroke, and cardiovascular disease. Sonja Schoonenbert describes the benefits of fasting and how the […]

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PODCAST: Dr. Alex Jimenez and Kenna Vaughn introduce Sonja Schoonenberg to discuss epigenetics and nutrition. Our diet can affect our gene expression. Therefore, eating unhealthy foods can ultimately increase our predisposition to develop a variety of health issues, such as diabetes, stroke, and cardiovascular disease. Sonja Schoonenbert describes the benefits of fasting and how the Regenerate program can help provide people with similar benefits to fasting in order to promote overall health and wellness. The purpose of the following podcast is to emphasize the connection between dietary changes and gene expression as well as focus on natural regenerative treatment protocols. – Podcast Insight

If you have enjoyed this video and/or we have helped you in any way
please feel free to subscribe and share us.

Thank You & God Bless.
Dr. Alex Jimenez RN, DC, MSACP, CCST

Subscribe: http://bit.ly/drjyt

Facebook Clinical Page: https://www.facebook.com/dralexjimenez/
Facebook Sports Page: https://www.facebook.com/pushasrx/
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Facebook Neuropathy Page: https://www.facebook.com/ElPasoNeuropathyCenter/
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Yelp: El Paso Rehabilitation Center: http://goo.gl/pwY2n2
Yelp: El Paso Clinical Center: Treatment: https://goo.gl/r2QPuZ

Clinical Testimonies: https://www.dralexjimenez.com/category/testimonies/

Information:
Clinical Site: https://www.dralexjimenez.com
Injury Site: https://personalinjurydoctorgroup.com
Sports Injury Site: https://chiropracticscientist.com
Back Injury Site: https://www.elpasobackclinic.com
Rehabilitation Center: https://www.pushasrx.com
Functional Medicine: https://wellnessdoctorrx.com
Fitness & Nutrition: http://www.push4fitness.com/team/

Twitter: https://twitter.com/dralexjimenez
Twitter: https://twitter.com/crossfitdoctor

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Regenerative Epigenetics & Dietary Changes | El Paso, Tx (2020) | PushAsRx Athletic Training Centers El Paso, TX | https://www.youtube.com/watch?v=P5joK7TqIok PODCAST: Dr. Alex Jimenez and Kenna Vaughn introduce Sonja Schoonenberg to discuss epigenetics and nutrition. crossfit,el paso crossfit center,Push fitness Center,pushasrx 25710
Learning About Food Substitutions | El Paso, Tx (2020) https://www.pushasrx.com/learning-about-food-substitutions-el-paso-tx-2020/ Tue, 14 Jul 2020 23:00:45 +0000 https://www.pushasrx.com/learning-about-food-substitutions-el-paso-tx-2020/

PODCAST: Dr. Alex Jimenez, Kenna Vaughn, and Lizette Ortiz discuss the importance of nutrition and diet for overall health and wellness as well as how several food substitutions can ultimately help people lose weight and avoid food sensitivities. The standard American diet is made up of processed, packaged foods that have too many ingredients that […]

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PODCAST: Dr. Alex Jimenez, Kenna Vaughn, and Lizette Ortiz discuss the importance of nutrition and diet for overall health and wellness as well as how several food substitutions can ultimately help people lose weight and avoid food sensitivities. The standard American diet is made up of processed, packaged foods that have too many ingredients that can cause a variety of health issues associated with diseases like diabetes, among others. The following podcast discusses how working with a client and closely developing a good diet for them can help improve their overall health and wellness. Dr. Alex Jimenez, Kenna Vaughn, and Lizette Ortiz share various delicious and healthy recipes. – Podcast Insight

If you have enjoyed this video and/or we have helped you in any way
please feel free to subscribe and share us.

Thank You & God Bless.
Dr. Alex Jimenez RN, DC, MSACP, CCST

Subscribe: http://bit.ly/drjyt

Facebook Clinical Page: https://www.facebook.com/dralexjimenez/
Facebook Sports Page: https://www.facebook.com/pushasrx/
Facebook Injuries Page: https://www.facebook.com/elpasochiropractor/
Facebook Neuropathy Page: https://www.facebook.com/ElPasoNeuropathyCenter/
Facebook Fitness Center Page: https://www.facebook.com/PUSHftinessathletictraining/

Yelp: El Paso Rehabilitation Center: http://goo.gl/pwY2n2
Yelp: El Paso Clinical Center: Treatment: https://goo.gl/r2QPuZ

Clinical Testimonies: https://www.dralexjimenez.com/category/testimonies/

Information:
Clinical Site: https://www.dralexjimenez.com
Injury Site: https://personalinjurydoctorgroup.com
Sports Injury Site: https://chiropracticscientist.com
Back Injury Site: https://www.elpasobackclinic.com
Rehabilitation Center: https://www.pushasrx.com
Functional Medicine: https://wellnessdoctorrx.com
Fitness & Nutrition: http://www.push4fitness.com/team/

Twitter: https://twitter.com/dralexjimenez
Twitter: https://twitter.com/crossfitdoctor

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Learning About Food Substitutions | El Paso, Tx (2020) | PushAsRx Athletic Training Centers El Paso, TX | https://www.youtube.com/watch?v=_vInczwRVrs PODCAST: Dr. Alex Jimenez, Kenna Vaughn, and Lizette Ortiz discuss the importance of nutrition and diet for crossfit,el paso crossfit center,Push fitness Center,pushasrx 25709
Sports Nutrition and Sports Dietitian | El Paso, Tx (2020) https://www.pushasrx.com/sports-nutrition-and-sports-dietitian-el-paso-tx-2020/ Mon, 13 Jul 2020 22:57:57 +0000 https://www.pushasrx.com/sports-nutrition-and-sports-dietitian-el-paso-tx-2020/

PODCAST: Dr. Alex Jimenez, a chiropractor in El Paso, and Kenna Vaughn, a health coach in El Paso, TX, introduce Taylor Lyle, a sports dietitian in El Paso, TX, to discuss the importance of nutrition and diet for young athletes and professional athletes. Taylor Lyle discusses her experience in sports nutrition as she describes how […]

The post Sports Nutrition and Sports Dietitian | El Paso, Tx (2020) appeared first on PushAsRx Athletic Training Centers El Paso, TX.

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PODCAST: Dr. Alex Jimenez, a chiropractor in El Paso, and Kenna Vaughn, a health coach in El Paso, TX, introduce Taylor Lyle, a sports dietitian in El Paso, TX, to discuss the importance of nutrition and diet for young athletes and professional athletes. Taylor Lyle discusses her experience in sports nutrition as she describes how it is that she chose to become a sports dietitian. With her tremendous knowledge in nutrition and diet, Taylor Lyle now has a new goal of helping athletes in El Paso, Texas improve their overall health and wellness as well as enhance their performance. Taylor Lyle is also willing to help anyone who wants to achieve overall health and wellness. Dr. Alex Jimenez, Kenna Vaughn, and Taylor Lyle conclude the podcast by discussing their future plans towards helping athletes understand the importance of nutrition and diet. – Podcast Insight

If you have enjoyed this video and/or we have helped you in any way
please feel free to subscribe and share us.

Thank You & God Bless.
Dr. Alex Jimenez RN, DC, MSACP, CCST

Subscribe: http://bit.ly/drjyt

Facebook Clinical Page: https://www.facebook.com/dralexjimenez/
Facebook Sports Page: https://www.facebook.com/pushasrx/
Facebook Injuries Page: https://www.facebook.com/elpasochiropractor/
Facebook Neuropathy Page: https://www.facebook.com/ElPasoNeuropathyCenter/
Facebook Fitness Center Page: https://www.facebook.com/PUSHftinessathletictraining/

Yelp: El Paso Rehabilitation Center: http://goo.gl/pwY2n2
Yelp: El Paso Clinical Center: Treatment: https://goo.gl/r2QPuZ

Clinical Testimonies: https://www.dralexjimenez.com/category/testimonies/

Information:
Clinical Site: https://www.dralexjimenez.com
Injury Site: https://personalinjurydoctorgroup.com
Sports Injury Site: https://chiropracticscientist.com
Back Injury Site: https://www.elpasobackclinic.com
Rehabilitation Center: https://www.pushasrx.com
Functional Medicine: https://wellnessdoctorrx.com
Fitness & Nutrition: http://www.push4fitness.com/team/

Twitter: https://twitter.com/dralexjimenez
Twitter: https://twitter.com/crossfitdoctor

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Sports Nutrition and Sports Dietitian | El Paso, Tx (2020) | PushAsRx Athletic Training Centers El Paso, TX | https://www.youtube.com/watch?v=L9yXI6Nq-oE PODCAST: Dr. Alex Jimenez, a chiropractor in El Paso, and Kenna Vaughn, a health coach in El Paso, TX, crossfit,el paso crossfit center,Push fitness Center,pushasrx 25708
Spinal Injury Could Cause Neurogenic Bladder Dysfunction https://www.pushasrx.com/spinal-injury-neurogenic-bladder-dysfunction/ Thu, 09 Jul 2020 01:46:44 +0000 https://www.pushasrx.com/?p=25624 11860 Vista Del Sol Ste. 128 Spinal Injury Could Cause Neurogenic Bladder Dysfunction

Spinal disorders and injuries could cause a nerve injury through compression or damage causing Neurogenic Bladder Dysfunction also known as Bladder Dysfunction. Neurogenic bladder disorder means an individual is having problems with urination. Neurogenic involves the nervous system and the nerve tissues that supply and stimulate the organs and muscles to function and operate correctly. […]

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11860 Vista Del Sol Ste. 128 Spinal Injury Could Cause Neurogenic Bladder Dysfunction Spinal disorders and injuries could cause a nerve injury through compression or damage causing Neurogenic Bladder Dysfunction also known as Bladder Dysfunction. Neurogenic bladder disorder means an individual is having problems with urination. Neurogenic involves the nervous system and the nerve tissues that supply and stimulate the organs and muscles to function and operate correctly. Neurogenic bladder dysfunction causes the nerves that control the bladder and muscles in urination to be overactive or underactive.  
11860 Vista Del Sol Ste. 128 Spinal Injury Could Cause Neurogenic Bladder Dysfunction
 

Symptoms

  • Constant bathroom visits
  • Control in urination is limited
  • Complete involuntary urination
  • Sudden urge/s to urinate
  • The bladder is unable to hold urine
  • The bladder fails to empty completely
  • Overfilling of the bladder creates intense pressure causing accidental leakage
11860 Vista Del Sol Ste. 128 Spinal Injury Could Cause Neurogenic Bladder Dysfunction
 

Nerves of the Bladder

The brain and spinal cord function as the headquarters with the spine as the body’s highway that transmits and relays signals/messages to and from the bladder. In the low back, the spinal cord splits apart into a bundle of nerves called the cauda equina.  
 
At the end of the lumbar spine is the sacrum this area is known as the sacral spine. The sacrum is the backside of the pelvis between the hip bones. The nerves in the sacral spine branch out and become part of the peripheral nervous system.  
Blog Image Anatomy of Pelvis and Force Distribution e
 
These nerves provide and stimulate bladder sensation and function. When these nerves become compressed, inflamed, injured, or damaged in some way, organ dysfunction can present. This is when any of the symptoms listed above can develop and progress.  

Potential Causes of Neurogenic Bladder Dysfunction

Spinal Cord Injury/s are a common cause of neurogenic bladder dysfunction. The spinal cord does not have to be severed to cause paralysis below the injured part of the spine. If the spinal cord gets bruised or there is improper blood flow, the spinal cord’s ability to send nerve signals can become inhibited. Cauda Equina Syndrome happens when the nerves spinal roots become pinched or compressed. It is rare, but it is a serious medical condition that requires immediate medical attention. Causes of cauda equina syndrome include:
  • Low back disc herniation
  • A tumor in or near the low back
  • Spinal fracture
  • Infection
  • Spinal stenosis which affects the spinal canal
  • Trauma like an auto accident, personal/work/sports injury
  • Spinal condition from injury or present from birth
spinal arthritis el paso tx.
 

Treatment

The treatment depends on the cause or causes of neurogenic bladder dysfunction. A primary physician could call upon a bladder specialist like a urologist, nephrologist, or urogynecologist to collaborate and coordinate the treatment plan. If the dysfunction is caused by a nerve root compression, a spinal procedure (discectomy) is performed to decompress and relieve the pressure on the nerves.

Nutrition and Fitness During These Times


 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

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%%title%% %%excerpt%% bladder,chiropractic,compressed,disorder,dysfunction,health,injury,nerve,neurogenic,pinched,spinal,wellness,neurogenic bladder dysfunction 11860 Vista Del Sol Ste. 128 Spinal Injury Could Cause Neurogenic Bladder Dysfunction 11860 Vista Del Sol Ste. 128 Spinal Injury Could Cause Neurogenic Bladder Dysfunction Blog Image Anatomy of Pelvis and Force Distribution e spinal arthritis el paso tx. 25624
Nutrition and Fitness During These Times | El Paso, Tx (2020) https://www.pushasrx.com/nutrition-and-fitness-during-these-times-el-paso-tx-2020/ Tue, 07 Jul 2020 23:13:52 +0000 https://www.pushasrx.com/nutrition-and-fitness-during-these-times-el-paso-tx-2020/

PODCAST: Dr. Alex Jimenez, Kenna Vaughn, Lizette Ortiz, and Daniel “Danny” Alvarado discuss nutrition and fitness during these times. During quarantine, people have become more interested in improving their overall health and wellness by following a proper diet and participating in exercise. The panel of experts in the following podcast offers a variety of tips […]

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PODCAST: Dr. Alex Jimenez, Kenna Vaughn, Lizette Ortiz, and Daniel “Danny” Alvarado discuss nutrition and fitness during these times. During quarantine, people have become more interested in improving their overall health and wellness by following a proper diet and participating in exercise. The panel of experts in the following podcast offers a variety of tips and tricks on how you can improve your well-being. Moreover, Lizette Ortiz and Danny Alvarado discuss how they’ve been helping their clients achieve their optimal well-being during these COVID times. From eating fruits, vegetables, lean meats, good fats, and complex carbohydrates to avoiding sugars and simple carbohydrates like white pasta and bread, following a proper diet and participating in exercise and physical activity is a great way to continue to promote your overall health and wellness. – Podcast Insight

If you have enjoyed this video and/or we have helped you in any way
please feel free to subscribe and share us.

Thank You & God Bless.
Dr. Alex Jimenez RN, DC, MSACP, CCST

Subscribe: http://bit.ly/drjyt

Facebook Clinical Page: https://www.facebook.com/dralexjimenez/
Facebook Sports Page: https://www.facebook.com/pushasrx/
Facebook Injuries Page: https://www.facebook.com/elpasochiropractor/
Facebook Neuropathy Page: https://www.facebook.com/ElPasoNeuropathyCenter/
Facebook Fitness Center Page: https://www.facebook.com/PUSHftinessathletictraining/

Yelp: El Paso Rehabilitation Center: http://goo.gl/pwY2n2
Yelp: El Paso Clinical Center: Treatment: https://goo.gl/r2QPuZ

Clinical Testimonies: https://www.dralexjimenez.com/category/testimonies/

Information:
Clinical Site: https://www.dralexjimenez.com
Injury Site: https://personalinjurydoctorgroup.com
Sports Injury Site: https://chiropracticscientist.com
Back Injury Site: https://www.elpasobackclinic.com
Rehabilitation Center: https://www.pushasrx.com
Functional Medicine: https://wellnessdoctorrx.com
Fitness & Nutrition: http://www.push4fitness.com/team/

Twitter: https://twitter.com/dralexjimenez
Twitter: https://twitter.com/crossfitdoctor

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Nutrition and Fitness During These Times | El Paso, Tx (2020) | PushAsRx Athletic Training Centers El Paso, TX | https://www.youtube.com/watch?v=hjM-8pPF03U PODCAST: Dr. Alex Jimenez, Kenna Vaughn, Lizette Ortiz, and Daniel "Danny" Alvarado discuss nutrition and crossfit,el paso crossfit center,Push fitness Center,pushasrx 25665
Personalized Medicine Genetics & Micronutrients | El Paso, Tx (2020) https://www.pushasrx.com/personalized-medicine-genetics-micronutrients-el-paso-tx-2020/ Mon, 06 Jul 2020 23:05:40 +0000 https://www.pushasrx.com/personalized-medicine-genetics-micronutrients-el-paso-tx-2020/

PODCAST: Dr. Alex Jimenez and Dr. Marius Ruja discuss the importance of personalized medicine genetics and micronutrients for overall health and wellness. Following a proper diet and participating in exercise alone isn’t enough to make sure that the human body is functioning properly, especially in the case of athletes. Fortunately, there are a variety of […]

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PODCAST: Dr. Alex Jimenez and Dr. Marius Ruja discuss the importance of personalized medicine genetics and micronutrients for overall health and wellness. Following a proper diet and participating in exercise alone isn’t enough to make sure that the human body is functioning properly, especially in the case of athletes. Fortunately, there are a variety of tests available that can help people determine if they have any nutritional deficiencies that may be affecting their cells and tissues. Vitamin and mineral supplements can also ultimately help improve an individual’s overall health and wellness. While we may not be able to change certain aspects of our genes, Dr. Alex Jimenez and Dr. Marius Ruja discuss that following a proper diet and participating in exercise while taking the proper supplements, can benefit our genes and promote well-being. – Podcast Insight

If you have enjoyed this video and/or we have helped you in any way
please feel free to subscribe and share us.

Thank You & God Bless.
Dr. Alex Jimenez RN, DC, MSACP, CCST

Subscribe: http://bit.ly/drjyt

Facebook Clinical Page: https://www.facebook.com/dralexjimenez/
Facebook Sports Page: https://www.facebook.com/pushasrx/
Facebook Injuries Page: https://www.facebook.com/elpasochiropractor/
Facebook Neuropathy Page: https://www.facebook.com/ElPasoNeuropathyCenter/
Facebook Fitness Center Page: https://www.facebook.com/PUSHftinessathletictraining/

Yelp: El Paso Rehabilitation Center: http://goo.gl/pwY2n2
Yelp: El Paso Clinical Center: Treatment: https://goo.gl/r2QPuZ

Clinical Testimonies: https://www.dralexjimenez.com/category/testimonies/

Information:
Clinical Site: https://www.dralexjimenez.com
Injury Site: https://personalinjurydoctorgroup.com
Sports Injury Site: https://chiropracticscientist.com
Back Injury Site: https://www.elpasobackclinic.com
Rehabilitation Center: https://www.pushasrx.com
Functional Medicine: https://wellnessdoctorrx.com
Fitness & Nutrition: http://www.push4fitness.com/team/

Twitter: https://twitter.com/dralexjimenez
Twitter: https://twitter.com/crossfitdoctor

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Personalized Medicine Genetics & Micronutrients | El Paso, Tx (2020) | PushAsRx Athletic Training Centers El Paso, TX | https://www.youtube.com/watch?v=tIwGz-A-HO4 PODCAST: Dr. Alex Jimenez and Dr. Marius Ruja discuss the importance of personalized medicine genetics and crossfit,el paso crossfit center,Push fitness Center,pushasrx 25666
Spinal Tap used to Diagnose, Administer Medicine, and Imaging Assistance https://www.pushasrx.com/spinal-tap-diagnose-medicine-image/ https://www.pushasrx.com/spinal-tap-diagnose-medicine-image/#respond Wed, 01 Jul 2020 02:27:41 +0000 https://www.pushasrx.com/?p=25591 11860 Vista Del Sol, Ste. 128 Spinal Tap used to Diagnose, Administer Medicine, and Imaging Assistance

Most of us have heard the term spinal tap, or have seen it on a tv medical drama show. It is known as a lumbar puncture, but what does this procedure involve and how is it utilized? What to know. This procedure is performed in the lower part of the back. It can be used […]

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11860 Vista Del Sol, Ste. 128 Spinal Tap used to Diagnose, Administer Medicine, and Imaging Assistance Most of us have heard the term spinal tap, or have seen it on a tv medical drama show. It is known as a lumbar puncture, but what does this procedure involve and how is it utilized? What to know. This procedure is performed in the lower part of the back. It can be used for: A spinal tap is performed by a doctor or nurse trained to do lumbar punctures. A specialized needle is inserted between the vertebrae to collect cerebrospinal fluid. Cerebrospinal fluid is a watery, colorless fluid that cushions the spinal cord and brain, protecting them from injury/damage. Questions may arise as to when an individual would need a spinal tap, how dangerous it is, and what to expect from this procedure?  
11860 Vista Del Sol, Ste. 128 Spinal Tap used to Diagnose, Administer Medicine, and Imaging Assistance
 

Spinal Tap Utilization

Spinal taps are often utilized in helping to diagnose infections of the central nervous system. One of the most common infections is meningitis. A sample of cerebrospinal fluid is taken, tested, and if infectious organisms are growing within, these are clue/s for determining and customizing a treatment plan and antibiotic therapy. The procedure also helps with:
  • Identifying central nervous system disorders, like multiple sclerosis, or epilepsy for example.
  • Diagnosing cancers that affect the brain or spinal cord
  • Administration of chemotherapy or anesthesia

Spinal taps are also used with imaging assistance.

For example, a contrast dye can be injected into the cerebrospinal fluid to get an anatomical view of the spinal cord and coverings. They are quite helpful when an individual cannot have an MRI done.  
 

Spinal cord coverings from a cross-section of a nerve

 

Spinal cord rear view

 
 
  1. spinal cord
  2. arachnoid
  3. dorsal rootlets of the
  4. spinal nerve
  5. the spinal nerve of
  6. the posterior surface of the body of the vertebra
  7. conus medullaris
  8. cauda equina
  9. filum terminale
  10. subarachnoid space
A spinal tap is done in a hospital or outpatient facility, depending on the reason for the tap. It is not an emergency procedure. Emergencies bring to mind situations and events that have to be done within seconds/minutes. A lumbar puncture does not entail that type of action.

Preparation

Listen and follow the provider’s instructions regarding what to eat and drink.
  • An individual could be told to not eat or drink anything for a specific set of hours before.
  • Any prescription/s, over-the-counter meds, and drug allergies need to be disclosed to the medical team that will perform the procedure.
  • Individuals can wear their own clothes but preferably loose-fitting and comfortable should be the objective.
  • Once at the location a hospital gown is given to the patient for the procedure.
  • The day of the appointment, tell the doctor of any unusual symptoms.
  • Have a designated driver for the ride home, as sometimes a patient can feel weak and dizzy after the procedure.

The Procedure

A tap is a simple procedure that usually takes a half-hour or less to complete.
  • The patient sits bent forward or lying down on the side.
  • The knees should be pulled up as far as possible with the chin down into the chest curled into a ball.
  • This arcs the back and spaces out the vertebrae, so there is a wider area for the needle to enter.
  • The skin is cleaned with an antiseptic.
  • A sterile sheet or towel is placed over the patient that has an opening exposing the lower back.
  • Local anesthesia is injected to numb the area.
  • Unless the doctor instructs movement, remaining still is key as the advancement of the needle into the small area is a delicate procedure.
  • There is an initial what feels like a stinging sensation, but the patient does not feel the actual needle as it advances.
  • The needle gets inserted into the spinal space where the cerebrospinal fluid resides.
  • The cerebrospinal fluid pressure is measured.
  • Sometimes an ultrasound or specialized x-ray technique, known as fluoroscopy is used to locate the best place for the needle.
  • This is where the reason for the tap determines what action is taken. Either medicine is administered or a small amount of cerebrospinal fluid is taken.
  • The needle is retracted.
  • A bandage is applied.
  • Spinal tap pain is rare, but sometimes the needle can brush a nerve root when it is inserted. It could feel like an electric shock down the leg.
11860 Vista Del Sol, Ste. 128 Spinal Tap used to Diagnose, Administer Medicine, and Imaging Assistance
 

Recovery

Once finished, the patient lies on their back for 30 to 60 minutes so the doctor can check for any abnormalities or affects. Being sent home depends on the reason for the tap. If there is unexplained fever, nausea, etc, a patient will not be sent home. If it was an outpatient procedure the patient can leave and resume some simple activities after having a few hours of relaxation. Temporary pain meds are prescribed to address any discomfort. Results could come a day or a week later. They depend on the reason for the spinal tap.

Risks and Complications

It is considered a safe procedure with rare complications. The most common effect is a headache and usually comes on several hours, to a day or two later. These will not lead to any neurologic problems. Water or tea can help prevent and reduce the headache. Over-the-counter pain relievers can help too. However, if the headache continues after two days, call the doctor. A very small possibility of a more severe complication could happen including:
  • Infection
  • Bleeding
  • Numbness
  • Brain herniation or movement of the brain tissue from the added pressure
  • Nerve or spinal cord damage
This is a very safe procedure with the medical team being highly trained and skilled professionals that are careful and gentle.

Auto Accident Doctors & Chiropractic Treatment

 

 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

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https://www.pushasrx.com/spinal-tap-diagnose-medicine-image/feed/ 0 %%title%% %%excerpt%% chiropractic,diagnosis,health,imaging,lumbar,medicine,puncture,spinal tap,wellness,spinal tap 11860 Vista Del Sol, Ste. 128 Spinal Tap used to Diagnose, Administer Medicine, and Imaging Assistance 11860 Vista Del Sol, Ste. 128 Spinal Tap used to Diagnose, Administer Medicine, and Imaging Assistance 25591
BR – BRANDING TOPICS | El Paso, Tx (2020) https://www.pushasrx.com/br-branding-topics-el-paso-tx-2020/ Thu, 25 Jun 2020 21:29:10 +0000 https://www.pushasrx.com/br-branding-topics-el-paso-tx-2020/

– If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share us. Thank You & God Bless. Dr. Alex Jimenez RN, DC, MSACP, CCST Subscribe: http://bit.ly/drjyt Facebook Clinical Page: https://www.facebook.com/dralexjimenez/ Facebook Sports Page: https://www.facebook.com/pushasrx/ Facebook Injuries Page: https://www.facebook.com/elpasochiropractor/ Facebook Neuropathy Page: https://www.facebook.com/ElPasoNeuropathyCenter/ Facebook Fitness […]

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If you have enjoyed this video and/or we have helped you in any way
please feel free to subscribe and share us.

Thank You & God Bless.
Dr. Alex Jimenez RN, DC, MSACP, CCST

Subscribe: http://bit.ly/drjyt

Facebook Clinical Page: https://www.facebook.com/dralexjimenez/
Facebook Sports Page: https://www.facebook.com/pushasrx/
Facebook Injuries Page: https://www.facebook.com/elpasochiropractor/
Facebook Neuropathy Page: https://www.facebook.com/ElPasoNeuropathyCenter/
Facebook Fitness Center Page: https://www.facebook.com/PUSHftinessathletictraining/

Yelp: El Paso Rehabilitation Center: http://goo.gl/pwY2n2
Yelp: El Paso Clinical Center: Treatment: https://goo.gl/r2QPuZ

Clinical Testimonies: https://www.dralexjimenez.com/category/testimonies/

Information:
Clinical Site: https://www.dralexjimenez.com
Injury Site: https://personalinjurydoctorgroup.com
Sports Injury Site: https://chiropracticscientist.com
Back Injury Site: https://www.elpasobackclinic.com
Rehabilitation Center: https://www.pushasrx.com
Functional Medicine: https://wellnessdoctorrx.com
Fitness & Nutrition: http://www.push4fitness.com/team/

Twitter: https://twitter.com/dralexjimenez
Twitter: https://twitter.com/crossfitdoctor

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BR - BRANDING TOPICS | El Paso, Tx (2020) | PushAsRx Athletic Training Centers El Paso, TX | https://www.youtube.com/watch?v=ofWHFsBBgkw - If you have enjoyed this video and/or we have helped you in any way please feel free to subscribe and share crossfit,el paso crossfit center,Push fitness Center,pushasrx 25648
TT – TALENT TOPICS | Health Voice 360 https://www.pushasrx.com/tt-talent-topics-health-voice-360/ Thu, 25 Jun 2020 21:18:40 +0000 https://www.pushasrx.com/tt-talent-topics-health-voice-360/

Dr Alex Jimenez & ( Talent) Discuss topics and issues …

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Dr Alex Jimenez & ( Talent) Discuss topics and issues …

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TT - TALENT TOPICS | Health Voice 360 | PushAsRx Athletic Training Centers El Paso, TX | https://www.youtube.com/watch?v=5aS-TMJ-jFs Dr Alex Jimenez & ( Talent) Discuss topics and issues ... crossfit,el paso crossfit center,Push fitness Center,pushasrx 25647
What is Degenerative Disc Disease (DDD)?: An Overview https://www.pushasrx.com/what-is-degenerative-disc-disease-ddd-an-overview/ https://www.pushasrx.com/what-is-degenerative-disc-disease-ddd-an-overview/#respond Tue, 23 Jun 2020 22:49:57 +0000 https://www.pushasrx.com/?p=25563 What is Degenerative Disc Disease (DDD)?: An Overview | El Paso, TX Chiropractor

Degenerative Disc Disease is a general term for a condition in which the damaged intervertebral disc causes chronic pain, which could be either low back pain in the lumbar spine or neck pain in the cervical spine. It is not a “disease” per se, but actually a breakdown of an intervertebral disc of the spine. […]

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What is Degenerative Disc Disease (DDD)?: An Overview | El Paso, TX Chiropractor

Degenerative Disc Disease is a general term for a condition in which the damaged intervertebral disc causes chronic pain, which could be either low back pain in the lumbar spine or neck pain in the cervical spine. It is not a “disease” per se, but actually a breakdown of an intervertebral disc of the spine. The intervertebral disc is a structure that has a lot of attention being focused on recently, due to its clinical implications. The pathological changes that can occur in disc degeneration include fibrosis, narrowing, and disc desiccation. Various anatomical defects can also occur in the intervertebral disc such as sclerosis of the endplates, fissuring and mucinous degeneration of the annulus, and the formation of osteophytes.

 

Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative changes in the disk. Back pain is the second leading cause of the visit to the clinician in the USA. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. (Modic, Michael T., and Jeffrey S. Ross) Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition.

 

Anatomy of Related Structures

 

Anatomy of the Spine

 

The spine is the main structure, which maintains the posture and gives rise to various problems with disease processes. The spine is composed of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, and fused sacral and coccygeal vertebrae. The stability of the spine is maintained by three columns.

 

The anterior column is formed by anterior longitudinal ligament and the anterior part of the vertebral body. The middle column is formed by the posterior part of the vertebral body and the posterior longitudinal ligament. The posterior column consists of a posterior body arch that has transverse processes, laminae, facets, and spinous processes. (“Degenerative Disk Disease: Background, Anatomy, Pathophysiology”)

 

Anatomy of the Intervertebral Disc

 

Intervertebral disc lies between two adjacent vertebral bodies in the vertebral column. About one-quarter of the total length of the spinal column is formed by intervertebral discs. This disc forms a fibrocartilaginous joint, also called a symphysis joint. It allows a slight movement in the vertebrae and holds the vertebrae together. Intervertebral disc is characterized by its tension resisting and compression resisting qualities. An intervertebral disc is composed of mainly three parts; inner gelatinous nucleus pulposus, outer annulus fibrosus, and cartilage endplates that are located superiorly and inferiorly at the junction of vertebral bodies.

 

Nucleus pulposus is the inner part that is gelatinous. It consists of proteoglycan and water gel held together by type II Collagen and elastin fibers arranged loosely and irregularly. Aggrecan is the major proteoglycan found in the nucleus pulposus. It comprises approximately 70% of the nucleus pulposus and nearly 25% of the annulus fibrosus. It can retain water and provides the osmotic properties, which are needed to resist compression and act as a shock absorber. This high amount of aggrecan in a normal disc allows the tissue to support compressions without collapsing and the loads are distributed equally to annulus fibrosus and vertebral body during movements of the spine. (Wheater, Paul R, et al.)

 

The outer part is called annulus fibrosus, which has abundant type I collagen fibers arranged as a circular layer. The collagen fibers run in an oblique fashion between lamellae of the annulus in alternating directions giving it the ability to resist tensile strength. Circumferential ligaments reinforce the annulus fibrosus peripherally. On the anterior aspect, a thick ligament further reinforces annulus fibrosus and a thinner ligament reinforces the posterior side. (Choi, Yong-Soo)

 

Usually, there is one disc between every pair of vertebrae except between atlas and axis, which are first and second cervical vertebrae in the body. These discs can move about 6ᵒ in all the axes of movement and rotation around each axis. But this freedom of movement varies between different parts of the vertebral column. The cervical vertebrae have the greatest range of movement because the intervertebral discs are larger and there is a wide concave lower and convex upper vertebral body surfaces. They also have transversely aligned facet joints. Thoracic vertebrae have the minimum range of movement in flexion, extension, and rotation, but have free lateral flexion as they are attached to the rib cage. The lumbar vertebrae have good flexion and extension, again, because their intervertebral discs are large and spinous processes are posteriorly located. However, lateral lumbar rotation is limited because the facet joints are located sagittally. (“Degenerative Disk Disease: Background, Anatomy, Pathophysiology”)

 

Blood Supply

 

The intervertebral disc is one of the largest avascular structures in the body with capillaries terminating at the endplates. The tissues derive nutrients from vessels in the subchondral bone which lie adjacent to the hyaline cartilage at the endplate. These nutrients such as oxygen and glucose are carried to the intervertebral disc through simple diffusion. (“Intervertebral Disc – Spine – Orthobullets.Com”)

 

Nerve Supply

 

Sensory innervation of intervertebral discs is complex and varies according to the location in the spinal column. Sensory transmission is thought to be mediated by substance P, calcitonin, VIP, and CPON. Sinu vertebral nerve, which arises from the dorsal root ganglion, innervates the superficial fibers of the annulus. Nerve fibers don’t extend beyond the superficial fibers.

 

Lumbar intervertebral discs are additionally supplied on the posterolateral aspect with branches from ventral primary rami and from the grey rami communicantes near their junction with the ventral primary rami. The lateral aspects of the discs are supplied by branches from rami communicantes. Some of the rami communicantes may cross the intervertebral discs and become embedded in the connective tissue, which lies deep to the origin of the psoas. (Palmgren, Tove, et al.)

 

The cervical intervertebral discs are additionally supplied on the lateral aspect by branches of the vertebral nerve. The cervical sinu vertebral nerves were also found to be having an upward course in the vertebral canal supplying the disc at their point of entry and the one above. (BOGDUK, NIKOLAI, et al.)

 

Pathophysiology of Degenerative Disc Disease

 

Approximately 25% of people before the age of 40 years show disc degenerative changes at some level. Over 40 years of age, MRI evidence shows changes in more than 60% of people. (Suthar, Pokhraj) Therefore, it is important to study the degenerative process of the intervertebral discs as it has been found to degenerate faster than any other connective tissue in the body, leading to back and neck pain. The changes in three intervertebral discs are associated with changes in the vertebral body and joints suggesting a progressive and dynamic process.

 

Degeneration Phase

 

The degenerative process of the intervertebral discs has been divided into three stages, according to Kirkaldy-Willis and Bernard, called ‘‘degenerative cascade’’. These stages can overlap and can occur over the course of decades. However, identifying these stages clinically is not possible due to the overlap of symptoms and signs.

 

Stage 1 (Degeneration Phase)

 

This stage is characterized by degeneration. There are histological changes, which show circumferential tears and fissures in the annulus fibrosus. These circumferential tears may turn into radial tears and because the annulus pulposus is well innervated, these tears can cause back pain or neck pain, which is localized and with painful movements. Due to repeated trauma in the discs, endplates can separate leading to disruption of the blood supply to the disc and therefore, depriving it of its nutrient supply and removal of waste. The annulus may contain micro-fractures in the collagen fibrils, which can be seen on electron microscopy and an MRI scan may reveal desiccation, bulging of the disc, and a high-intensity zone in the annulus. Facet joints may show a synovial reaction and it may cause severe pain with associated synovitis and inability to move the joint in the zygapophyseal joints. These changes may not necessarily occur in every person. (Gupta, Vijay Kumar, et al.)

 

The nucleus pulposus is also involved in this process as its water imbibing capacity is reduced due to the accumulation of biochemically changed proteoglycans. These changes are brought on mainly by two enzymes called matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinase-1 (TIMP-1). (Bhatnagar, Sushma, and Maynak Gupta) Their imbalance leads to the destruction of proteoglycans. The reduced capacity to absorb water leads to a reduction of hydrostatic pressure in the nucleus pulposus and causes the annular lamellae to buckle. This can increase the mobility of that segment resulting in shear stress to the annular wall. All these changes can lead to a process called annular delamination and fissuring in the annulus fibrosus. These are two separate pathological processes and both can lead to pain, local tenderness, hypomobility, contracted muscles, painful joint movements. However, the neurological examination at this stage is usually normal.

 

Stage 2 (Phase of Instability)

 

The stage of dysfunction is followed by a stage of instability, which may result from the progressive deterioration of the mechanical integrity of the joint complex. There may be several changes encountered at this stage, including disc disruption and resorption, which can lead to a loss of disc space height. Multiple annular tears may also occur at this stage with concurrent changes in the zagopophyseal joints. They may include degeneration of the cartilage and facet capsular laxity leading to subluxation. These biomechanical changes result in instability of the affected segment.

 

The symptoms seen in this phase are similar to those seen in the dysfunction phase such as “giving way” of the back, pain when standing for prolonged periods, and a “catch” in the back with movements. They are accompanied by signs such as abnormal movements in the joints during palpation and observing that the spine sways or shifts to a side after standing erect for sometime after flexion. (Gupta, Vijay Kumar et al.)

 

Stage 3 (Re-Stabilization Phase)

 

In this third and final stage, the progressive degeneration leads to disc space narrowing with fibrosis and osteophyte formation and transdiscal bridging. The pain arising from these changes is severe compared to the previous two stages, but these can vary between individuals. This disc space narrowing can have several implications on the spine. This can cause the intervertebral canal to narrow in the superior-inferior direction with the approximation of the adjacent pedicles. Longitudinal ligaments, which support the vertebral column, may also become deficient in some areas leading to laxity and spinal instability. The spinal movements can cause the ligamentum flavum to bulge and can cause superior aricular process subluxation. This ultimately leads to a reduction of diameter in the anteroposterior direction of the intervertebral space and stenosis of upper nerve root canals.

 

Formation of osteophytes and hypertrophy of facets can occur due to the alteration in axial load on the spine and vertebral bodies. These can form on both superior and inferior articular processes and osteophytes can protrude to the intervertebral canal while the hypertrophied facets can protrude to the central canal. Osteophytes are thought to be made from the proliferation of articular cartilage at the periosteum after which they undergo endochondral calcification and ossification. The osteophytes are also formed due to the changes in oxygen tension and due to changes in fluid pressure in addition to load distribution defects. The osteophytes and periarticular fibrosis can result in stiff joints. The articular processes may also orient in an oblique direction causing retrospondylolisthesis leading to the narrowing of the intervertebral canal, nerve root canal, and the spinal canal. (KIRKALDY-WILLIS, W H et al.)

 

All of these changes lead to low back pain, which decreases with severity. Other symptoms like reduced movement, muscle tenderness, stiffness, and scoliosis can occur. The synovial stem cells and macrophages are involved in this process by releasing growth factors and extracellular matrix molecules, which act as mediators. The release of cytokines has been found to be associated with every stage and may have therapeutic implications in future treatment development.

 

Etiology of the Risk Factors of Degenerative Disc Disease

 

Aging and Degeneration

 

It is difficult to differentiate aging from degenerative changes. Pearce et al have suggested that aging and degeneration is representing successive stages within a single process that occur in all individuals but at different rates. Disc degeneration, however, occurs most often at a faster rate than aging. Therefore, it is encountered even in patients of working age.

 

There appears to be a relationship between aging and degeneration, but no distinct cause has yet been established. Many studies have been conducted regarding nutrition, cell death, and accumulation of degraded matrix products and the failure of the nucleus. The water content of the intervertebral disc decreases with the increasing age. Nucleus pulposus can get fissures that can extend into the annulus fibrosus. The start of this process is termed chondrosis inter vertebralis, which can mark the beginning of the degenerative destruction of the intervertebral disc, the endplates, and the vertebral bodies. This process causes complex changes in the molecular composition of the disc and has biomechanical and clinical sequelae that can often result in substantial impairment in the affected individual.

 

The cell concentration in the annulus decreases with increasing age. This is mainly because the cells in the disc are subjected to senescence and they lose the ability to proliferate. Other related causes of age-specific degeneration of intervertebral discs include cell loss, reduced nutrition, post-translational modification of matrix proteins, accumulation of products of degraded matrix molecules, and fatigue failure of the matrix. Decreasing nutrition to the central disc, which allows the accumulation of cell waste products and degraded matrix molecules seems to be the most important change out of all these changes. This impairs nutrition and causes a fall in the pH level, which can further compromise cell function and may lead to cell death. Increased catabolism and decreased anabolism of senescent cells may promote degeneration. (Buckwalter, Joseph A.) According to one study, there were more senescence cells in the nucleus pulposus compared to annulus fibrosus and herniated discs had a higher chance of cell senescence.  (Roberts, S. et al.)

 

When the aging process goes on for some time, the concentrations of chondroitin 4 sulfate and chondroitin 5 sulfate, which is strongly hydrophilic, gets decreased while the keratin sulfate to chondroitin sulfate ratio gets increased. Keratan sulfate is mildly hydrophilic and it also has a minor tendency to form stable aggregates with hyaluronic acid. As aggrecan is fragmented, and its molecular weight and numbers are decreased, the viscosity and hydrophilicity of the nucleus pulposus decrease. Degenerative changes to the intervertebral discs are accelerated by the reduced hydrostatic pressure of the nucleus pulposus and the decreased supply of nutrients by diffusion. When the water content of the extracellular matrix is decreased, intervertebral disc height will also be decreased. The resistance of the disc to an axial load will also be reduced. Because the axial load is then transferred directly to the annulus fibrosus, annulus clefts can get torn easily.

 

All these mechanisms lead to structural changes seen in degenerative disc disease. Due to the reduced water content in the annulus fibrosus and associated loss of compliance, the axial load can get redistributed to the posterior aspect of facets instead of the normal anterior and middle part of facets. This can cause facet arthritis, hypertrophy of the adjacent vertebral bodies, and bony spurs or bony overgrowths, known as osteophytes, as a result of degenerative discs. (Choi, Yong-Soo)

 

Genetics and Degeneration

 

The genetic component has been found to be a dominant factor in degenerative disc disease. Twin studies, and studies involving mice, have shown that genes play a role in disc degeneration. (Boyd, Lawrence M., et al.) Genes that code for collagen I, IX, and XI, interleukin 1, aggrecan, vitamin D receptor, matrix metalloproteinase 3 (MMP – 3), and other proteins are among the genes that are suggested to be involved in degenerative disc disease. Polymorphisms in 5 A and 6 A alleles occurring in the promoter region of genes that regulate MMP 3 production are found to be a major factor for the increased lumbar disc degeneration in the elderly population. Interactions among these various genes contribute significantly to intervertebral disc degeneration disease as a whole.

 

Nutrition and Degeneration

 

Disc degeneration is also believed to occur due to the failure of nutritional supply to the intervertebral disc cells. Apart from the normal aging process, the nutritional deficiency of the disc cells is adversely affected by endplate calcification, smoking, and the overall nutritional status. Nutritional deficiency can lead to the formation of lactic acid together with the associated low oxygen pressure. The resulting low pH can affect the ability of disc cells to form and maintain the extracellular matrix of the discs and causes intervertebral disc degeneration. The degenerated discs lack the ability to respond normally to the external force and may lead to disruptions even from the slightest back strain. (Taher, Fadi, et al.)

 

Growth factors stimulate the chondrocytes and fibroblasts to produce more amount of extracellular matrix. It also inhibits the synthesis of matrix metalloproteinases. Example of these growth factors includes transforming growth factor, insulin-like growth factor, and basic fibroblast growth factor. The degraded matrix is repaired by an increased level of transforming growth factor and basic fibroblast growth factor.

 

Environment and Degeneration

 

Even though all the discs are of the same age, discs found in the lower lumbar segments are more vulnerable to degenerative changes than the discs found in the upper segment. This suggests that not only aging but, also mechanical loading, is a causative factor. The association between degenerative disc disease and environmental factors has been defined in a comprehensive manner by Williams and Sambrook in 2011. (Williams, F.M.K., and P.N. Sambrook) The heavy physical loading associated with your occupation is a risk factor that has some contribution to disc degenerative disease. There is also a possibility of chemicals causing disc degeneration, such as smoking, according to some studies. (Battié, Michele C.) Nicotine has been implicated in twin studies to cause impaired blood flow to the intervertebral disc, leading to disc degeneration. (BATTIÉ, MICHELE C., et al.) Moreover, an association has been found among atherosclerotic lesions in the aorta and the low back pain citing a link between atherosclerosis and degenerative disc disease. (Kauppila, L.I.) The disc degeneration severity was implicated in overweight, obesity, metabolic syndrome, and increased body mass index in some studies. (“A Population-Based Study Of Juvenile Disc Degeneration And Its Association With Overweight And Obesity, Low Back Pain, And Diminished Functional Status. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. J Bone Joint Surg Am 2011;93(7):662–70”)

 

Pain in Disc Degeneration (Discogenic Pain)

 

Discogenic pain, which is a type of nociceptive pain, arises from the nociceptors in the annulus fibrosus when the nervous system is affected by the degenerative disc disease. Annulus fibrosus contains immune reactive nerve fibers in the outer layer of the disc with other chemicals such as a vasoactive intestinal polypeptide, calcitonin gene-related peptide, and substance P. (KONTTINEN, YRJÖ T., et al.) When degenerative changes in the intervertebral discs occur, normal structure and mechanical load are changed leading to abnormal movements. These disc nociceptors can get abnormally sensitized to mechanical stimuli. The pain can also be provoked by the low pH environment caused by the presence of lactic acid, causing increased production of pain mediators.

 

Pain from degenerative disc disease may arise from multiple origins. It may occur due to the structural damage, pressure, and irritation on the nerves in the spine. The disc itself contains only a few nerve fibers, but any injury can sensitize these nerves, or those in the posterior longitudinal ligament, to cause pain. Micro movements in the vertebrae can occur, which may cause painful reflex muscle spasms because the disc is damaged and worn down with the loss of tension and height. The painful movements arise because the nerves supplying the area are compressed or irritated by the facet joints and ligaments in the foramen leading to leg and back pain. This pain may be aggravated by the release of inflammatory proteins that act on nerves in the foramen or descending nerves in the spinal canal.

 

Pathological specimens of the degenerative discs, when observed under the microscope, reveals that there are vascularized granulation tissue and extensive innervations found in the fissures of the outer layer of the annulus fibrosus extending into the nucleus pulposus. The granulation tissue area is infiltrated by abundant mast cells and they invariably contribute to the pathological processes that ultimately lead to discogenic pain. These include neovascularisation, intervertebral disc degeneration, disc tissue inflammation, and the formation of fibrosis. Mast cells also release substances, such as tumor necrosis factor and interleukins, which might signal for the activation of some pathways which play a role in causing back pain. Other substances that can trigger these pathways include phospholipase A2, which is produced from the arachidonic acid cascade. It is found in increased concentrations in the outer third of the annulus of the degenerative disc and is thought to stimulate the nociceptors located there to release inflammatory substances to trigger pain. These substances bring about axonal injury, intraneural edema, and demyelination. (Brisby, Helena)

 

The back pain is thought to arise from the intervertebral disc itself. Hence why the pain will decrease gradually over time when the degenerating disc stops inflicting pain. However, the pain actually arises from the disc itself only in 11% of patients according to endoscopy studies. The actual cause of back pain seems to be due to the stimulation of the medial border of the nerve and referred pain along the arm or leg seems to arise due to the stimulation of the core of the nerve. The treatment for disc degeneration should mainly focus on pain relief to reduce the suffering of the patient because it is the most disabling symptom that disrupts a patient’s lives. Therefore, it is important to establish the mechanism of pain because it occurs not only due to the structural changes in the intervertebral discs but also due to other factors such as the release of chemicals and understanding these mechanisms can lead to effective pain relief. (Choi, Yong-Soo)

 

Clinical Presentation of Degenerative Disc Disease

 

Patients with degenerative disc disease face a myriad of symptoms depending on the site of the disease. Those who have lumbar disc degeneration get low back pain, radicular symptoms, and weakness. Those who have cervical disc degeneration have neck pain and shoulder pain.

 

Low back pain can get exacerbated by the movements and the position. Usually, the symptoms are worsened by the flexion, while the extension often relieves them. Minor twisting injuries, even from swinging a golf club, can trigger the symptoms. The pain is usually observed to be less when walking or running, when changing the position frequently and when lying down. However, the pain is usually subjective and in many cases, it varies considerably from person to person and most people will suffer from a low level of chronic pain of the lower back region continuously while occasionally suffering from the groin, hip, and leg pain. The intensity of the pain will increase from time to time and will last for a few days and then subside gradually. This “flare-up” is an acute episode and needs to be treated with potent analgesics. Worse pain is experienced in the seated position and is exacerbated while bending, lifting, and twisting movements frequently. The severity of the pain can vary considerably with some having occasional nagging pain to others having severe and disabling pain intermittently.  (Jason M. Highsmith, MD)

 

The localized pain and tenderness in the axial spine usually arises from the nociceptors found within the intervertebral discs, facet joints, sacroiliac joints, dura mater of the nerve roots, and the myofascial structures found within the axial spine. As mentioned in the previous sections, the degenerative anatomical changes may result in a narrowing of the spinal canal called spinal stenosis, overgrowth of spinal processes called osteophytes, hypertrophy of the inferior and superior articular processes, spondylolisthesis, bulging of the ligamentum flavum and disc herniation. These changes result in a collection of symptoms that is known as neurogenic claudication. There may be symptoms such as low back pain and leg pain together with numbness or tingling in the legs, muscle weakness, and foot drop. Loss of bowel or bladder control may suggest spinal cord impingement and prompt medical attention is needed to prevent permanent disabilities. These symptoms can vary in severity and may present to varying extents in different individuals.

 

The pain can also radiate to other parts of the body due to the fact that the spinal cord gives off several branches to two different sites of the body. Therefore, when the degenerated disc presses on a spinal nerve root, the pain can also be experienced in the leg to which the nerve ultimately innervates. This phenomenon, called radiculopathy, can occur from many sources arising, due to the process of degeneration. The bulging disc, if protrudes centrally, can affect descending rootlets of the cauda equina, if it bulges posterolaterally, it might affect the nerve roots exiting at the next lower intervertebral canal and the spinal nerve within its ventral ramus can get affected when the disc protrudes laterally. Similarly, the osteophytes protruding along the upper and lower margins of the posterior aspect of vertebral bodies can impinge on the same nervous tissues causing the same symptoms. Superior articular process hypertrophy may also impinge upon nerve roots depending on their projection. The nerves may include nerve roots prior to exiting from the next lower intervertebral canal and nerve roots within the upper nerve root canal and dural sac. These symptoms, due to the nerve impingement, have been proven by cadaver studies. Neural compromise is thought to occur when the neuro foraminal diameter is critically occluded with a 70% reduction. Furthermore, neural compromise can be produced when the posterior disc is compressed less than 4 millimeters in height, or when the foraminal height is reduced to less than 15 millimeters leading to foraminal stenosis and nerve impingement. (Taher, Fadi, et al.)

 

Diagnostic Approach

 

Patients are initially evaluated with an accurate history and thorough physical examination and appropriate investigations and provocative testing. However, history is often vague due to the chronic pain which cannot be localized properly and the difficulty in determining the exact anatomical location during provocative testing due to the influence of the neighboring anatomical structures.

 

Through the patient’s history, the cause of low back pain can be identified as arising from the nociceptors in the intervertebral discs. Patients may also give a history of the chronic nature of the symptoms and associated gluteal region numbness, tingling as well as stiffness in the spine which usually worsens with activity. Tenderness may be elicited by palpating over the spine. Due to the nature of the disease being chronic and painful, most patients may be suffering from mood and anxiety disorders. Depression is thought to be contributing negatively to the disease burden. However, no clear relationship between disease severity and mood or anxiety disorders. It is good to be vigilant about these mental health conditions as well. In order to exclude other serious pathologies, questions must be asked regarding fatigue, weight loss, fever, and chills, which might indicate some other diseases. (Jason M. Highsmith, MD)

 

Another etiology for the low back pain has to be excluded when examining the patient for degenerative disc disease. Abdominal pathologies, which can give rise to back pain such as aortic aneurysm, renal calculi, and pancreatic disease, have to be excluded.

 

Degenerative disc disease has several differential diagnoses to be considered when a patient presents with back pain. These include; idiopathic low back pain, zygapophyseal joint degeneration, myelopathy, lumbar stenosis, spondylosis, osteoarthritis, and lumbar radiculopathy. (“Degenerative Disc Disease – Physiopedia”)

 

Investigations

 

Investigations are used to confirm the diagnosis of degenerative disc disease. These can be divided into laboratory studies, imaging studies, nerve conduction tests, and diagnostic procedures.

 

Imaging Studies

 

The imaging in degenerative disc disease is mainly used to describe anatomical relations and morphological features of the affected discs, which has a great therapeutic value in future decision making for treatment options. Any imaging method, like plain radiography, CT, or MRI, can provide useful information. However, an underlying cause can only be found in 15% of the patients as no clear radiological changes are visible in degenerative disc disease in the absence of disc herniation and neurological deficit. Moreover, there is no correlation between the anatomical changes seen on imaging and the severity of the symptoms, although there are correlations between the number of osteophytes and the severity of back pain. Degenerative changes in radiography can also be seen in asymptomatic people leading to difficulty in conforming clinical relevance and when to start treatment. (“Degenerative Disc Disease – Physiopedia”)

 

Plain Radiography

 

This inexpensive and widely available plain cervical radiography can give important information on deformities, alignment, and degenerative bony changes. In order to determine the presence of spinal instability and sagittal balance, dynamic flexion, or extension studies have to be performed.

 

Magnetic Resonance Imaging (MRI)

 

MRI is the most commonly used method to diagnose degenerative changes in the intervertebral disc accurately, reliably, and most comprehensively. It is used in the initial evaluation of patients with neck pain after plain radiography. It can provide non-invasive images in multiple plains and gives excellent quality images of the disc. MRI can show disc hydration and morphology-based on the proton density, chemical environment, and the water content. Clinical picture and history of the patient have to be considered when interpreting MRI reports as it has been shown that as much as 25% of radiologists change their report when the clinical data are available. Fonar produced the first open MRI scanner with the ability of the patient to be scanned in different positions such as standing, sitting, and bending. Because of these unique features, this open MRI scanner can be used for scanning patients in weight-bearing postures and stand up postures to detect underlying pathological changes which are usually overlooked in conventional MRI scan such as lumbar degenerative disc disease with herniation. This machine is also good for claustrophobic patients, as they get to watch a large television screen during the scanning process. (“Degenerative Disk Disease: Background, Anatomy, Pathophysiology.”)

 

Nucleus pulposus and annulus fibrosus of the disc can usually be identified on MRI, leading to the detection of disc herniation as contained and non contained. As MRI can also show annular tears and the posterior longitudinal ligament, it can be used to classify herniation. This can be simple annular bulging to free fragment disc herniations. This information can describe the pathologic discs such as extruded disc, protruded discs, and migrated discs.

 

There are several grading systems based on MRI signal intensity, disc height, the distinction between nucleus and annulus, and the disc structure. The method, by Pfirrmann et al, has been widely applied and clinically accepted. According to the modified system, there are 8 grades for lumbar disc degenerative disease. Grade 1 represents normal intervertebral disc and grade 8 corresponds to the end stage of degeneration, depicting the progression of the disc disease. There are corresponding images to aid the diagnosis. As they provide good tissue differentiation and detailed description of the disc structure, sagittal T2 weighted images are used for the classification purpose. (Pfirrmann, Christian W. A., et al.)

 

Modic has described the changes occurring in the vertebral bodies adjacent to the degenerating discs as Type 1 and Type 2 changes. In Modic 1 changes, there is decreased intensity of T1 weighted images and increased intensity T2 weighted images. This is thought to occur because the end plates have undergone sclerosis and the adjacent bone marrow is showing inflammatory response as the diffusion coefficient increases. This increase of diffusion coefficient and the ultimate resistance to diffusion is brought about by the chemical substances released through an autoimmune mechanism. Modic type 2 changes include the destruction of the bone marrow of adjacent vertebral endplates due to an inflammatory response and the infiltration of fat in the marrow. These changes may lead to increased signal density on T1 weighted images. (Modic, M T et al.)

 

Computed Tomography (CT)

 

When MRI is not available, Computed tomography is considered a diagnostic test that can detect disc herniation because it has a better contrast between posterolateral margins of the adjacent bony vertebrae, perineal fat, and the herniated disc material. Even so, when diagnosing lateral herniations, MRI remains the imaging modality of choice.

 

CT scan has several advantages over MRI such as it has a less claustrophobic environment, low cost, and better detection of bonny changes that are subtle and may be missed on other modalities. CT can detect early degenerative changes of the facet joints and spondylosis with more accuracy. Bony integrity after fusion is also best assessed by CT.

 

Disc herniation and associated nerve impingement can be diagnosed by using the criteria developed by Gundry and Heithoff. It is important for the disc protrusion to lie directly over the nerve roots traversing the disc and to be focal and asymmetrical with a dorsolateral position. There should be demonstrable nerve root compression or displacement. Lastly, the nerve distal to the impingement (site of herniation) often enlarges and bulges with resulting edema, prominence of adjacent epidural veins, and inflammatory exudates resulting in blurring the margin.

 

Lumbar Discography

 

This procedure is controversial and, whether knowing the site of the pain has any value regarding surgery or not, has not been proven. False positives can occur due to central hyperalgesia in patients with chronic pain (neurophysiologic finding) and due to psychosocial factors. It is questionable to establish exactly when discogenic pain becomes clinically significant. Those who support this investigation advocates strict criteria for selection of the patients and when interpreting results and believe this is the only test that can diagnose discogenic pain. Lumbar discography can be used in several situations, although it is not scientifically established. These include; diagnosis of lateral herniation, diagnosing a symptomatic disc among multiple abnormalities, assessing similar abnormalities seen on CT or MRI, evaluation of the spine after surgery, selection of fusion level, and the suggestive features of discogenic pain existence.

 

The discography is more concerned about eliciting pathophysiology rather than determining the anatomy of the disc. Therefore, discogenic pain evaluation is the aim of discography. MRI may reveal an abnormally looking disc with no pain, while severe pain may be seen on discography where MRI findings are few. During the injection of normal saline or the contrast material, a spongy endpoint can occur with abnormal discs accepting more amounts of contrast. The contrast material can extend into the nucleus pulposus through tears and fissures in the annulus fibrosus in the abnormal discs. The pressure of this contrast material can provoke pain due to the innervations by recurrent meningeal nerve, mixed spinal nerve, anterior primary rami, and gray rami communicantes supplying the outer annulus fibrosus. Radicular pain can be provoked when the contrast material reaches the site of nerve root impingement by the abnormal disc. However, this discography test has several complications such as nerve root injury, chemical or bacterial diskitis, contrast allergy, and the exacerbation of pain. (Bartynski, Walter S., and A. Orlando Ortiz)

 

Imaging Modality Combination

 

In order to evaluate the nerve root compression and cervical stenosis adequately, a combination of imaging methods may be needed.

 

CT Discography

 

After performing initial discography, CT discography is performed within 4 hours. It can be used in determining the status of the disc such as herniated, protruded, extruded, contained or sequestered. It can also be used in the spine to differentiate the mass effects of scar tissue or disc material after spinal surgery.

 

CT Myelography

 

This test is considered the best method for evaluating nerve root compression. When CT is performed in combination or after myelography, details about bony anatomy different planes can be obtained with relative ease.

 

Diagnostic Procedures

 

Transforaminal Selective Nerve Root Blocks (SNRBs)

 

When multilevel degenerative disc disease is suspected on an MRI scan, this test can be used to determine the specific nerve root that has been affected. SNRB is both a diagnostic and therapeutic test that can be used for lumbar spinal stenosis. The test creates a demotomal level area of hypoesthesia by injecting an anesthetic and a contrast material under fluoroscopic guidance to the interested nerve root level. There is a correlation between multilevel cervical degenerative disc disease clinical symptoms and findings on MRI and findings of SNRB according to Anderberg et al. There is a 28% correlation with SNRB results and with dermatomal radicular pain and areas of neurologic deficit. Most severe cases of degeneration on MRI are found to be correlated with 60%. Although not used routinely, SNRB is a useful test in evaluating patients before surgery in multilevel degenerative disc disease especially on the spine together with clinical features and findings on MRI. (Narouze, Samer, and Amaresh Vydyanathan)

 

Electro Myographic Studies

 

Distal motor and sensory nerve conduction tests, called electromyographic studies, that are normal with abnormal needle exam may reveal nerve compression symptoms that are elicited in the clinical history. Irritated nerve roots can be localized by using injections to anesthetize the affected nerves or pain receptors in the disc space, sacroiliac joint, or the facet joints by discography. (“Journal Of Electromyography & Kinesiology Calendar”)

 

Laboratory Studies

 

Laboratory tests are usually done to exclude other differential diagnoses.

 

As seronegative spondyloarthropathies, such as ankylosing spondylitis, are common causes of back pain, HLA B27 immuno-histocompatibility has to be tested. Estimated 350,000 persons in the US and 600,000 in Europe have been affected by this inflammatory disease of unknown etiology. But HLA B27 is extremely rarely found in African Americans. Other seronegative spondyloarthropathies that can be tested using this gene include psoriatic arthritis, inflammatory bowel disease, and reactive arthritis or Reiter syndrome. Serum immunoglobulin A (IgA) can be increased in some patients.

 

Tests like the erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) level test for the acute phase reactants seen in inflammatory causes of lower back pain such as osteoarthritis and malignancy. The full blood count is also required, including differential counts to ascertain the disease etiology. Autoimmune diseases are suspected when Rheumatoid factor (RF) and anti-nuclear antibody (ANA) tests become positive. Serum uric acid and synovial fluid analysis for crystals may be needed in rare cases to exclude gout and pyrophosphate dihydrate deposition.

 

Treatment

 

There is no definitive treatment method agreed by all physicians regarding the treatment of degenerative disc disease because the cause of the pain can differ in different individuals and so is the severity of pain and the wide variations in clinical presentation. The treatment options can be discussed broadly under; conservative treatment, medical treatment, and surgical treatment.

 

Conservative Treatment

 

This treatment method includes exercise therapy with behavioral interventions, physical modalities, injections, back education, and back school methods.

 

Exercise-Based Therapy with Behavioral Interventions

 

Depending on the diagnosis of the patient, different types of exercises can be prescribed. It is considered one of the main methods of conservative management to treat chronic low back pain. The exercises can be modified to include stretching exercises, aerobic exercises, and muscle strengthening exercises. One of the major challenges of this therapy includes its inability to assess the efficacy among patients due to wide variations in the exercise regimens, frequency, and intensity. According to studies, most effectiveness for sub-acute low back pain with varying duration of symptoms was obtained by performing graded exercise programs within the occupational setting of the patient. Significant improvements were observed among patients suffering from chronic symptoms with this therapy with regard to functional improvement and pain reduction. Individual therapies designed for each patient under close supervision and compliance of the patient also seems to be the most effective in chronic back pain sufferers. Other conservative approaches can be used in combination to improve this approach. (Hayden, Jill A., et al.)

 

Aerobic exercises, if performed regularly, can improve endurance. For relieving muscle tension, relaxation methods can be used. Swimming is also considered an exercise for back pain. Floor exercises can include extension exercises, hamstring stretches, low back stretches, double knee to chin stretches, seat lifts, modified sit-ups, abdominal bracing, and mountain and sag exercises.

 

Physical Modalities

 

This method includes the use of electrical nerve stimulation, relaxation, ice packs, biofeedback, heating pads, phonophoresis, and iontophoresis.

 

Transcutaneous Electrical Nerve Stimulation (TENS)

 

In this non-invasive method, electrical stimulation is delivered to the skin in order to stimulate the peripheral nerves in the area to relieve the pain to some extent. This method relieves pain immediately following application but its long term effectiveness is doubtful. With some studies, it has been found that there is no significant improvement in pain and functional status when compared with placebo. The devices performing these TENS can be easily accessible from the outpatient department. The only side effect seems to be a mild skin irritation experienced in a third of patients. (Johnson, Mark I)

 

Back School

 

This method was introduced with the aim of reducing the pain symptoms and their recurrences. It was first introduced in Sweden and takes into account the posture, ergonomics, appropriate back exercises, and the anatomy of the lumbar region. Patients are taught the correct posture to sit, stand, lift weights, sleep, wash face, and brush teeth avoiding pain. When compared with other treatment modalities, back school therapy has been proven to be effective in both immediate and intermediate periods for improving back pain and functional status.

 

Patient Education

 

In this method, the provider instructs the patient on how to manage their back pain symptoms. Normal spinal anatomy and biomechanics involving mechanisms of injury is taught at first. Next, using the spinal models, the degenerative disc disease diagnosis is explained to the patient. For the individual patient, the balanced position is determined and then asked to maintain that position to avoid getting symptoms.

 

Bio-Psychosocial Approach to Multidisciplinary Back Therapy

 

Chronic back pain can cause a lot of distress to the patient, leading to psychological disturbances and low mood. This can adversely affect the therapeutic outcomes rendering most treatment strategies futile. Therefore, patients must be educated on learned cognitive strategies called “behavioral” and “bio-psychosocial” strategies to get relief from pain. In addition to treating the biological causes of pain, psychological, and social causes should also be addressed in this method. In order to reduce the patient’s perception of pain and disability, methods like modified expectations, relaxation techniques, control of physiological responses by learned behavior, and reinforcement are used.

 

Massage Therapy

 

For chronic low back pain, this therapy seems to be beneficial. Over a 1 year period, massage therapy has been found to be moderately effective for some patients when compared to acupuncture and other relaxation methods. However, it is less efficacious than TENS and exercise therapy although individual patients may prefer one over the other. (Furlan, Andrea D., et al.)

 

Spinal Manipulation

 

This therapy involves the manipulation of a joint beyond its normal range of movement, but not exceeding that of the normal anatomical range. This is a manual therapy that involves long lever manipulation with a low velocity. It is thought to improve low back pain through several mechanisms like the release of entrapped nerves, destruction of articular and peri-articular adhesions, and through manipulating segments of the spine that had undergone displacement. It can also reduce the bulging of the disc, relax the hypertonic muscles, stimulate the nociceptive fibers via changing the neurophysiological function and reposition the menisci on the articular surface.

 

Spinal manipulation is thought to be superior in efficacy when compared to most methods such as TENS, exercise therapy, NSAID drugs, and back school therapy. The currently available research is positive regarding its effectiveness in both the long and short term. It is also very safe to administer under-trained therapists with cases of disc herniation and cauda equina being reported only in lower than 1 in 3.7 million people. (Bronfort, Gert, et al.)

 

Lumbar Supports

 

Patients suffering from chronic low back pain due to degenerative processes at multiple levels with several causes may benefit from lumbar support. There is conflicting evidence with regards to its effectiveness with some studies claiming moderate improvement in immediate and long term relief while others suggesting no such improvement when compared to other treatment methods. Lumbar supports can stabilize, correct deformity, reduce mechanical forces, and limit the movements of the spine. It may also act as a placebo and reduce the pain by massaging the affected areas and applying heat.

 

Lumbar Traction

 

This method uses a harness attached to the iliac crest and lower rib cage and applies a longitudinal force along the axial spine to relieve chronic low back pain. The level and duration of the force are adjusted according to the patient and it can be measured by using devices both while walking and lying down. Lumbar traction acts by opening the intervertebral disc spaces and by reducing the lumbar lordosis. The symptoms of degenerative disc disease are reduced through this method due to temporary spine realignment and its associated benefits. It relieves nerve compression and mechanical stress, disrupts the adhesions in the facet and annulus, and also nociceptive pain signals. However, there is not much evidence with regard to its effectiveness in reducing back pain or improving daily function. Furthermore, the risks associated with lumbar traction are still under research and some case reports are available where it has caused a nerve impingement, respiratory difficulties, and blood pressure changes due to heavy force and incorrect placement of the harness. (Harte, A et al.)

 

Medical Treatment

 

Medical therapy involves drug treatment with muscle relaxants, steroid injections, NSAIDs, opioids, and other analgesics. This is needed, in addition to conservative treatment, in most patients with degenerative disc disease. Pharmacotherapy is aimed to control disability, reduce pain and swelling while improving the quality of life. It is catered according to the individual patient as there is no consensus regarding the treatment.

 

Muscle Relaxants

 

Degenerative disc disease may benefit from muscle relaxants by reducing the spasm of muscles and thereby relieving pain. The efficacy of muscle relaxants in improving pain and functional status has been established through several types of research. Benzodiazepine is the most common muscle relaxant currently in use.

 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

 

These drugs are commonly used as the first step in disc degenerative disease providing analgesia, as well as anti-inflammatory effects. There is strong evidence that it reduces chronic low back pain. However, its use is limited by gastrointestinal disturbances, like acute gastritis. Selective COX2 inhibitors, like celecoxib, can overcome this problem by only targeting COX2 receptors. Their use is not widely accepted due to its potential side effects in increasing cardiovascular disease with prolonged use.

 

Opioid Medications

 

This is a step higher up in the WHO pain ladder. It is reserved for patients suffering from severe pain not responding to NSAIDs and those with unbearable GI disturbances with NSAID therapy. However, the prescription of narcotics for treating back pain varies considerably between clinicians. According to literature, 3 to 66% of patients may be taking some form of the opioid to relieve their back pain. Even though the short term reduction in symptoms is marked, there is a risk of long term narcotic abuse, a high rate of tolerance, and respiratory distress in the older population. Nausea and vomiting are some of the short term side effects encountered. (“Systematic Review: Opioid Treatment For Chronic Back Pain: Prevalence, Efficacy, And Association With Addiction”)

 

Anti-Depressants

 

Anti-depressants, in low doses, have analgesic value and may be beneficial in chronic low back pain patients who may present with associated depression symptoms. The pain and suffering may be disrupting the sleep of the patient and reducing the pain threshold. These can be addressed by using anti-depressants in low doses even though there is no evidence that it improves the function.

 

Injection Therapy

 

Epidural Steroid Injections

 

Epidural steroid injections are the most widely used injection type for the treatment of chronic degenerative disc disease and associated radiculopathy. There is a variation between the type of steroid used and its dose. 8- 10 mL of a mixture of methylprednisolone and normal saline is considered an effective and safe dose. The injections can be given through interlaminar, caudal, or trans foramina routes. A needle can be inserted under the guidance of fluoroscopy. First contrast, then local anesthesia and lastly, the steroid is injected into the epidural space at the affected level via this method. The pain relief is achieved due to the combination of effects from both local anesthesia and the steroid. Immediate pain relief can be achieved through the local anesthetic by blocking the pain signal transmission and while also confirming the diagnosis. Inflammation is also reduced due to the action of steroids in blocking pro-inflammatory cascade.

 

During the recent decade, the use of epidural steroid injection has increased by 121%. However, there is controversy regarding its use due to the variation in response levels and potentially serious adverse effects. Usually, these injections are believed to cause only short term relief of symptoms. Some clinicians may inject 2 to 3 injections within a one-week duration, although the long term results are the same for that of a patient given only a single injection. For a one year period, more than 4 injections shouldn’t be given. For more immediate and effective pain relief, preservative-free morphine can also be added to the injection. Even local anesthetics, like lidocaine and bupivacaine, are added for this purpose. Evidence for long term pain relief is limited. (“A Placebo-Controlled Trial To Evaluate Effectivity Of Pain Relief Using Ketamine With Epidural Steroids For Chronic Low Back Pain”)

 

There are potential side effects due to this therapy, in addition to its high cost and efficacy concerns. Needles can get misplaced if fluoroscopy is not used in as much as 25% of cases, even with the presence of experienced staff. The epidural placement can be identified by pruritus reliably. Respiratory depression or urinary retention can occur following injection with morphine and so the patient needs to be monitored for 24 hours following the injection.

 

Facet Injections

 

These injections are given to facet joints, also called zygapophysial joints, which are situated between two adjacent vertebrae. Anesthesia can be directly injected to the joint space or to the associated medial branch of the dorsal rami, which innervates it. There is evidence that this method improves the functional ability, quality of life, and relieves pain. They are thought to provide both short and long term benefits, although studies have shown both facet injections and epidural steroid injections are similar in efficacy. (Wynne, Kelly A)

 

SI Joint Injections

 

This is a diarthrodial synovial joint with nerve supply from both myelinated and non-myelin nerve axons. The injection can effectively treat degenerative disc disease involving sacroiliac joint leading to both long and short term relief from symptoms such as low back pain and referred pain at legs, thigh, and buttocks. The injections can be repeated every 2 to 3 months but should be performed only if clinically necessary. (MAUGARS, Y. et al.) 

 

Intradiscal Non-Operative Therapies for Discogenic Pain

 

As described under the investigations, discography can be used both as a diagnostic and therapeutic method. After the diseased disc is identified, several minimally invasive methods can be tried before embarking on surgery. Electrical current and its heat can be used to coagulate the posterior annulus thereby strengthening the collagen fibers, denaturing and destroying inflammatory mediators and nociceptors, and sealing figures. The methods used in this are called intradiscal electrothermal therapy (IDET) or radiofrequency posterior annuloplasty (RPA), in which an electrode is passed to the disc. IDET has moderate evidence in relief of symptoms for disc degenerative disease patients, while RPA has limited support regarding its short term and long term efficacy. Both these procedures can lead to complications such as nerve root injury, catheter malfunction, infection, and post-procedure disc herniation.

 

Surgical Treatment

 

Surgical treatment is reserved for patients with failed conservative therapy taking into account the disease severity, age, other comorbidities, socio-economic condition, and the level of outcome expected. It is estimated that around 5% of patients with degenerative disc disease undergo surgery, either for their lumbar disease or cervical disease. (Rydevik, Björn L.)

 

Lumbar Spine Procedures

 

Lumbar surgery is indicated in patients with severe pain, with a duration of 6 to 12 months of ineffective drug therapy, who have critical spinal stenosis. The surgery is usually an elective procedure except in the case of cauda equina syndrome. There are two procedure types that aim to involve spinal fusion or decompression or both. (“Degenerative Disk Disease: Background, Anatomy, Pathophysiology.”)

 

Spinal fusion involves stopping movements at a painful vertebral segment in order to reduce the pain by fusing several vertebrae together by using a bone graft. It is considered effective in the long term for patients with degenerative disc disease having spinal malalignment or excessive movement. There are several approaches to fusion surgery. (Gupta, Vijay Kumar, et al)

 

  • Lumbar spinal posterolateral guttur fusion

 

This method involves placing a bone graft in the posterolateral part of the spine. A bone graft can be harvested from the posterior iliac crest. The bones are stripped off from its periosteum for successful grafting. A back brace is needed in the post-operative period and patients may need to stay in the hospital for about 5 to 10 days. Limited motion and cessation of smoking are needed for successful fusion. However, several risks such as non-union, infection, bleeding, and solid union with back pain may occur.

 

  • Posterior lumbar interbody fusion

 

In this method, decompression or diskectomy methods can also be performed via the same approach. The bone grafts are directly applied to the disc space and ligamentum flavum is excised completely. For the degenerative disc disease, interlaminar space is widened additionally by performing a partial medial facetectomy. Back braces are optional with this method. It has several disadvantages when compared to anterior approach such as only small grafts can be inserted, the reduced surface area available for fusion, and difficulty when performing surgery on spinal deformity patients. The major risk involved is non-union.

 

  • Anterior lumbar interbody fusion

 

This procedure is similar to the posterior one except that it is approached through the abdomen instead of the back. It has the advantage of not disrupting the back muscles and the nerve supply. It is contraindicated in patients with osteoporosis and has the risk of bleeding, retrograde ejaculation in men, non-union, and infection.

 

  • Transforaminal lumbar interbody fusion

 

This is a modified version of the posterior approach which is becoming popular. It offers low risk with good exposure and it is shown to have an excellent outcome with a few complications such as CSF leak, transient neurological impairment, and wound infection.

 

Total Disc Arthroplasty

 

This is an alternative to disc fusion and it has been used to treat lumbar degenerative disc disease using an artificial disc to replace the affected disc. Total prosthesis or nuclear prosthesis can be used depending on the clinical situation.

 

Decompression involves removing part of the disc of the vertebral body, which is impinging on a nerve to release that and provide room for its recovery via procedures called diskectomy and laminectomy. The efficacy of the procedure is questionable although it is a commonly performed surgery. Complications are very few with a low chance of recurrence of symptoms with higher patient satisfaction. (Gupta, Vijay Kumar, et al)

 

  • Lumbar discectomy

 

The surgery is performed through a posterior midline approach by dividing the ligamentum flavum. The nerve root that is affected is identified and bulging annulus is cut to release it. Full neurological examination should be performed afterward and patients are usually fit to go home 1 – 5 days later. Low back exercises should be started soon followed by light work and then heavy work at 2 and 12 weeks respectively.

 

  • Lumbar laminectomy

 

This procedure can be performed thorough one level, as well as through multiple levels. Laminectomy should be as short as possible to avoid spinal instability. Patients have marked relief of symptoms and reduction in radiculopathy following the procedure. The risks may include bowel and bladder incontinence, CSF leakage, nerve root damage, and infection.

 

Cervical Spine Procedures

 

Cervical degenerative disc disease is indicated for surgery when there is unbearable pain associated with progressive motor and sensory deficits. Surgery has a more than 90% favorable outcome when there is radiographic evidence of nerve root compression. There are several options including anterior cervical diskectomy (ACD), ACD, and fusion (ACDF), ACDF with internal fixation, and posterior foraminotomy. (“Degenerative Disk Disease: Background, Anatomy, Pathophysiology.”)

 

Cell-Based Therapy

 

Stem cell transplantation has emerged as a novel therapy for degenerative disc disease with promising results. The introduction of autologous chondrocytes has been found to reduce discogenic pain over a 2 year period. These therapies are currently undergoing human trials. (Jeong, Je Hoon, et al.)

 

Gene Therapy

 

Gene transduction in order to halt the disc degenerative process and even inducing disc regeneration is currently under research. For this, beneficial genes have to be identified while demoting the activity of degeneration promoting genes. These novel treatment options give hope for future treatment to be directed at regenerating intervertebral discs. (Nishida, Kotaro, et al.)

 

 

Degenerative disc disease is a health issue characterized by chronic back pain due to a damaged intervertebral disc, such as low back pain in the lumbar spine or neck pain in the cervical spine. It is a breakdown of an intervertebral disc of the spine. Several pathological changes can occur in disc degeneration. Various anatomical defects can also occur in the intervertebral disc. Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative disc disease. Back pain is the second leading cause of doctor office visits in the United States. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico* 

 

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

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Spinal Injuries from a Motor Vehicle Accident/Collision https://www.pushasrx.com/spinal-injuries-vehicle-accident-collision/ https://www.pushasrx.com/spinal-injuries-vehicle-accident-collision/#respond Tue, 23 Jun 2020 02:42:07 +0000 https://www.pushasrx.com/?p=25555 11860 Vista Del Sol, Ste. 128 Spinal Injuries from a Motor Vehicle Accident/Collision

Accident/Collisions are seeing a rise and along with those crashes are spinal injuries. What you need to know about: Accident-related injuries Treatment Recovery Legal issues We take a risk, however small, every time we get in the car/truck, of being involved in a car wreck that results in injuries and specifically a spinal injury/s. The […]

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11860 Vista Del Sol, Ste. 128 Spinal Injuries from a Motor Vehicle Accident/Collision Accident/Collisions are seeing a rise and along with those crashes are spinal injuries. What you need to know about:
  • Accident-related injuries
  • Treatment
  • Recovery
  • Legal issues
We take a risk, however small, every time we get in the car/truck, of being involved in a car wreck that results in injuries and specifically a spinal injury/s. The National Spinal Cord Injury Statistical Center has seen that motor vehicle accidents/collisions with the majority being car/truck accidents.  
11860 Vista Del Sol, Ste. 128 Spinal Injuries from a Motor Vehicle Accident/Collision
 
However, with all the construction taking place nowadays, excavators, bulldozers, steamrollers, forklifts, and other vehicles are also seeing a rise in accidents. This is also generating a rise in spinal cord injury/s. Auto accidents are now ranked as the number one cause of spinal injury. The risk of an accident is small and the risk of a resulting serious spine injury is smaller still, it’s not anything. What you need to know about a motor vehicle accident/collision includes:
  • Injuries
  • Treatment
  • Recovery
  • Insurance
  • Legal issues

Common Motor Vehicle Accidents/Collisions

acute whiplash el paso tx.

Whiplash

Whiplash is one of the most typical injuries following an accident, especially when rear-ended or a rear-end collision. Its a neck injury that happens when the neck snaps suddenly back and forth causing trauma to the tissues in the neck. Symptoms often develop a few days after the accident including:
  1. Limited neck movement
  2. Stiffness and pain in the neck
  3. Pain or tenderness in the upper back, shoulders, and arms
  4. Numbness or tingling in the arms
  5. Dizzyness
  6. Headaches starting at the base of the skull
  7. Problems with concentration or memory
  8. Ringing in the ears
  9. Sleep issues
  10. Depression

Herniated Disc

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The discs in the spine cushion the vertebrae by absorbing the weight, force, and overall impact of a regular day. They are made of a soft, gel-like substance in the center that behaves like the gel in foot orthotics, shoes, mattresses, etc made to feel soft and comfortable. It has a tough outer membrane. A herniated disc happens when that soft gel springs a leak/s out from a tear, meaning the shock-absorbing cushion has been compromised and is not delivering the absorption it’s supposed to and places added pressure on the surrounding nerve/s and roots. Herniations can happen naturally from age and from jobs that involve consistent and constant repetitive:
  • Pushing
  • Pulling
  • Bending
  • Twisting
Herniations also happen after going through some type of physical trauma like a motor vehicle accident/collision. Symptoms depend on where the herniation occurs and include:
  • Muscle weakness around the affected nerve/s
  • Sharp shooting pain that can spread out from the shoulders to the arms, legs and low back
  • Tingling in arms or legs
  • Numbness
  • There could also be no symptoms and no discovery of a herniated disc until tested for something else.

Vertebral Fractures

Vertebral Fracture Diagnosis Imaging Studies | El Paso, TX Chiropractor
 
The vertebrae are highly susceptible to fractures of all types and can appear at any spot along the spine. For many, the injuries are mild and heal with non-surgical treatment and time. Major trauma to the spine can cause severe injuries/conditions which include:

Burst fractures

 
This is where the vertebra fractures in multiple places into bony fragments that fall into the spinal cord getting lodged inside with the jagged edges of the bones creating tears, cuts, etc that can result in paralysis and even death.

Flexion fracture

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This is an injury seen in head-on collisions where the upper part of the body gets thrown forward and the bottom part stays in place likely from the seatbelt. This tears the vertebra apart resulting in a flexion teardrop fracture.

Vertebral compression

spinal neoplasms diagnostic imaging el paso tx.
 
These types cause the front of the vertebra to collapse while the back keeps its position that forms a wedge-like shape. However, more often it is associated with osteoporosis, healthy individuals can experience a vertebral compression fracture from a serious traumatic event like an auto accident. Fractures can cause mild to severe pain that is exacerbated with movement. If the spinal cord is injured the individual could experience:
  • Tingling
  • Numbness
  • Weakness in the limbs
  • Loss of bladder/bowel function
Because of the increased safety features in today’s vehicles, fractures of the spine are rare except for severe motor vehicle accidents/collisions.

Diagnosis and treatment

A doctor will review medical history along with the accident information. Imaging tests will follow like:
  • X-ray
  • CT or computed tomography scan
  • MRI or magnetic resonance imaging
 
The way these techniques of imaging are done depends on the accident and the state of the spine. Being brought into the hospital from a motor vehicle accident/collision with a suspected spinal injury means the imaging will be done first to rule out or not potentially life-threatening injury/s to the spine. Treatment for spinal injuries can range from:
  • Soft collar
  • Chiropractic
  • Over-the-counter anti-inflammatory medications
  • Corticosteroid injection/s
  • Nerve blocks
  • Physical therapy
  • Surgery to correct certain injuries when all other forms of treatment are not working

Recovery

Every case, accident, and injury is different and depends on several factors, like age, health, and how severe the accident/collision was. Severe and extreme injures like a burst fracture can take a long time to heal.  
PersonalInjuryLawyer|ChavezLawFirm ElPasoChiropractor
 

Legal Issues

Individuals with a spinal injury can face thousands in medical bills. If there is medical equipment involved along with therapeutic services for long-term care, like physical therapy then bills will accumulate. Also, a personal injury claim could be necessary to pay for everything, especially, if the accident/collision is no fault of your own. Compensation could help with:
  • Loss of employment
  • Employment benefits
  • Wages lost
  • Ability to work/earn income
  • Medical expenses
  • Pain
  • Suffering
  • Consult with a specialist when considering filing a personal injury claim

Work Compensation

If a spinal injury accident happens at work there could be worker’s compensation. Workers’ compensation is insurance that replaces wages and medical benefits to workers that have been injured while doing their job. These are injuries that happened during the operation of a motor vehicle, like a truck, or forklift. The worker must file an injury report immediately so there is documentation supporting the injury claim. Waiting to file can make the employer question if there even was an injury. A workers’ compensation claim works differently than a personal injury claim, based primarily on what is covered under the job’s insurance policies. An example is the legal term pain and suffering. This is not covered by workers’ compensation. However, a work training accident would be covered by work comp in the event that the individual cannot return to their job/occupation after the injury. However, any injury/s after a motor vehicle accident/collision should never be taken lightly or ignored. Individuals must be proactive in their treatment after an accident/collision. This is to prevent and avoid further injury.

Auto Accident Doctors & Chiropractor Treatments

 
 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

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https://www.pushasrx.com/spinal-injuries-vehicle-accident-collision/feed/ 0 %%title%% Auto Injuries | Accident/Collisions are seeing a rise and along with those crashes are spinal injuries. What you need to know about: Accident-related injuries Treatment accident,auto,chiropractic,collision,health,injuries,motor,pain,relief,spinal,treatment,vehicle,wellness,accident/collision 11860 Vista Del Sol, Ste. 128 Spinal Injuries from a Motor Vehicle Accident/Collision acute whiplash el paso tx. radiculopathies chiropractic care el paso tx. Vertebral Fracture Diagnosis Imaging Studies | El Paso, TX Chiropractor spinal trauma el paso tx. spinal neoplasms diagnostic imaging el paso tx. PersonalInjuryLawyer|ChavezLawFirm ElPasoChiropractor 25555
Disc Bulge & Herniation Chiropractic Care Overview https://www.pushasrx.com/disc-bulge-herniation-chiropractic-care-overview/ https://www.pushasrx.com/disc-bulge-herniation-chiropractic-care-overview/#respond Fri, 19 Jun 2020 20:27:25 +0000 https://www.pushasrx.com/?p=25546 Disc Bulge & Herniation Chiropractic Care Overview | El Paso, TX Chiropractor

Disc bulge and disc herniation are some of the most common conditions that can affect the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician for the treatment of spinal disorders. Approximately $ 7.1 billion alone is lost due to the time away […]

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Disc Bulge & Herniation Chiropractic Care Overview | El Paso, TX Chiropractor

Disc bulge and disc herniation are some of the most common conditions that can affect the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician for the treatment of spinal disorders. Approximately $ 7.1 billion alone is lost due to the time away from work.

 

Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.

 

There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the level of the intervertebral disc and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with complete annular tear. In this type of disc extrusion, there is a neck or base which is narrower than the dome or the herniation.

 

A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because it is limited by the annulus fibrosus attachment. It differs from disc herniation because it involves less than 25% of the circumference of the disc. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into 2 types. In circumferential bulge, the whole disc circumference is involved. In asymmetrical bulging, more than 90 degrees of the circumference is involved in an asymmetric way.

 

Normal Intervertebral Disc Anatomy

 

Before going into detail into the definition of disc herniation and disc bulge, we need to take a look at how the normal intervertebral disc looks like. According to spine guidelines in 2014, a normal disc is something that has a normal shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one third to one-fourth of the height of the spinal column.

 

One intervertebral disc is about 7 – 10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and in the coccyx. About 23 discs are found in the spine with 6 found in the cervical spine, 12 in the thoracic spine, and only 5 found in the lumbar spine.

 

Intervertebral discs are made of fibro cartilages and they form a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus is made up of concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. The endplates with its cartilaginous part, anchor the discs in its proper place.

 

The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain water hence giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day the amount of water found in the nucleus pulposus varies according to the level of activity of the person. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.

 

Effect of Intervertebral Disc Morphology on Structure and Function

 

The type of components presents in the intervertebral disc and how it is arranged determines the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.

 

The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation, and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.

 

Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.

 

Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.

 

The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in T4 – 5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.

 

From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by L5 – S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.

 

What is a Disc Bulge?

 

The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although the disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.

 

Causes for Disc Bulging

 

Bulging disc can be due to several causes. It can occur due to normal age-related changes such as seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.

 

General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.

 

When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.

 

The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weaken causing long term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility for disc diseases. Other environmental facts may also play a part in this disease process.

 

Symptoms of Disc Bulging

 

As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to fingers.

 

This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.

 

In the thoracic region, there may be a pain in the upper back which radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.

 

The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.

 

Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from back down to the feet.

 

The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.

 

Diagnosis of Disc Bulging

 

The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.

 

MRI of Disc Bulge

 

Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.

 

The magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.

 

Treatment of Disc Bulging

 

The treatment for the bulging disc can be conservative, but sometimes surgery is required.

 

Conservative Treatment

 

When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.

 

The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery.

 

If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.

 

Surgical Treatment

 

When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.

 

Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.

 

Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.

 

Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery through the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.

 

What is a Disc Herniation?

 

As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause for spinal surgery.

 

Classifications of Disc Herniation

 

There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis is not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.

 

Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.

 

Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.

 

The disc protrusion can also be divided into two as focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.

 

In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack of continuity.

 

This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.

 

The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.

 

Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.

 

Even though some fragments that are migrated can be sequestered ones the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.

 

The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-third and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.

 

The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.

 

Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.

 

Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation

 

Lumbar disc herniation is the commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region is L 5 – 6, in the Cervical region between C7, in the thoracic region T12.

 

Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.

 

Cervical disc herniation gives rise to neck pain, shoulder pain, or pain radiating from neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.

 

Epidemiology

 

Although disc herniation can occur in all age groups, it predominantly occurs in between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.

 

Risk Factors

 

In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to shrinking of the disc with narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.

 

Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.

 

When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with the legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.

 

Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.

 

There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).

 

Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.

 

Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) – 3, MMP – 9, cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.

 

Pathogenesis of Sciatica and Disc Herniation

 

The sciatic pain is originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.

 

The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.

 

These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.

 

Clinical Disc Herniation and What to Look for in the History

 

The symptoms of the disc herniation can vary to a great deal depending on the location of the pain, the type of herniation, and on the individuals. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.

 

The chief complain can be neck pain in cervical disc herniation and there can be referred pain to the arms, shoulders, neck, head, face, and even to the lower back region. However, it is most commonly referred to the interscapular region. The radiation of pain can occur according to the level the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, motor changes with changes in the reflexes.

 

The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as Valsalva maneuver, lifting.

 

Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, the activities that decrease intradiscal pressure can reduce the symptoms as in lying down.

 

The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.

 

The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.

 

When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.

 

The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.

 

Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.

 

The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation on nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness and spasticity of one or both legs due to exaggerated reflexes.

 

The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired in detail to exclude red flag symptoms such as pain which occurs at night without activity which can be seen in pelvic vein compression, non-mechanical pain which may be seen in tumors or infections.

 

If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.

 

Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.

 

Differential Diagnosis

 

  • Degenerative disc disease
  • Mechanical pain
  • Myofascial pain leading to sensory disturbances and local or referred pain
  • Hematoma
  • Cyst leading to occasional motor deficits and sensory disturbances
  • Spondylosis or spondylolisthesis
  • Discitis or osteomyelitis
  • Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
  • Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
  • Epidural abscess which can cause symptoms similar to radicular pain involving spinal disc herniation
  • Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
  • Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
  • Tumors
  • Pelvic endometriosis
  • Facet hypertrophy
  • Lumbar nerve root schwannoma
  • Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots

 

Examination in Disc Herniation

 

Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.

 

A complete neurological examination is often necessary. This should test the muscle weakness and sensory weakness. In order to detect the muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.

 

There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as Braggart sign, flip sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.

 

Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.

 

In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels a pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80 – 90ᵒ without having any pain or difficulty.

 

However, if the angle is just 30 – 70ᵒ degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.

 

The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect the foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.

 

Investigation of Disc Herniation

 

For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level and serum protein electrophoresis may also be needed in specific circumstances guided by history.

 

Magnetic Resonance Imaging (MRI)

 

MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.

 

On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.

 

There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, lesions located completely outside the intervertebral disc space.

 

MRI can detect abnormalities in the intervertebral discs superiorly than other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.

 

This is also a problem in children and anxious patients undergoing MRI because good image quality depends on patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.

 

Computed Tomography (CT)

 

CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior to both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.

 

However, CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath is helpful in making a diagnosis.

 

The images will show a soft tissue mass and displaced thecal sac along with the effacement of the fat in the epidural region. An irregular, lobulated mass near the margin of the disc is seen in fragments that are not restrained by the posterior longitudinal ligament but are still in contact with the margin of the disc. The nuclear fragment of the disc that is fragmented is 80 – 120 HU.

 

The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.

 

Myelopathy can occur when the spinal canal is affected due to the disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.

 

In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass which is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.

 

Radiography

 

Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore is used to exclude other conditions such as tumors, infections, and fractures.

 

In myelography, there may be deformity or displacement of the extradural contrast filled thecal sac seen in herniation of the disc. There may also be featured in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.

 

Diskography

 

In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.

 

Treatment of Herniated Disc

 

The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.

 

Conservative Therapy

 

Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.

 

Bed rest has long been considered as a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.

 

In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAID. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up in the WHO analgesics ladder. However, the long term use of NSAID and analgesics can lead to gastric ulcers, liver, and kidney problems.

 

In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.

 

However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.

 

When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore foraminal approach is used carefully if needed.

 

This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.

 

Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.

 

Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. The physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.

 

The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.

 

If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.

 

Surgical Therapy

 

The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.

 

Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.

 

There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.

 

Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be in the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.

 

However, there are some studies suggesting microdiscectomy is more favorable because of its both short term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.

 

In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration in the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.

 

However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.

 

There is a discussion on whether to remove a large portion of the disc fragment and curetting of the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.

 

In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.

 

These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed by either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.

 

In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.

 

The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.

 

Complications of the Surgery

 

Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.

 

Outcomes of the Surgery

 

There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.

 

Novel Therapies

 

Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.

 

The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF α are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and α2 adrenergic receptor antagonists.

 

Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF α and IL 1β have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers which target the microglia that is thought to initiate the inflammatory cascade has been tested with the neuroprotective antibiotic minocycline.

 

There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)

 

 

A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico* 

 

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

References

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  • Fraser I (2009) Statistics on hospital-based care in the United States. Agency for Healthcare Research and Quality, Rockville
  • Ricci, Judith A. et al. “Back Pain Exacerbations And Lost Productive Time Costs In United States Workers.” Spine, vol 31, no. 26, 2006, pp. 3052-3060. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/01.brs.0000249521.61813.aa.
  • Fardon, D.F., et al., Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J, 2014. 14(11): p. 2525-45.
  • Costello RF, Beall DP. Nomenclature and standard reporting terminology of intervertebral disk herniation. Magn Reson Imaging Clin N Am. 2007;15 (2): 167-74, v-vi.
  • Roberts, S. “Disc Morphology In Health And Disease.” Biochemical Society Transactions, vol 30, no. 5, 2002, pp. A112.4-A112. Portland Press Ltd., doi:10.1042/bst030a112c.
  • Johnson, W. E. B., and S. Roberts. “Human Intervertebral Disc Cell Morphology And Cytoskeletal Composition: A Preliminary Study Of Regional Variations In Health And Disease.” Journal Of Anatomy, vol 203, no. 6, 2003, pp. 605-612. Wiley-Blackwell, doi:10.1046/j.1469-7580.2003.00249.x.
  • Gruenhagen, Thijs. “Nutrient Supply And Intervertebral Disc Metabolism.” The Journal Of Bone And Joint Surgery (American), vol 88, no. suppl_2, 2006, p. 30. Ovid Technologies (Wolters Kluwer Health), doi:10.2106/jbjs.e.01290.
  • Mercer, S.R., and G.A. Jull. “Morphology Of The Cervical Intervertebral Disc: Implications For Mckenzie’s Model Of The Disc Derangement Syndrome.” Manual Therapy, vol 1, no. 2, 1996, pp. 76-81. Elsevier BV, doi:10.1054/math.1996.0253.
  • KOELLER, W et al. “Biomechanical Properties Of Human Intervertebral Discs Subjected To Axial Dynamic Compression.” Spine, vol 9, no. 7, 1984, pp. 725-733. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-198410000-00013.
  • Lieberman, Isador H. “Disc Bulge Bubble: Spine Economics 101.” The Spine Journal, vol 4, no. 6, 2004, pp. 609-613. Elsevier BV, doi:10.1016/j.spinee.2004.09.001.
  • Lappalainen, Anu K et al. “Intervertebral Disc Disease In Dachshunds Radiographically Screened For Intervertebral Disc Calcifications.” Acta Veterinaria Scandinavica, vol 56, no. 1, 2014, Springer Nature, doi:10.1186/s13028-014-0089-4.
  • Moazzaz, Payam et al. “80. Positional MRI: A Valuable Tool In The Assessment Of Cervical Disc Bulge.” The Spine Journal, vol 7, no. 5, 2007, p. 39S. Elsevier BV, doi:10.1016/j.spinee.2007.07.097.
  • “Lumbar Disc Disease: Background, History Of The Procedure, Problem.” Emedicine.Medscape.Com, 2017, http://emedicine.medscape.com/article/249113-overview.
  • Vialle, Luis Roberto et al. “LUMBAR DISC HERNIATION.” Revista Brasileira de Ortopedia 45.1 (2010): 17–22. PMC. Web. 1 Oct. 2017.
  • “Herniated Nucleus Pulposus: Background, Anatomy, Pathophysiology.” http://emedicine.medscape.com/article/1263961-overview.
  • Vialle, Luis Roberto et al. “LUMBAR DISC HERNIATION.” Revista Brasileira De Ortopedia (English Edition), vol 45, no. 1, 2010, pp. 17-22. Elsevier BV, doi:10.1016/s2255-4971(15)30211-1.
  • Mulleman, Denis et al. “Pathophysiology Of Disk-Related Sciatica. I.—Evidence Supporting A Chemical Component.” Joint Bone Spine, vol 73, no. 2, 2006, pp. 151-158. Elsevier BV, doi:10.1016/j.jbspin.2005.03.003.
  • Jacobs, Wilco C. H. et al. “Surgical Techniques For Sciatica Due To Herniated Disc, A Systematic Review.” European Spine Journal, vol 21, no. 11, 2012, pp. 2232-2251. Springer Nature, doi:10.1007/s00586-012-2422-9.
  • Rutkowski, B. “Combined Practice Of Electrical Stimulation For Lumbar Intervertebral Disc Herniation.” Pain, vol 11, 1981, p. S226. Ovid Technologies (Wolters Kluwer Health), doi:10.1016/0304-3959(81)90487-5.
  • Weber, Henrik. “Spine Update The Natural History Of Disc Herniation And The Influence Of Intervention.” Spine, vol 19, no. 19, 1994, pp. 2234-2238. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-199410000-00022.
  • “Disk Herniation Imaging: Overview, Radiography, Computed Tomography.” Emedicine.Medscape.Com, 2017,
  • Carvalho, Lilian Braighi et al. “Hérnia De Disco Lombar: Tratamento.” Acta Fisiátrica, vol 20, no. 2, 2013, pp. 75-82. GN1 Genesis Network, doi:10.5935/0104-7795.20130013.
  • Kerr, Dana et al. “What Are Long-Term Predictors Of Outcomes For Lumbar Disc Herniation? A Randomized And Observational Study.” Clinical Orthopaedics And Related Research®, vol 473, no. 6, 2014, pp. 1920-1930. Springer Nature, doi:10.1007/s11999-014-3803-7.
  • Buy, Xavier, and Afshin Gangi. “Percutaneous Treatment Of Intervertebral Disc Herniation.” Seminars In Interventional Radiology, vol 27, no. 02, 2010, pp. 148-159. Thieme Publishing Group, doi:10.1055/s-0030-1253513.
  • Haro, Hirotaka. “Translational Research Of Herniated Discs: Current Status Of Diagnosis And Treatment.” Journal Of Orthopaedic Science, vol 19, no. 4, 2014, pp. 515-520. Elsevier BV, doi:10.1007/s00776-014-0571-x.

 

 

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Discitis Spinal Disc Infection Causing Inflammation https://www.pushasrx.com/discitis-spinal-infection/ https://www.pushasrx.com/discitis-spinal-infection/#respond Wed, 10 Jun 2020 01:33:42 +0000 https://www.pushasrx.com/?p=25495 11860 Vista Del Sol, Ste. 128 Discitis Spinal Disc Infection Causing Inflammation

Discitis is typically caused by an infection that grows in one of the spine’s vertebral bones and possibly in the intervertebral discs. Discitis is usually a bacterial infection, but it can be viral. Discitis affects around 1 out of every 100,000 people. This means that it is not a common spinal disease. Discitis can occur […]

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11860 Vista Del Sol, Ste. 128 Discitis Spinal Disc Infection Causing Inflammation Discitis is typically caused by an infection that grows in one of the spine’s vertebral bones and possibly in the intervertebral discs. Discitis is usually a bacterial infection, but it can be viral. Discitis affects around 1 out of every 100,000 people. This means that it is not a common spinal disease. Discitis can occur in adults and children, however, it is more common in children.  
11860 Vista Del Sol, Ste. 128 Discitis Spinal Disc Infection Causing Inflammation
 
  • Discitis mostly occurs in the low back region of the spine
  • Followed by the neck region
  • Finally the middle-back region
It accompanies vertebral osteomyelitis. Both types of infections share many of the same symptoms/characteristics. Although these are uncommon conditions, they can produce severe symptoms affecting an individual’s quality of life. This is why early diagnosis and treatment are essential.

Discitis Causes

There are two recognized causes of discitis. The rarest form comes from a prior surgical or diagnostic procedure. This usually happens when a needle or other tool/device transfers the infection. The other is the more common, and it is known as spontaneous discitis. Here the infection develops from a bacterial or viral organism that travels to the disc/s via the blood supply from another part of the body. When an infection starts somewhere else and then travels to the disc, it is called transient bacteremia, which is bacteria in the bloodstream that has a short life. Ear infections along with skin infections are perfect examples of infections that can lead to transient bacteremia and discitis.  
  After a disc becomes infected, it can be quite difficult for the body to fight the infection. The disc/s are the largest avascular organs in the body, which means they do not have their own blood supply. The discs get their nutrition and blood supply, which includes the white blood cells for fighting infections, from the vertebral endplates. Because the discs lack the resources to fight infections on their own, there is a struggle when trying to protect against infection. Because discitis is usually caused by an infection that developed in another area of the body, individuals with medical conditions are at a higher risk for developing discitis. These conditions include:
  • Diabetes
  • A.I.D.S
  • Cancer
  • Chronic kidney disease

Symptoms

Intense back pain that starts gradually is the distinctive characteristic symptom of discitis. The pain is usually localized to the area where the infection is located. This means that the pain doesn’t radiate or spread out like other types of back pain conditions.  
blog illustration of low back pain

Diagnosis

A doctor, spine specialist, or chiropractor will review medical history and symptoms with the individual. A fever is normally not present once the infection is inside the disc, along with the white blood cell count being normal. However, the erythrocyte sedimentation rate increases. This is a blood test that examines how fast red blood cells fall to the bottom of a tube. The faster that they fall to the bottom, the more likely there is inflammation somewhere in the body. Blood tests can be utilized during diagnosis, however, the most accurate diagnostic tool to confirm discitis is magnetic resonance imaging or MRI that shows if an infection is present.  
The Importance of MRI

Treatment

Treatment can be challenging. This is because of the fact that the discs do not have a blood supply, and medications/antibiotics travel through the blood. It is treatable and is usually done within a six to eight-week course of antibiotics intravenously or through an IV. IV administered antibiotics could require treatment on an outpatient basis. The entire course of antibiotics must be completed in its entirety in order to manage the discitis. A doctor could also prescribe a spinal brace to help stabilize the spine and reduce pain. A brace can limit movement, however, it will help ensure proper healing.

Spinal Infections

Spinal infections can present spontaneously or as secondary conditions, e.g. after a surgical procedure. Spinal infections can affect different structures, like the:
  • Vertebral column or the bones of the spine
  • Intervertebral disc space, which is the cushion-gel structures between the vertebrae
  • Spinal canal
11860 Vista Del Sol, Ste. 128 Discitis Spinal Disc Infection Causing Inflammation
  Here are some facts about the occurrence and prevalence of different infections of the spine:
  • Vertebral osteomyelitis is the most common type of infection. It affects an estimated 27,000 to 66,000 people a year.
  • Epidural abscess is an infection inside the spinal canal that affects up to two cases per 10,000 in hospital admissions around the U.S. It is pretty common in individuals with vertebral osteomyelitis or discitis. Eighteen percent of those individuals can develop this infection. However, it is more common in people fifty and older.
  • Discitis, as aforementioned is a pretty uncommon condition. Although, treatment has advanced, around twenty percent of individuals with this infection do not survive.

Infection Risk Factors

There are certain factors that increase the risk of developing an infection. These factors include:

Symptoms and Diagnosis

Symptoms from a spinal infection can vary. However, continuous back pain with no history of trauma or injury. Usually, there is a delay in the diagnosis for an infection of the spine because of the:
  • Subtle nature of the symptoms
  • Individual’s belief that the pain is not serious
  • Absence of body-wide symptoms like a fever
Lab results can also complicate the diagnostic process, as they can be misleading. There could be normal white blood cell counts, x-rays that show no abnormalities, and a sensitive diagnostic test like a bone scan might not show that an individual is positive until a week later. An erythrocyte sedimentation rate is a valuable screening test when it comes to spinal infections. The test can measure inflammation and infection in the body. If a spinal infection is suspected, an MRI could be the most reliable tool to confirm early diagnosis.

Health & Immunity Series

 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico

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Purpose of a Bone Graft in Spinal Fusion Surgery https://www.pushasrx.com/bone-graft-spinal-fusion/ https://www.pushasrx.com/bone-graft-spinal-fusion/#respond Thu, 04 Jun 2020 00:16:47 +0000 https://www.pushasrx.com/?p=25465 11860 Vista Del Sol, Ste. 128 Purpose of a Bone Graft in Spinal Fusion Surgery

A bone graft is defined as using bone-in spine fusion surgery. Spinal fusion’s purpose is to link or weld bones together, in this case, the spinal bones. There are a variety of spinal conditions cause instability and pain: Degenerative disc disease Scoliosis Trauma from an auto accident, sports injury, slip, and fall accident Spine surgeons […]

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11860 Vista Del Sol, Ste. 128 Purpose of a Bone Graft in Spinal Fusion Surgery A bone graft is defined as using bone-in spine fusion surgery. Spinal fusion’s purpose is to link or weld bones together, in this case, the spinal bones. There are a variety of spinal conditions cause instability and pain:
  • Degenerative disc disease
  • Scoliosis
  • Trauma from an auto accident, sports injury, slip, and fall accident
Spine surgeons use a bone graft to:
  • Stop motion between two or more vertebrae
  • Stabilize a spinal deformity
  • Repair fractures of the spine
11860 Vista Del Sol, Ste. 128 Purpose of a Bone Graft in Spinal Fusion Surgery

Spinal Fusion Stimulates New Bone Growth

A bone graft does not heal or fuse the spine instantly. Rather a bone graft sets up a foundational frame for the individual’s body to generate and grow new bone. A bone graft stimulates new bone production. It is when this new bone begins to grow and solidify, that fusion takes place. With these types of surgeries, instrumentation like screws, and rods are typically used for the beginning stabilization. But it is the actual healing of the bone that welds the vertebrae together creating long-term stability. A bone graft can be used for structural purposes for supporting the spine, usually this is done in place of a disc or bone that was removed. Or it can be an onlay, this means that a mass of bone fragments will grow together to stabilize the spine bridging the joint. There are two generalized bone graft types:
  • Real bone
  • Substituted bone graft
Real bone can come from the patient, which is called an auto-graft or from a donor’s bone, called an allograft.

The Individual’s Bone or Auto-graft

An auto-graft is bone taken or harvested from the individual’s body and transplanted to a specific area, in this case, the spine. An auto-graft is considered the gold standard because it is the individual’s own bone, which contains: These all help to stimulate the healing of the fusion. There are advantages for an auto-graft, which include a higher probability for fusion success and a lower risk for disease transmission. The only real setback for individuals of an auto-graft is the post-operative pain that usually comes with the procedure when harvesting an individuals’ bone. Bone can be harvested from one of the individual’s:
  • Iliac crests
  • Pelvic bones
  • Ribs
  • Spine
11860 Vista Del Sol, Ste. 128 Purpose of a Bone Graft in Spinal Fusion Surgery
  Bone graft harvesting creates a new set of risks. These include: Because of these risks and the possibility that the bone could be poor quality, a surgeon could decide to use another type of bone graft. When this happens a surgeon could go with what is known as a local auto-graft. This is bone harvested from the decompression itself. These are the parts that are removed to decompress the nerves. They usually consist of bone spurs, lamina, and portions of the spinous process. These same bone pieces can be reused to assist with the fusion of the decompressed areas.

Donor Bone or Allograft

An allograft is a bone harvested from another person, usually from a tissue bank. Tissue banks harvest bone and other tissues from cadavers for medical purposes. An allograft is prepared by freezing or freeze-drying the bone or tissues. This helps limit the risk of graft rejection. Bone from an allograft does not have living bone cells and is not as effective at fusion stimulation when compared to an autograft. However, it still does work. Tissue banks:
  • Screen all their donors
  • Supervise bone recovery
  • Test donations
  • Sterilize donations
  • Store for use
Look for tissue banks that are accredited by the American Association of Tissue Banks. US Food and Drug Administration has strict regulations when it comes to human cell and tissue processing. These include rules about the eligibility of donors. These guidelines/protocols help reduce the risk of tissue contamination and the spread of disease.

Bone Graft Substitute

These substitutes are man-made or are made from a manipulated version of a natural product. These alternatives are safe and can provide a solid foundation for the individual’s body to grow bone. Substitutes have similar properties of human bone, which include a porous structure and proteins that stimulate healing.

Demineralized Bone Matrix – DBM

A demineralized bone matrix is an allograft that has gone through a process where the mineral content has been removed. This demineralization helps reveal bone-forming proteins like collagen, and growth factors hidden within the bone that can stimulate healing. This procedure is often considered a bone graft extender. It is not considered a replacement. This is because its ability to fuse the human spine on its own has not been proven. DBM can be combined with the regular bone for more volume and is available in these forms:
  • Chip
  • Granule
  • Gel
  • Powder
  • Putty

Ceramic-based Extenders

Ceramic-based extenders are mixed in combination with other sources of bone. This is because they consist of calcium matrix for fusion, but there are no cells or proteins to stimulate the healing process. These include: Ceramic-based extenders do not present a risk for disease transfer but can cause inflammation. They are available in porous and mesh forms.

Morphogenetic Protein – BMP

Different types of bone morphogenetic proteins or BMP’s are used to stimulate new bone growth. These proteins are found in human bone, however, they are trace amounts. They are then produced in larger amounts through genetic engineering. This all depends on the type of spine surgery an individual undergoes. Bone morphogenetic protein could be considered an option in promoting new bone growth along with healing fusion.
 

Treating Severe & Complex Sciatica Syndromes

 

 

Telemedicine Mobile App

 
Telemedicine Mobile App

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Minimally Invasive Spine Surgery El Paso, Texas https://www.pushasrx.com/minimally-invasive-spine-surgery/ https://www.pushasrx.com/minimally-invasive-spine-surgery/#respond Wed, 27 May 2020 00:59:22 +0000 https://www.pushasrx.com/?p=25423 11860 Vista Del Sol, Ste. 128 Minimally Invasive Spine Surgery El Paso, Texas

Minimally invasive spine surgery known as M.I.S.S is an option to traditional open surgical procedures, as well as an alternative when non-surgical approaches are working but the pain or condition is becoming worse, regardless. These are performed to treat a variety of spinal disorders like: Bone spurs Degenerative disc disease Herniated disc Scoliosis Spinal instability […]

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11860 Vista Del Sol, Ste. 128 Minimally Invasive Spine Surgery El Paso, Texas Minimally invasive spine surgery known as M.I.S.S is an option to traditional open surgical procedures, as well as an alternative when non-surgical approaches are working but the pain or condition is becoming worse, regardless. These are performed to treat a variety of spinal disorders like:
  • Bone spurs
  • Degenerative disc disease
  • Herniated disc
  • Scoliosis
  • Spinal instability
  • Spinal stenosis
  • Spinal tumors
Minimally invasive surgery can offer potential benefits. These include
  • A small/tiny incision/s
  • Minimal cutting through soft tissues like ligaments, and muscles
  • Outpatient option/s
  • Reduced post-operative pain
  • Quicker recovery

The Focus of Spine Surgery

There are two main goals when it comes to spine surgery or rather the goal/focus of the surgery. These are decompressing and stabilizing the spine.
spinal trauma el paso tx.

Decompression of the spine

Spinal decompression involves removing any tissue/s that are compressing/pinching the nerve structures like a spinal nerve root or the spinal cord itself. Bone spurs and fragments from a herniated disc are the types of tissue/s that can cause neural compression.

Stabilization of the spine

An abnormal movement of one or more levels/segments of the spinal cord can cause back pain, neck pain, or both. Surgeries that are meant to stabilize and stop these abnormal movements utilize spine instrumentation combined with fusion.

Spine Surgery Techniques

Minimally invasive spine surgery techniques include:
  • Percutaneous or through the skin
  • Mini-open or small incision procedure/s
Rather than cutting through soft tissues, a tubular retraction instrument generates a tunnel that expands and passes between the muscle/s to access the spine’s column. Then an endoscope or a tiny video camera goes in and around the area, projecting a visualization of what’s happening on a monitor during the procedure.
11860 Vista Del Sol, Ste. 128 Minimally Invasive Spine Surgery El Paso, Texas
 
This is the surgeon’s/team’s eyes as they work to repair the damage. The surgery is run through the tubular retraction system along with any specially designed instruments that are needed. Types of surgical procedures performed with minimally invasive surgery include:
  • Discectomy
  • Microdiscectomy
  • Foraminotomy
  • Microforaminotomy
  • Microlaminectomy
  • Microlaminotomy
The micro means that the surgery is done using a special microscopic camera to view the disc/s and nerve/s. Imaging scans, systems, and image-guidance technologies, like fluoroscopy, which is a real-time x-ray are utilized during the surgery pinpointing the key aspects of the patient’s spinal anatomy. The surgical imaging shows 2D and 3D views, which guides the placement of any instrumentation, like pedicle screws.

Disorders Treated with Minimally Invasive Surgery

Degenerative disc disease

Degenerative disc disease is known as DDD often develops progressively in older adults and affects the intervertebral discs. The normal wear and tear of cellular age-related changes in the body can cause the spine’s discs to:
  • Stiffen
  • Lose Flexibility
  • Loss of Strength
  • Loss of Height
  • Lose shape, along with the ability to absorb/distribute the forces associated with moving
These structural changes increase the risk of disc herniation and subluxations.

Herniated discs

A herniated disc also called a slipped, bulging, and ruptured disc. This happens when the soft gel cushion of a disc breaks through the protective outer layer. Other than the damaged disc, the loose interior gel can also irritate and inflame the nerves causing back pain.  
BulgingandHerniatedDiscs ElPasoChiropractor

Scoliosis

Scoliosis is an abnormal sideways curve of the spine that can cause progressive spinal deformity. A scoliotic curve can look like an “S” or “C.” Most cases have no known cause, and while the condition is more commonly associated with children, adults can develop scoliosis, as well.
scoliosis treatment el paso tx.

Spinal stenosis

Spinal stenosis happens when the spinal nerve roots and the spinal cord become compressed/pinched. These nerves branch off the spinal cord and exit the spinal canal through passageways called neuroforamen. Nerve and spinal cord compression can cause symptoms like:
  • Pain
  • Weakness
  • Tingling sensations
  • Numbness
  • Sometimes, pain can travel into the arms or legs
11860 Vista Del Sol, Ste. Exactly What Is Minimally Invasive Spine Surgery

Spine Surgery Risks

With any spine surgery there are potential risks and complications that can occur. Here are some possible complications that can happen during and after surgery, with both open and minimally invasive procedures.

Candidate for Surgery

Minimally invasive spine surgery does offer many benefits:
  • Tiny incision
  • Less pain
  • Reduced risk
  • Faster recovery
Let’s not forget that M.I.S.S is still surgery. Less than 5% of people with back or neck pain need spine surgery and, surgery is the last resort for treating pain and symptoms caused by a spinal condition/disorder. It is only when non-surgical treatments like chiropractic, acupuncture, physical therapy, medication, or spinal injections do not reduce symptoms in 3 to 6 months. This is when you qualify to be a candidate for spine surgery. There are certain types of spinal disorders that require urgent or immediate surgical intervention.
11860 Vista Del Sol, Ste. 128 Minimally Invasive Spine Surgery El Paso, Texas
Talk with your doctor, chiropractor, or spine specialist about the pain, the symptoms, and compare the results of the different therapies/treatments and go from there. With any type of surgery there are many considerations to discuss before making a decision to treat back or neck pain and if minimally invasive surgery could be an option.

Lower Back Pain Rehabilitation Chiropractor

 
 

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How To Handle Back Pain When You Can’t See A Doctor or Chiropractor https://www.pushasrx.com/handle-back-pain-cant-see-doctor/ https://www.pushasrx.com/handle-back-pain-cant-see-doctor/#respond Fri, 22 May 2020 01:07:07 +0000 https://www.pushasrx.com/?p=25413 11860 Vista Del Sol, Ste. 128 How To Handle Back Pain When You Can’t See A Doctor or Chiropractor

Staying at home means it can be tough to see a doctor, chiropractor, spine specialist, or neurosurgeon to handle back pain, especially when it tends to flare up at the most inconvenient times. There are still options, here’s what to do. What options are available when you want to see a doctor about back pain, […]

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11860 Vista Del Sol, Ste. 128 How To Handle Back Pain When You Can’t See A Doctor or Chiropractor Staying at home means it can be tough to see a doctor, chiropractor, spine specialist, or neurosurgeon to handle back pain, especially when it tends to flare up at the most inconvenient times. There are still options, here’s what to do. What options are available when you want to see a doctor about back pain, but getting to the clinic can be a challenge.
11860 Vista Del Sol, Ste. 126 How Topical Medications Alleviate Back/Neck Pain El Paso, TX.
Fortunately, there are a variety of tools to handle back pain that can provide some relief.
  • Ice is a great place to start to relieve pain.
  • Hot/Warm baths combined with Epsom salt
  • Microwavable hot packs can help
  • Over-the-counter pain medications like Motrin are one of the best medicines for non-traumatic back pain inflammation.

Heat Packs/Heat Therapy

Heat therapy promotes vasodilation and draws nutrient-rich blood into the targeted tissues. Increased blood flow delivers oxygen and nutrients and cell waste is removed. The warmth decreases muscle spasms, relaxes tense muscles, relieves pain, and increases range of motion. Superficial heat is available in different forms, which include:
  • Hot and moist compresses
  • Dry or moist heating pads
  • Hydrotherapy
  • Commercial chemical/gel packs
Remember heat packs in any form should be wrapped in a towel to prevent burns, as a punctured heat pack should be discarded, as the chemical agent/gel can burn skin.  
blog picture of lady icing shoulder

Cold Packs/Cold Therapy

Cold therapy produces vasoconstriction. This slows blood circulation, which reduces inflammation, muscle spasms, and pain. Superficial cold is also available in different forms, which include:
  • Commercial cold packs
  • Ice cubes
  • Iced towels/compresses
  • Hydrotherapy.
The application of cold therapy is usually less than 15 minutes, as the effects of cold are known to last longer than heat. Cold packs or ice should never be applied directly to the skin. A towel, should be placed between the cold object and the skin surface to prevent any skin and nerve damage. A punctured cold pack should be discarded, as the chemical agent/gel will also burn the skin.

Telemedicine

It might be hard to believe that a virtual video visit can work to handle back pain. On a video call, a chiropractor is unable to physically palpate the sore areas and measure the range of motion and strength. However, this should not discourage you from scheduling a virtual appointment. Telemedicine, without a physical examination, can be highly beneficial. A chiropractor can start the process of ordering tests, like MRI, X-ray, etc. Even if the pain is tolerable, meaning the kind that doesn’t need medicine or imaging tests, this should not be an excuse to skip an orthopedic visit. With telemedicine, a chiropractor can still give advice, show back stretches, exercises, order back pain supplements, and talk about the risks and benefits of treatments available to try on your own.  
11860 Vista Del Sol, Ste. 128 How To Handle Back Pain When You Can’t See A Doctor or Chiropractor
 

Physical Therapy

With chronic low back pain, chances are your chiropractor suggested physical therapy or PT. Now is the time to bring back those PT exercises, especially with a back-pain flare-up. Low-back pain or any back pain for that matter with no neurological issues, could mean that a stretching and exercise program is all that is needed. Find out if your chiropractor or a physical therapist offers other options:
  • Patient portal communication or e-visits.
  • Uploads of illustrated handouts describing how to do various stretches and exercises.
  • Remote evaluation. The individual submits pictures or a video of their movements for personalized feedback, which the chiropractor or physical therapist evaluates and provides.
core strength reduces back pain el paso tx.

Get Active

Evidence shows that being active is better than resting. Moving increases the blood flow to the muscles, which helps with muscle spasms, trigger points, tense muscles/ligaments, and other issues.

Pilates

Pilates focuses on controlled movement, breathing, and stretching. A review found Pilates can be a highly effective and beneficial approach to handle back pain and related discomfort. Check out beginner Pilates videos. Be sure to avoid any move/s that cause pain, worsens the existing pain, or generate new pain.
11860 Vista Del Sol, Ste. 128 How To Handle Back Pain When You Can’t See A Doctor or Chiropractor

Yoga

A review found that yoga can help improve mobility and decrease pain. If this is a new practice, start with gentle yoga or restorative yoga.
11860 Vista Del Sol, Ste. 128 How To Handle Back Pain When You Can’t See A Doctor or Chiropractor

Walking

Going for a walk is easy, accessible, and is beneficial for the spine. Walking can be as effective as non-drug interventions in decreasing pain and discomfort in chronic low-back pain. Simple movements along with rollers and massagers can handle back pain as well. These include:
  • Self-massage with a tennis ball
  • Foam rolling
  • Hand-held massager
  • Stretching
  • McKenzie Method, comprised of gentle stretching exercises
These strategies and approaches can become the methods and techniques for the relief of existing back-pain in the absence of a doctor, chiropractor, or physical therapist.

Chiropractors & Sciatica


 

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Ease Pregnancy Back Pain at Home the Smart Way https://www.pushasrx.com/ease-pregnancy-back-pain-smart/ https://www.pushasrx.com/ease-pregnancy-back-pain-smart/#respond Tue, 19 May 2020 01:02:19 +0000 https://www.pushasrx.com/?p=25401 11860 Vista Del Sol, Ste. 128 Ease Pregnancy Back Pain at Home the Smart Way

Pregnancy back pain is very common. At least 50 percent of pregnant women and up to 80 percent will experience back pain at some point during their pregnancy. This is completely natural from the added weight of the baby. However, combined with all the other issues that arise during pregnancy ranging from: Mood swings Morning […]

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11860 Vista Del Sol, Ste. 128 Ease Pregnancy Back Pain at Home the Smart Way Pregnancy back pain is very common. At least 50 percent of pregnant women and up to 80 percent will experience back pain at some point during their pregnancy. This is completely natural from the added weight of the baby. However, combined with all the other issues that arise during pregnancy ranging from:
  • Mood swings
  • Morning sickness
  • Fatigue
  • Urinary issues
  • Lower back pain
11860 Vista Del Sol, Ste. 128 Ease Pregnancy Back Pain at Home the Smart Way
This can cause uncomfortable symptoms and take a serious toll on the body. Severe back pain during pregnancy is rare. We’ll look at why you could develop pregnancy back pain, along with steps and proven ways to feel better.

Back Pain Causes

Pain can occur at any trimester, but it usually arises in the later months as the baby and belly grow. Pain can be mild to severe and usually happens in the lower back. There does not have to be pre-existing back problems. Pregnancy itself changes the body in ways that can lead to back pain. Example: As the uterus gets heavier, there is the added strain placed on the back muscles. This can alter proper posture and cause discomfort/pain. Pregnancy changes the center of gravity and accentuates the spine’s curve in the lower back. When the abdominal muscles and core are weak and not strong enough, the changes of the curvature worsen since it is these muscles that stabilize the back. When pregnant, the body releases a hormone called relaxin that loosens ligaments, which is the tissue that connects the bones to each other inside the pelvis. The ligament loosening can affect back support and be a cause for pain. Other reasons women experience pregnancy back pain include:
  • Stress
  • Poor posture
  • Standing for too long
  • Injury
  • Trauma
 

Tips for Relief

There are ways to ease pregnancy back pain without medical intervention. Here’s how:

Pay Attention to Posture

When standing up, make sure to stand straight with the shoulders held back. If you must remain standing for a long time, elevate one foot on a box, chair, or stool to relieve the pressure on the spine. Try to avoid standing for long periods. Remember to take regular breaks and get off your feet. Maintain proper posture when sitting, as well.

Utilize an Ergonomic Chair

Both at home and at work that offers plenty of support for the back. Also, a small cushion or pillow placed behind the lower back, along with a stool or footrest for elevating the feet can be highly beneficial.

Proper Lifting

Of course, do not lift heavy objects, and avoid bending at the waist to pick up items off the floor. Instead squat, bend the knees, and lift with the legs, not with the back.

Exercise

The best time to start an exercise regiment is before conception. Regular physical activity/exercise can help prevent and ease back pain, along with all of the other benefits. Doing simple exercises before getting pregnant can improve core strength, which can go a long way. Try to get as close as possible to a healthy weight before getting pregnant. This has the added benefit of reducing pregnancy risks and cesarean delivery.
11860 Vista Del Sol, Ste. 126 Is My Pregnancy Causing Back Pain or Something Else El Paso, TX?
Once pregnant, mild or moderate exercise can help get a handle on back pain and prep the body for childbirth. Gentle workouts are the way to go. These will strengthen the back, core, and leg muscles. Recommended for pregnant women are:
  • Walking
  • Swimming
  • Prenatal yoga
  • Stretches
Ask your provider which exercises, stretches are best for you. Remember movement is far better than resting too much. Also, working with a physical therapist or chiropractor in back strength will help immensely.

Exercise Clothes

Wear comfortable, spine supportive shoes. High heels should be removed altogether and take caution with flats, as these can and do often lack arch support. Shoe inserts/orthotics can help. Maternity support belts for back pain relief can also be an added tool. Currently, there is not a great deal of scientific proof that they work. But many women swear by them when they were pregnant.

Sleep Adjustments

Try sleeping on one side with the knees bent, along with a pillow between the knees or under the abdomen. Another possibility is using a firmer mattress. This can support the back better than a soft sinking mattress. If a firm mattress is not possible, consider placing a stiff board under the mattress for added firmness. Take naps, making sure to get the proper sleep that the body needs. This is especially true as the later weeks of pregnancy approach. This is easier said than done, but a warm bath can help the body relax before bed.

Complementary practices

Some women have found alternative medical approaches like acupuncture and prenatal massage to be quite helpful in easing pregnancy back pain. Before trying it out talk to your OB/GYN. Once discussed, you can decide if it’s a healthy choice. Make sure the masseuse or alternative practitioner has experience working with pregnant women.

Pain Meds

Pregnancy back pain is a leading cause of opioid prescriptions. When it comes to medication, a critical issue is a potential for opioid abuse. There are some over-the-counter meds that can help ease back pain. However, Non-steroidal anti-inflammatory drugs or NSAIDs have been linked to pregnancy complications, and most doctors recommend not using them. Instead, try acetaminophen, which is just as effective and safe during pregnancy. Using hot and cold compresses and pain relief creams/ointments can also help. Pregnant women should always speak with a healthcare provider before starting any medication.

Medical Help for Pregnancy Back Pain

During pregnancy, some back pain is normal. When there is severe pain, sudden pain, or pain that lasts longer than two weeks this could be a sign of a more serious condition. It could be an indication of preterm labor, a urinary tract infection, or kidney stones. Call a doctor if you experience any of the following:
  • Back pain that does not get better/improve
  • Back pain on one side of the body
  • Back pain along with weakness in one or both legs
  • Rhythmic back pain/s
  • Accompanied back pain with vaginal bleeding, fever, urinary burning or change in vaginal discharge
  • Suddenly unable to walk due to pain or weakness
  • Lose feeling in the back, legs, buttocks, and pelvis
  • Numbness could be the sign of a compressed nerve

Conclusion

Pregnancy back pain usually fades away once the baby is born, these steps can be taken in the meantime to ease any discomfort. Don’t forget to ask your OB/GYN for recommendations.

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NCBI Resources

 

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