Spinal Cord Stimulation

Spinal cord stimulation is a therapy that masks pain signals before they reach the brain. A small device, similar to a pacemaker, is implanted in the body to deliver electrical pulses.

Causes of Chronic pain

Damaged nerves can overproduce pain signals.
The stronger the signal, the stronger the pain.

Chronic pain generally falls into one of two categories. There is mechanical pain, which is generally caused by damage to the bones or muscles. There is also nerve pain, in which it is more difficult to identify the source. Chronic pain may come from an illness, accident, or injury to the nerve-or appear for no reason at all. That’s why it’s so difficult to manage. May patients have a mix of both pain types.

Doctors may prescribe medications, surgery, or injections. The goal is to find a treatment tailored to fit individual needs. However, individual responses to these treatments vary, which may leave patients unsatisfied or managing unwanted side effects.

Limitations of common treatments of chronic pain.

Prescription medications | Shown to be effective for acute pain, but with limited effectiveness for chronic pain. There are also significant risks of addiction and side effects, such as constipation.

Spinal surgery | Appropriate for correcting mechanical issues, but often ineffective for resolving
debilitating nerve pain. It’s also the most invasive option.

Epidural steroid injections | Often effective for short-term pain relief, but usually ineffective for
sustained pain relief. Also requires frequent office visits.

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Lumbar radiculopathy is a combination of symptoms consisting of back and lower extremity pain caused by the lumbar nerve roots.

Causes of Lumbar Radiculopathy:

  • Herniated Disc
  • Foraminal Stenosis
  • Tumor
  • Osteophyte Formation
  • Infection.

Signs and Symptoms:

  • Pain
  • Numbness
  • Tingling
  • Weakness
  • Referred Pain
  • Muscle Spasms
  • Back Pain

Testing:

  • Plain X-rays
  • MRI
  • CT
  • Myelography
  • Bone Scan
  • Electromyography
  • Nerve Conduction Testing
  • Lab Work

Diagnosis:

Lumbar radiculopathy is a clinical diagnosis that is supported by a combination of clinical history, physical examination, and diagnostic studies/testing.

Treatment:

  • Drug Therapy
  • Physical Therapy
  • Spinal Nerve Root Injection

In between each of the five lumbar vertebrae (bones) is a disc, a tough fibrous shock-absorbing pad. Endplates line the ends of each vertebra and help hold individual discs in place. Each disc contains a tire-like outer band (called the annulus fibrosus) that encases a gel-like substance (called the nucleus pulposus). Nerve roots exit the spinal canal through small passageways between the vertebrae and discs.

Pain and other symptoms can develop when the damaged disc pushes into the spinal canal or nerve roots. Disc herniation occurs when the annulus fibrous breaks open or cracks, allowing the nucleus pulposus to escape. This is called a Herniated Nucleus Pulposus (HNP) or herniated disc. A herniation may develop suddenly or gradually over weeks or months.

Many factors increase the risk for disc herniation:

  • Inadequate nutrition
  • Age
  • Natural biochemical
  • Poor posture
  • Incorrect body mechanics
  • daily wear and tear
  • Tobacco use
  • Injury

Signs and Symptoms:

  • Low back pain
  • Sharp pain/burning pain/stabbing pain
  • Radiating pain down the posterior or lateral aspect of the leg
  • Numbness
  • Tingling
  • Motor deficit
  • Diminished reflexes
  • Weakness
  • Prior back surgeries
  • Impotence
  • Bowel or Bladder dysfunction

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • CT or CAT scan
  • Discography
  • Myelograms
  • EMG
  • Ultrasound imaging

Diagnosis:

Obtaining a vocational history is also very important because many skilled laborers or assembly line workers perform the same offending motion at work. Also a very comprehensive medical history along with proper testing can determine diagnosis as well as what type of herniation is involved.

  • Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation.
  • Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.
  • Extrusion: the gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
  • Sequestration or Sequestered Disc: the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP).

Treatment:

  • Drug therapy
  • Physical therapy
  • Spinal Injections
  • Anesthetic/Corticosteroid Injections
  • Spinal Cord Stimulator
  • Psychotherapy
  • Behavioral methods of pain control

Discogenic back pain is considered a “degenerative” or aging process, patients with discogenic back pain often improve over time. Most patients with discogenic back pain will improve with time and some simple treatments.

Signs and Symptoms:

  • Back pain associated with activities such as: Sitting, Bending forward, Coughing, Sneezing
  • Sharp pain
  • Burning pain
  • Stabbing pain
  • Radiating pain (called radiculopathy) down leg while: Sitting, Standing, Walking

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • Discogram

Diagnosis:

A comprehensive medical history along with proper testing and a vocational history is important, because many skilled laborers or assembly line workers perform the same offending motion at work.

Treatment:

  • Drug therapy
  • Physical therapy
  • Spinal Injections
  • Anesthetic/Corticosteroid Injections
  • Facet Joint Nerve Rhizotomy
  • Spinal Cord Stimulator
  • Neurosurgical procedures

The iliolumbar ligament runs from the transverse process (side) of the 5th lumbar vertibrae to the back of the iliac crest. Damage to this ligament may cause pain in the sacroiliac joint area and it can be virtually impossible to tell the difference between this injury and a sacroiliac joint injury. Inflammation of the sacroiliac joints and associated ligaments are very common, especially following pregnancy where the hormone relaxing is released and results in the relaxation of ligaments in preparation for childbirth.

Signs and Symptoms:

  • Low back pain
  • Chronic groin pain
  • Hip pain
  • Pelvic pain
  • Rectal pain
  • Testicular pain
  • Vaginal pain of unknown origin

Testing:

  • Physical exam
  • X-Ray

Diagnosis:

A comprehensive physical exam and medical history by clinician, along with appropriate testing to determine treatment is required.

Treatment:

  • Drug therapy
  • Physical therapy
  • Anesthetic/Corticosteroid Injections
  • Osteopathic manipulation

Failed back surgery syndrome can be due to a number of factors that doctors and researchers are still discussing. These include, Scar tissue that forms around the surgery site, interrupting normal neurological functioning.

The technicalities of the operation are not successful:

  • The performing surgeon had poor technique, and/or there is iatrogenic injury present.
  • The surgery is not performed at the site that causes the pain.
  • The surgery performed is not actually necessary.
  • The patient is a poor fit for a successful surgery.
  • The diagnosis was incorrect or Complications of surgery arise.
  • Most patients with FBSS have accompanying psychological, social and/or vocational

Signs and Symptoms:

  • Low back pain
  • Sharp pain
  • Burning pain
  • Stabbing pain
  • Radiating pain down the posterior or lateral aspect of the leg
  • Numbness
  • Tingling
  • Motor deficit
  • Diminished reflexes
  • Weakness
  • Prior back surgeries
  • Impotence
  • Bowel or Bladder dysfunction

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • CT or CAT scan
  • Discography
  • Myelograms
  • EMG
  • Ultrasound imaging

Diagnosis:

A comprehensive physical exam and medical history to establish an understanding of an individual’s pain and characteristics of the pain such as: onset/offset, character/radiation of pain, associated symptoms, time pattern, exacerbating/ameliorating factors and severity.

Treatment:

  • Drug therapy
  • Physical therapy
  • Spinal Injections
  • Anesthetic/Corticosteroid Injections
  • Facet Joint Nerve Rhizotomy
  • Spinal Cord Stimulator
  • Neurosurgical procedures

What causes vertebral compression fractures?

The leading cause of vertebral body fractures is osteoporosis. The following factors will increase the likelihood of acquiring osteoporosis:

  • Thin or underweight
  • Elderly
  • Low calcium intake
  • Female
  • Steroid use
  • Post menopausal
  • Smoking
  • Eating disorders
  • Family history of osteoporosis

Signs and Symptoms:

  • Sudden, severe back pain
  • Worsening of pain when standing or walking
  • Some pain relief when lying down
  • Difficulty and pain when bending and twisting
  • Loss of height
  • Deformity of the spine
  • Testing
  • Plain X-Rays
  • CT Scan
  • MRI

Diagnosis:

A targeted history and physical examination combined with appropriate testing should help the clinician to identify and properly treat this condition.

Treatment:

  • Drug Therapy
  • Application of Heat/Cold
  • Orthotic Device
  • Bed Rest
  • Vertebroplasty
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