Spinal Decompression

An epiduroscopy is a minimally invasive procedure that uses a flexible instrument containing a tiny camera known as an epiduroscope. The procedure is performed to diagnose the cause of pain in the lower spine and legs. The pain is often the result of sciatica. Epiduroscopy was developed in the 1990's and involves and involves a steerable catheter system enhanced by a saline flush system that is attached to a side port on the sheath.

During the procedure, the pain doctor often administers medication to treat the pain. IN preparation for the procedure, the patient is positioned with appropriate padding and the patient is given local anesthesia. The doctor utilizes x-ray fluoroscopy during the procedure to hopefully ensure accurate placement of the camera.

Once the problem area is located on the fluoroscopy, a small incision is made through which a catheter is inserted containing the epiduroscope. The scope is inserted through the sacrococcygeal membrane to allow direct visualization of the epidural space.

The scope contains a fiberoptic camera which enables visualization of damage and scar tissue on the spine which may be causing sciatica. Adhesions can be visualized, nerve roots may be inspected and the specific areas of inflammation hopefully identified. A small needle is placed through the sacral hiatus into the epidural area. Through this a small metal guide wire is positioned. The doctor then removes the small needle which then leaves the guide wire in place. A series of dilators are then passed over the guide wire and once a large enough space is created, the sheath cannula is positioned.

The physician may use instruments inserted through the catheter to break down some of this scar tissue. This is called an adhesiolysis and it can dramatically reduce a patient's pain.

Anesthetic or corticosteroid medication may also be injected to relieve pain from inflammation. Once the procedure is complete, patients may be discharged same day making it an outpatient procedure. Getting back to work should be within a few days.

Complications can occur during an epidurolysis. When a significantly sized camera is placed near a nerve root, the root can be injured. A dural tear may occur if the epiduroscope makes a small hole in the dural membrane. This can cause a post dural puncture spinal headache.

One additional complication that may be seen is a macular hemorrhage. This is bleeding in the internal layers of the eye. If excessive flush is used during the procedure, a rapid rise in cerebral pressure may occur and cause this complication.

Previously we discussed briefly conditions such as rheumatic diseases, cervical spondylotic myelopathy, degenerative disk disease, and stenosis but there are several other conditions which can cause difficulty for your spine.

Ruptured, slipped, or herniated disk, all have the same meaning. They are a condition which occur when one of the pads between your vertebrae is bulging out and putting pressure on a nerve. To explain further, a disk is made up of two layers, one is outer and tough in form but the other is centered and gel like. A disk becomes ruptured when the center pushes the other layer out of its 'proper position'. There is a possibility that a massive herniated disk can cause severe problems. Losing control over your bladder or bowels can be warning sign of this condition and needs to be addressed by your doctor immediately.

Sciatica is a condition which occurs when the sciatic nerve is being compressed. This nerve extends from the lower point of the spinal column in the pelvis and all the way down your leg. When the nerve is compressed it can cause burning lower back pain, pain though the butt cheeks and down one leg below the knee, numbness, and loss control over the leg. The causes of this condition may include: a ruptured disk, tumors or cysts, and degeneration of the sciatic nerve root.

Spondyloysis and spondylolisthesis is described as a stress fracture in the lower spine. Spondylolisthesis is recognized as the poor alignment that causes the vertebrae to slip and put pressure on the nerve root.

Osteoporosis is a condition which weakens the bones and causes them to become brittle. As a result fractures can occur. Scoliosis is defined as a curvature off the spine which can result in stenosis or other accompanying problems.

Spinal tumors and cysts can cause great discomfort. A cyst is described as a closed sac of fluid. Much like a tumor, a cyst can cause pressure on the spine column or nerves and may cause intense pain. It can also cause increased stiffness in other areas of your body. Some cysts can be extremely dangerous because they can expand and destroy the center of the spinal cord.

Trauma, of course, can have a lasting effect on your spine. Injuries caused by an accident may never allow for complete recovery. However, working closely with your doctor can help decrease the severity of its effects.

As you may be aware, both spinal decompression and physical therapy can be used to treat pain that originates in the neck and spine.  That said, it is important to realize that physical therapy is designed to rehabilitate your muscles.  In most cases, if a bone is out of place, or pinching a nerve, this therapy will not move it back into alignment. On the other hand, computer guided spinal traction can easily manipulate the discs in your spine and neck in order to relieve nerve damage.

Typically, when you first have an accident that causes neck or back pain, you will be sent for physical therapy. 

Unfortunately, if a disc is even slightly out of alignment, the added stress from this therapy can make things much worse. Perhaps it should come as no surprise that people often experience a significant increase in pain after going for physical therapy.  Regardless of whether you have a minor injury, or a more severe one, you should do everything possible to make sure that your spinal column is in proper alignment.

If you do not know where to begin with treatment, you should at least ask your doctor to send you for chiropractic treatment. Ideally, you should look to have any bone issues addressed before you try to use therapy to adjust the condition of your muscles. Without a question, if you can gain access to spinal decompression, you should see if you can have this type of therapy first, ahead of all the others.

For those of us who have suffered from a pinched nerve, we realize exactly how inconvenient and painful it can be. A pinched nerve can occur at almost any part of the body were a nerve is present and may occur as a result of bone or cartilage pressing against the nerve itself.

Although pinched nerve pain is often associated with back problems, it is possible for the pain to occur in many other places in the body as well.

Here are a few of the most common areas where a pinched nerve can occur along with some possible treatment options.

Sciatica

Sciatica is probably one of the best-known cases of a pinched nerve that occurs in the body. It is important to note that sciatica is not a condition in and of itself. It is actually a symptom of another condition in which the sciatic nerve is pinched or compressed. Since the sciatic nerve is quite long -- running through the lumbar area down the back of the thigh and towards the feet -- there is a greater chance that this nerve can experience some form of disruption. The pain associated with sciatica can range from somewhat mild to crippling and often occurs in the lower back, buttocks or hips. It may also cause tingling that can go the whole way down into the feet.

Carpal Tunnel Syndrome

Another type of pinched nerve which is often found in many individuals is known as carpal tunnel syndrome. This is where the median nerve that travels through your wrist is compressed by the carpal bones. This can be found in individuals as a result of a repetitive stress injury, such as that which is found whenever an individual types frequently. This also can be extremely painful and can cause numbness in the hand and fingers.

Pinched Nerve Treatments

There are several different things that can be done in order to help with a pinched nerve. Sometimes simple bed rest can help or just relieving stress in the afflicted area is all that is needed to reduce or stop the pain.

Another common way to treat the pain is through the use of over-the-counter pain medication or perhaps a prescription medication from your doctor. As long as the pain is not too intense, it can easily be controlled in this matter.

There may also be times when physical therapy is prescribed by your doctor in order to help overcome the problem.

Spinal decompression therapy is also becoming a popular form of non-invasive treatment. This type of treatment addresses pinched nerve pain that is often caused by neck and back problems.

Finally, there may be times when surgery is required in order to alleviate some of the pain of a pinched nerve. Typically surgery is done so that the bone or cartilage which is compressing the nerve can be moved out of the way. Most people view surgery as a treatment of last resort and prefer to explore non-surgical options first.

This article is for informational purposes only and does not replace the advice of your personal healthcare provider. Be sure to consult with your doctor to understand your full set of treatment options and their associated risks.

Spinal decompression centers are places where patients with degenerative disc disease, herniated discs, protruded disks, foraminal stenosis, sciatica, spinal stenosis, facet syndrome, lower back pain, and post surgical back pain are treated. Spinal decompression is a non-surgical treatment that is painless and free from side effects. Decompression therapy is safe, effective and often affordable.

Before making a diagnosis, the physicians at these centers analyze the patients' medical history and perform a thorough physical examination. To decide on the appropriate treatment, several tests including orthopedic and neurological examination are performed on the patient. For making a more accurate diagnosis, imaging tests such as X-rays and MRI scans may also be advised. The doctor then determines the treatment plan and the number of sessions required for the patient to get relief from the symptoms of dysfunction. When the therapy concludes, the therapists may advise cardiovascular protocols, neuromuscular protocols, diet therapy, and exercises to improve the mobility, strength and to avoid further injury.

During the spinal decompression process, a distraction force is applied to the spine to remove pressure from the compressed discs and nerves. The negative pressure formed at some point in decompression therapy will cause the herniated areas to retract back to the normal disc space, and allow oxygen and blood to flow into the affected areas. This would speed up the healing process. It has been seen that this treatment is effective in treating the pain associated with the bulging or degeneration of discs. Patients who underwent this treatment have been able to return to their normal lifestyle.

Spinal decompression centers will have licensed medical practitioners including spinal decompression therapists, chiropractors, physical therapists, orthopedic surgeons, pain management specialists and neurologists. Most health centers make use of the latest technologies and equipment to provide spinal decompression services. Spinal decompression therapy, when performed safely and with clinical expertise, will highly enhance the treatment results and lead to a more rapid recovery.

Retrolisthesis is one type of vertebral misplacement, or subluxation, that can occur in the spine. It is the backward slipping of a vertebra in relation to one above or below it. Retrolisthesis is less common than forward slipping, called spondylolisthesis. It occurs most often in the cervical or lumbar segments of the spine, as these are the most mobile.

A number of mechanical or external forces can cause vertebral misalignment. Conditions like arthritis and degenerative disc disease can cause a vertebra to shift. An injury, such as a hard fall, can sometimes jolt the spine enough to cause misalignment. Years of improper body mechanics can create enough stress on the spine to throw it out of alignment, as can being overweight. Blunt trauma can also cause the shift.

A number of changes occur in the back surrounding retrolisthesis. The joints that connect vertebrae are stressed when they become misaligned. The discs surrounding the shifted bone will be pushed toward the innermost part of the body and caused to bulge, providing inadequate shock absorption to the spine and potentially allowing friction between the bones. The slipping vertebra may begin to compress nerve roots exiting the spine. Soft tissue surrounding the shifting area of the spine - namely, ligaments and muscles - become stretched and injured.

Symptoms of retrolisthesis vary greatly depending on the degree to which the vertebra has shifted and whether or not it is impinging spinal nerves. Decreased range of motion and localized back pain may be felt. Tenderness due to muscle and ligament injury is possible. If nerves are being compressed, then sharp pain, tingling, numbness and weakness may be felt along the nerve pathway.

Treating Restrolisthesis

Many surgeons jump prescribe spinal fusion surgery as a treatment for subluxation. There are a number of safe, conservative treatments that should be tried before surgery is even considered, however. The goal of treating retrolisthesis is to realign the spine, and to do so, a number of things must be accomplished: 1) The joint must be mobilized to move the bone back into alignment; 2) the disc, if degenerating, must be re-hydrated; 3) surrounding soft tissues need to recover their tone in order to provide structural support to the realignment.

Chiropractic care is the best conservative option for restoring alignment to the spine. Chiropractors specialize in joint range of motion and alignment of vertebrae. If disc degeneration has caused your misalignment, or if the misalignment has caused disc degeneration, look for a chiropractor equipped with a decompression machine. Decompression treatments gently pull your vertebrae apart to increase intervertebral space and allow discs to reabsorb lost fluids. These machines have biofeedback technology that assesses how surrounding tissues respond to the pulling force exerted to separate vertebrae. If the pull is too great, your muscles will react by contracting against it, thereby limiting the effectiveness of the treatment for your discs and causing injury to the muscles. Biofeedback technology makes decompression treatments preferable to the simpler inversion table treatment for people with injuries like retrolisthesis.

Repairing your soft tissues will likely take more time than restoring alignment. Once alignment is attained, the stress on tissues will be decreased, but restoring tone to the tissues will be a process. Physical therapy may be needed to target overstretched ligaments and muscles. Simple core exercises, such as the bird dog, may be prescribed to ensure balanced core strength to support the spine.

Your best chance of recovering fully from retrolisthesis comes with education. Make sure you are not being sent out of the doctor's office with nothing but pain medications to mask the symptoms or rushed into the operating room when conservative options are available. Ask for a referral to a well-reputed chiropractor and begin the path to safe, thorough recovery.

Lumbar transformanial epidural steroid injections are performed to relieve low back and radiating leg pain.

The steroid medication can reduce the swelling and inflammation caused by spinal conditions such as spinal stenosis, radiculopathy, sciatica, and herniated discs. The patient lies face down. A cushion is placed under the stomach area to provide comfort and to flex the back.

This position causes the spine to pull allowing for easier access to the epidural space. The physician uses a fluoroscope to locate the appropriate lumbar vertebra and nerve root and a local anesthetic numbs the skin. All of the tissue down to the surface of the vertebral transverse process is anesthetized. The physician slides a thin bent needle with a slightly curved point through the anesthetized track.

With the aid of a flouroscope, the physician carefully guides the needle into the foraminal space near the nerve root. The physician injects a contrast solution and uses the fluoroscope to see the painful areas and confirm the correct location of the needle tip. A steroid anesthetic mix is injected into the foraminal epidural space bathing the painful nerve root with soothing medication. the needle is removed and a small band aid is used to cover the tiny needle surface wound. In some cases, it may be necessary to repeat the procedure as much as 3 times to provide the full benefit of the medication. However, many patients feel significant relief after only one or two injections.

Additional pain management options my be extremely beneficial in conjunction with epidural injections. These may include physical therapy, chiropractic, spinal decompression, and pain medications.

The primary goal of treating chronic back pain with epidural steroids is to decrease the frequency and/or intensity of pain, and improve function overall. This can be done with the use of an epidural steroid injection or ESI for short. Perhaps your physician has already suggested one? In conjunction with other forms of treatment, such as physical therapy, healing back pain and the eradication of symptoms can be hastened with an ESI.

What is an epidural steroid anyway?

It is a very potent anti-inflammatory medication. Usually the medication used is either triamcinolone or methylprednisolone.

How does and epidural steroid injection work anyway?

When a physician injects an extremely potent anti-inflammatory into the epidural space, it can maximize the effect of the medication and potentially reduce the physical size of the nerve root in question. And thereby reduce pain symptoms.

Who should get an epidural steroid injection?

People with a history of lumbar radiculopathy and corresponding sensory changes (e.g. numbness) who have not yet responded well to conservative treatment alone.

It has been my clinical experience as a physical therapist that most people do well with epidural steroid injections. Rarely is there an increase in patient symptoms. Usually, as the client responds, it will happen on the first or second injection. Often, physicians do not administer more than a series of three injections, especially as they have been without benefit.

All though it requires greater skill, an ESI done under fluoroscopy significantly improves correct needle placement. So medication is placed where it counts! At the same time, there is a decreased risk of a "dural puncture" as well since greater accuracy is increased.

Just be warned, not all physician practices are equipped with fluoroscopy capabilities and so he/she may prefer to sort of do it "on the blind."

Mild complications following an ESI do occur and can include headache (usually this disappears in 24 hours), and post procedure back pain near the injection site.

As you are experiencing back pain that is not responding to the usual medication and physical therapy intervention, consider an epidural steroid injection to put you on the right path to healing back pain faster. Especially now that you know the facts.

Good Luck,

Tommy Hoffman, P.T.

Cure Back Pain Now!

Getting fired from your pain doctor may or may not be your fault. What I mean by that is it could be you were out of town and had a car accident necessitating an Emergency Room Visit with narcotics involved. It could be that your medications were stolen by a family member, and you are not the kind of person to get the police involved with the necessary police report per your pain management agreement.

Or it may be completely your fault and you "cheated" by getting pain medications from two separate doctors and got caught. Whichever the reason, now you still have chronic pain and no one to help right?

Here's some tips for finding and keeping a new pain doctor.

1) Obtain your complete medical records. You are entitled to them, but it may take a bit of legwork and persistence to obtain them since you are leaving on a bad note. You will need these records to make it easy on your new doctor. You will not exactly be in the driver's seat after being fired.

2) Try and find a pain doctor who works in a comprehensive center. Meaning their surgery center is on-site, and they offer additional services such as chiropractic and PT. The objective is to lower the dosing on your medications so these additional treatments can help.

3) Do not lie to the new doctor when meeting with him or her. You just came off a bad experience, why start immediately on bad footing that is dishonest? With pain management doctors being under a microscope by state medical boards and the DEA, there is minimal patience for someone who lies about their medications.

4) Do not use illicit drugs. I'm not talking about medical marijuana, although that may be a factor in whether or not you would be accepted by a new pain doctor (and also maybe why you got fired in the first place). I'm talking about heroin, cocaine, ecstasy, etc. Understand? Your new pain doctor will be drug testing you as is the norm these days. It would be a waste of your time and the doctor to pop positive for one of these substances on the first visit.

5) If you have insurance, use it. One of the distrust factors in pain patients comes in when they use insurance for one doctor and cash for another. It is a red flag and is one of the top drug seeking behaviors.

6) Be flexible in your pain medication needs. What I mean by this is when you see your new doctor, do not be overly insistent on a specific medication at a specific dose. This can be another red flag for drug seeking behavior. If you are seeing a board certified, fellowship trained pain management doctor, do you really want to question too much the wisdom of that doctor's experience?

7) The last and most important tip is to simply be very very nice and respectful at all times of the doctor and staff. Pain management patients can be very difficult to work with due to the complexities of the individual's condition. Making things complex for the doctor is one thing, that's typically what he or she likes is mental stimulation and helping people. Being downright rude will ruin the trust and relationship from developing. You will get fired again, and that includes being mean and disrespectful of the office staff.

8) Show up for your appointments. Too many missed appointments will cause you to get fired (again). It is disrespectful, especially with no advance warning to the office. Put yourself in their shoes, they are setting aside time to help. Show up for your doctor visits, procedures, and therapy, and get better!

It is pain in the butt quite literally. It can also be a pain in the hip, the thigh, the lower leg, or even the foot. In fact, the condition known as sciatica can send pain shooting anywhere in your lower body. What is causing all the commotion is the sciatic nerve, which is not one but a group of nerves bound together in a single sheath. The sciatica nerve runs from your lower back down each leg all the way to the foot. When it is injured, inflamed, or irritated, it can produce pain at any point or every point along its route. The most common cause of sciatica is a herniated disk. Disks separate the vertebrae in your spine. The result is excruciating pain. On rare occasions, sciatica can result from other health problems. Some are serious, such as diabetes, blood clots, and tumors. But others are minor. You can even get sciatic pain from sitting too long in an awkward position. So have your pain checked out before you proceed with self-care. Here are some tips that you can consider to adopt to relieve your pain.

1. Adjust Your Seat

Most people position the car seat too far back when they drive. You put a lot of strain on your back when you have to stretch to reach your pedals. You should be able to press the gas pedal just by flexing your ankle. Your hips should be at about 90-degree angle, and your back should be in neutral, not bent, not perfectly straight, but comfortable.

2. Don't Get Crossed

You tend to cross the same leg all the time. That means you are always sitting on the same buttock, which puts a lot of pressure on the sciatic nerve on that side. Ideally, you should not cross your legs at all. But if you must, at least try to switch sides from time to time.

3. Go For Yoga

Practicing certain yoga exercises can help ease sciatic pain. It is recommended to try out this exercise. Lie on your back with your claves resting on the seat of a chair. Your hips and knees should be bent at about 90-degrees angles. Cross your arms over your chest and place your hands on your shoulders, not on your neck. Inhale, then begin a long, slow exhalation. During the exhalation, tilt your pelvis so that your lower back moves to the floor as you flatten your abdomen. Raise your shoulders 6 to 10 inches off the ground. Lower your right shoulder to touch the floor. Repeat, this time lowering and raising your left shoulder instead. Do this five to six times per side.

4. Take A Seat The Right Way

When you do have to sit, make sure that your posture does not make your sciatica worse. Your knees and hips should be bent at about 90-degree angles. Your weight should be on the ischium tuberosity - the sitting bones - and not on the tailbone.

5. Flex Your Pelvis

Pelvic tilts allow you to gently move the lumbar region of your spine, increasing circulation in the area. It is recommended to follow these instructions. Lie on your back with your feet on the floor and your knees bent. Tilt your pelvis so that your back flattens against the ground, then lift it up. Hold for 5 seconds and relax. Continue tilting and lifting and relaxing five to six times every hour when sciatica flares up.

6. Write Your Own Prescription

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen remain the treatment of choice for sciatica. They can reduce any nerve inflammation caused by the pressure of a herniated disk. These medications won't cure your pain, but they will make it more tolerable.

7. Give Your Legs A Lift

Try to keep pressure off the lumbar region of your spine, from which most sciatica pain radiates. It is recommended lying on your back with your lower legs resting on a chair or a low table such as a coffee table. Your knees and hips should be bent at about 90-degree angles. Do this as needed for relief.