The Epidural Injection treatment for low back pain

Many patients come into our office with extreme low back pain caused by a herniated or bulging disc. This pain is often rated as a 10/10 (where 0=no pain, 10= worst possible pain). Before they come into our office, they have often tried other types of treatment. Often they have tried pain medications prescribed by their Dr, physical therapy, acupuncture, chiropractic, and epidural injections. Today I want to discuss what an epidural injection is, how it is performed and the risks involved with this treatment. It is called an epidural injection because because pain medication is injected into the epidural space of the spine. It is often used to treat such conditions as sciatica or pain caused by a pinched nerve in the lumbar spine. The injection is composed of a anesthetic medicine that caused a numbing sensation as well as long lasting corticosteroid. The purpose of these medications is to reduce inflammation around the irritated nerve and flush out those chemicals causing the pain.

Possible Risks of Epidurals

There are some possible risks of having an epidural treatment. These risks include:

• Infection
  
• Bleeding
  
• Damage to the nerve- this can occur from direct contact from the needle
  
• Dural Puncture
  
• Paralysis
  

Possible Side Effects of Epidurals

There are possible short term side effects that can occur with epidural treatment. They include: numbness in your low back, buttocks or legs for several hours after the procedure, and pain at the injection site.

Contraindications to having an Epidural

Contraindications include patients who have a local or systemic bacterial infection, are pregnant, or have bleeding problems. It is also important to make sure check are completed for heart disease, diabetes and blood pressure as these medical conditions can be a contraindication.

What is the difference between disc herniation and disc bulge in the lumbar spine ?

There is a difference between a disc herniation and a disc bulge. Both can be diagnosed by looking at a lumbar MRI. A disc is made up of two parts

• Nucleus- the inside part of the disc that is soft and compressible
  
• Annulus- the outer portion or ring that contains the nucleus
  

With a disc bulge the material within a disc will remain within the annulus.
The inner nucleus pushes out against the annulus causing the disc to bulge out of the confines of the disc space and project to some extent into the spinal canal which is behind the disc.



With the disc herniation, the disc material breaks through the annulus of the disc. If this disc material then puts pressure on the nerves it can cause leg pain, pain into the buttocks, or numbness and tingling into the legs. A disc that is herniated is sometimes also known as a "slipped" or "ruptured" disc.

Non surgical spinal decompression using the DRX 9000 can provide pain relief from a disc bulge or disc herniation. Spinal Decompression creates a negative pressure or a vacuum inside the disc. This effect causes the disc to pull in the herniation and the increase in negative pressure also causes the flow of blood and nutrients back into the disc allowing the body's natural fibroblastic response to heal the injury and re-hydrate the disc.

Visit us at CT Spine and Disc Center- Our Chiropractic office is located in Central CT. Got Questions? Call us
860-633-8756 anytime or email us at info@ctbackdr.com

Happy New Year फ्रॉम कट स्पिन ऎंड डिस्क सेंटर !

Hello everyone, Happy New Year! May 2008 be a year that is filled with good health and happiness. CT Spine and Disc Center is committed to helping you with optimal health throughout the year.


Visit us at CT Spine and Disc Center- Our Chiropractic office is located in Central CT. Got Questions? Call us
860-633-8756 anytime or email us at info@ctbackdr.com

What is Degenerative Disc Disease and can Spinal Decompression help?

Degenerative Disc Disease (DDD) is a natural condition of the body that causes deterioration of the intervertebral discs.The discs that are in between the bones act as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region). This deterioration is a gradual process that can take place over years. This can compromise the spine. Although DDD is relatively common, its effects are usually not severe enough to warrant significant medical intervention.

Long before Degenerative Disc Disease can be seen radiographically, biochemical and histologic (structural) changes occur. Over time the collagen (protein) structure of the annulus fibrosis weakens and may become structurally unstable. Also, water and proteoglycans(PG) content decreases as one ages. PGs are molecules that attract water. These changes are linked and may lead to the disc's inability to handle mechanical stress. Degenerative disc changes are more likely to occur in people who smoke cigarettes and those who do heavy physical work (such as repeated heavy lifting). People who are obese are also more likely to have symptoms of degenerative disc disease. A sudden (acute) injury leading to a herniated disc (such as a fall or a motor vehicle accident) may also start the process of degeneration

When the space in between the vertebrae becomes smaller as in DDD, the body's natural reaction to this is the construction of bony growths called bone spurs (osteophytes). Bone spurs can put pressure on the spinal nerve roots or spinal cord, resulting in pain and affecting nerve function.


Non Surgical Spinal decompression is one treatment that can help to restore the disc height. For patients who have chronic low back pain from DDD, and want a non surgical approach, spinal decompression may be the answer. Call our Glastonbury CT office (860) 633-8756 today to see if you will be a candidate for lumbar spinal decompression.

What is the difference between Traction and Spinal Decompression?

Spinal traction is a treatment option that is based on the application of a longitudinal force to the axis of the spinal column. In other words, parts of the spinal column are “pulled” in opposite directions in order to stabilize or change the position of damaged aspects of the spine. For example, You can have traction to the neck, to the low back, to your leg or your arm
Traction is helpful at treating some of the conditions resulting from herniation or degeneration but traction is unable to address the source of the problem. Research has shown that Spinal Decompression therapy creates a negative pressure or a vacuum inside the disc. This effect causes the disc to pull in the herniation and the increase in negative pressure also causes the flow of blood and nutrients back into the disc allowing the body's natural fibroblastic response to heal the injury and re-hydrate the disc. The DRX 9000 is the premier spinal decompression therapy unit to accomplish this.

Traction and inversion tables, at best, can lower the intradiscal pressure from a +90 to a +30 mmHg. The DRX 9000 is clinically proven to reduce the intradiscal pressure to between a -150 to -200 mmHg. Traction triggers the body's normal response to stretching by creating painful muscle spasms that worsen the pain in affected area. Spinal decompression takes the muscles out of the equation and focuses on the disc herniation.

"I Was Told I Having Stenosis. They Said Nothing Can be Done And I've Gotta Live With My Pain!"

What is STENOSIS first of all? Stenosis is a closure of the hole or holes in the back of the spine where nerve roots branch off of your spinal cord. More specifically this is called neural foraminal stenosis. Those exit holes are called your neural foramen. You can also have spinal stenosis which typically means you have closure or shrinking of the canal in the back of the spine that the spinal cord travels down. This canal is from the brain down to your lower body.

So what happens and what creates this "stenosis"? Arthritis (in other s degeneration) takes place usually in the discs and endplates of the vertebrae. When the disc flattens and bulges (aka degenerates) then #1 - that bulge can literally fill up those canals meaning your neaural canals and or your spinal canal.
#2 - the bones start to break down creating rigid/ jagged edges and spurring (bone spurs) that also put pressure on nerves and contributes to shrinking the neural foramen or spinal canal. Remember the disc acts as a spacer creating the gap or hole nerves travel out of. Once the disc flattens from a disc breakdown or herniation then you will lose the full opening in that foramen that should be there.

Facet degeneration and ligament hypertophy or inflammation also work to create pressure on the nerves or spinal cord.

So basically if the disc can be rehydrated and reheightened, and bulges and herniations can be pulled back into place, it can open these holes back up relieving nerve pressure and preventing more degeneration and arthritis to take place.

Great news, this is what Spinal Decompression does. Before Non-Surgical Spinal Decompression most patients were simply sent to physical therapy and given meds or pain shots. If this didn't work they were recommended surgery. Now we have an extra option for care of stenosis. No more just living with the pain!!!

How does Chropractic care help a disc herniation?

The the goal of chiropractic treatment is to put the spine in alignment. When the spine is in the normal, healthy alignment it holds the disc into place better. The adjustment helps take pressure of the nerves and restore motion back to the affected joints. Putting motion back and taking pressure off the nerves restores the function of the area. Fluid can be absorbed and released properly, nutrients can as well, waste material can be released, and inflammation will go down.

A Valuable tool in diagnosing Lumbar Disc Herniations: MRI's

One of the ways to determine if a patient has a disc herniation is with an x-ray- specifically a lumbar MRI will pin point exactly the nerve root responsible for the pain down your leg. MRI stands for Magnetic Resonance Imaging and it a very telling tool when it comes to looking at disc herniations. When looking at a lumbar spine MRI we can assess if the intervertebral disk spaces are of normal height, and the disks do not project past the posterior surface of the vertebral bodies in any segment. Here is a normal Lumbar MRI:



The patient lies inside a large, cylinder-shaped magnet. Radio waves 10,000 to 30,000 times stronger than the magnetic field of the earth are then sent through the body. This affects the body's atoms, forcing the nuclei into a different position. As they move back into place they send out radio waves of their own. The scanner picks up these signals and a computer turns them into a picture. These pictures are based on the location and strength of the incoming signals.

Our body consists mainly of water, and water contains hydrogen atoms. For this reason, the nucleus of the hydrogen atom is often used to create an MRI scan in the manner described above

History Of MRI
It was on July 3, 1977 that the first MRI exam was ever performed on a human being.

It took almost five hours to produce one image. The images were, by today's standards, quite ugly. Dr. Raymond Damadian, a physician and scientist, along with colleagues Dr. Larry Minkoff and Dr. Michael Goldsmith, labored tirelessly for seven long years to reach this point. They named their original machine "Indomitable" to capture the spirit of their struggle to do what many said could not be done.

This machine is now in the Smithsonian Institution. As late as 1982, there were but a handful of MRI scanners in the entire United States. Today there are thousands. We can image in seconds what used to take hours.

What is a Herniated Disc?

A Herniated Disc or Disc Protrusion or Extrusion or Prolapse or Slipped disc all essentially mean the same thing. Part of the disc has pushed out possibly putting pressure on a nerve or creates inflammation that is putting pressure on a nerve.

Technically speaking the diference between a Disc bulge and a disc herniation is that a disc hernation involves the inner part of the disc breaking out through the outer layers.

The disc is made up of an inner gel like part called the nucleus and an outer more cartilaginous section called the annulus. So a bulge is when that annulus is pushing outward or “bulging” outward but the border is not broken. A herniating disc, that inner material actually breaks through the annulus to the outside. A common analogy is a jelly donut – the nucleus is the jelly and the annulus is the rest of the donut. If you squeeze the donut the jeely pushes toward one side bulging the donut on that side. “a bulged disc” When you squeeze that donut and the jelly comes out that’s your disc “herniation”. Either a disc bulge or herniated disc can put pressure on a nerve. Typically a herniation creates more pressure but not always.

What is Sciatica?

Sciatica is low back/buttocks and leg pain. Basically your sciatic nerve is formed form nerve roots in the lower spine that come together to create the sciatic nerve. This nerve travels down the legs giving off multiple branches which supply and control our legs, knees, ankles, feet, etc…
The sciatic nerve exits out an area in the buttocks next to the piriformis muscle which is why people with sciatica can often have pain in the buttocks region. It then travels down the leg. Depending exactly on the severity of pressure and what nerve fibers are effected one may have pain in the leg but often can get other symptoms such as burning, numbness and tingling, or even weakness.