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Epidural Steroid Injections NO GOOD for Lumbar Disc Herniation

Jul
06
2012

Research in the American Journal of Bone and Joint Surgery says categorically: “Patients with lumbar disc herniation treated with epidural steroid injection had no improvement in short or long-term outcomes compared with patients who were not treated with epidural steroid injection.”1 Prior to this study, most doctors agree that epidural injections are only temporary in relieving pain from spinal stenosis, spondylolysis, herniated discs, degenerated discs and sciatica. Now they do not agree even on that. But they cannot agree on Prolotherapy either – despite a lot of evidence that says trying this minimally invasive technique is very effective.

In 2004, Hooper and Ding from the Advanced Spinal Care Centre in Alberta Canada reported: “Dextrose prolotherapy appears to be a safe and effective method for treating chronic spinal pain.”2 They researched one hundred and seventy-seven (177) consecutive chronic spinal pain patients who completed Prolotherapy treatment. More than two years after treatment 91% of patients reported reduction in level of pain; 84.8% of patients reported improvement in activities of daily living, and 84.3% reported an improvement in ability to work.2

Writing in the Journal of Prolotherapy, researchers noted: “Performing Prolotherapy to the spine for regenerative purposes often restores function completely.”3 Many people only become aware of Prolotherapy after they have undergone other failed procedures for back pain. Prolotherapy injections to the weakened segments in the lumbar vertebrae often result in definitive pain relief. Back pain is commonly due to several factors and clearly epidural steroid injections do not address the root problem – the biggest culprit is ligament laxity.

 

Ligament Laxity: Common Origin of Back Pain

When back pain originates from loose ligaments a characteristic behavior of pain can be observed. A patient with loose ligaments of the lumbar spine or pelvis will experience recurring dysfunctions at the intervertebral joint (degenerative disc and possible nerve compression), at the facet joints (locking in flexion or extension), and at the sacroiliac joints. In other words, the low back pain can be due to an unstable disc problem, facet joint locking, or sacroiliac dysfunction.

Low back pain can also originate in the ligaments themselves. The ligaments in the lower back contain an abundant supply of small nerve endings. Good and strong ligaments will stretch very little when a load is applied to them. When the ligaments are weak, an excessive stretching will occur with the same load. The greater the ligament laxity, the faster the ligament will elongate or stretch. This exaggerated elongation of the weak and overstretched ligaments allows excessive pull on the non-stretchable nerve endings. As a result, pain and/or numbness is felt locally over the ligaments or referred distally in the buttock or in the legs, following a specific pattern for each ligament.

Ligament injury is very painful. This is, in part, because of the nerves in the ligaments, but also because ligament injury typically occurs where the ligament attaches to the bone, an area called the fibro-osseous junction. The outside of the bone, where the ligament attaches (the periosteum), is also full of nerve endings. A patient with loose ligaments of the lumbar spine and pelvis will often complain of not only nagging low back pain, but also of an inability to maintain the same position for a long period of time. If the same position is held for a long time period, this will stretch the already injured ligaments with sensitive nerve endings. The patient will find relief by changing posture or position because the nerve endings are no longer being stretched. This relief is only temporary. As the new posture is maintained, the weak ligaments gradually start to give and the small nerve endings are again stretched, and the pain recurs.

 

Diagnosing and Treating Ligament Laxity

The first step in determining ligament laxity or instability in the lower back is by physical examination. The examination involves maneuvering the patient into various stretched positions. If weak ligaments exist, the stressor maneuver will cause pain.

Low back pain is one of the easiest conditions to treat with Prolotherapy injections. Ninety-five percent of low back pain is located in a 6-by-4 inch area, the weakest link in the vertebral-pelvis complex. At the end of the spine, four structures connect in a very small space that happens to be the 6-by-4 inch area. The fifth lumbar vertebrae connects with the base of the sacrum .This area is held together by the lumbosacral ligaments. The sacrum is connected on its sides to the ilium and iliac crest. The sacroiliac ligaments hold this area together. The lumbar vertebrae are held to the iliac crest and ilium by the iliolumbar ligaments. This is typically the area treated with Prolotherapy for chronic low back pain.

Contact us to learn more about Prolotherapy for disc herniation and low back pain.

 

 

1. Radcliff K, Hilibrand A, Lurie JD, Tosteson TD, Delasotta L, Rihn J, Zhao W, Vaccaro A, Albert TJ, Weinstein JN. The Impact of Epidural Steroid Injections on the Outcomes of Patients Treated for Lumbar Disc Herniation: A Subgroup Analysis of the SPORT Trial. J Bone Joint Surg Am. 2012 Jun 27. doi: 10.2106/JBJS.K.00341. [Epub ahead of print]

 

2. Hooper RA; Ding M Retrospective case series on patients with chronic spinal pain treated with dextrose prolotherapy J Altern Complement Med (United States), Aug 2004, 10(4) p670-4

 

3.Auburn A, Benjamin S, Bechtel R. A New Approach for Injecting Patients with Low Back Pain using Prolotherapy Agents: Functional Prolotherapy Journal of Prolotherapy. 2009;3:181-183.

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