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November 27, 2011

Intracranial Hypotension: Treatment with Stem Cells

 Intracranial hypotension is caused by spinal cerebrospinalfluid (CSF) leaks and is known for causing orthostatic headaches. It is most commonly seen in patients who have undergone lumbar punctures (LP’s) or inadverent dural puncture during epidural placment.

Spontaneous spinal cerebrospinal fluid leaks is also an important cause of new headaches in young and middle-aged individuals. The incidence has been estimated at 5 per 100 000 per year,with a peak around age 40 years. Women are affected more commonly than men.

Stem cell therapy in the form of Regenexx SCP  has been utilized in a patient with chronic dural leak.

Clincial improvement to date has been encouraging with an increase in function and decrease in symptoms.

Typical magnetic resonance imaging findings include:

  • subdural fluid collections
  • enhancement of the pachymeninges
  • pituitary hyperemia
  •  sagging of the brain
  • engorgement of venous structures

Myelography is the study of choice to identify the spinal CSF leak.

December 27, 2010

Radiofrequency Ablation for Facet Pain

Radiofrequency ablation is a treatment for neck, thoracic and back pain that is arising from the facet joint.  The facet joint is a small cartilage lined joint in the spine that is susceptable to injury and can cause significant pain and restriction in  range of motion.

Small nerves within the facet joint transmit a pain signal from the joint to the brain.  Radiofrequency ablation works by interrupting the transmission of the pain signal.

Alternative treatments for facet pain include prolotherapy, Regenexx SCP and Regenexx PL.

At the Centeno-Schultz Clinic radiofrequency ablation has been used extensively in the treatment of debilitating  pain.  Injuries to the facet joint are typically not detected by traditional radiographic studies.  Clinical experience, an understanding of the mechanism of injury and excellent physical examination skills are critical.  This is the standard of care at the Centeno-Schultz Clinic.

Diagnosis of a facet injury is confirmed if  a patient reports a  significant reduction in pain following injection of a small amount of local anesthetic into the facetjoint under x-ray.  This procedure is referred to as a intra-articular facet injection.  The first step is to identify where the pain is originating from.  Only then can an appropriate treatment plan can be formulated.

November 15, 2010

Elbow Pain: Finding the Missing Pieces to the Puzzle

At the Centeno-Schultz Clinic we are commited to identifying the source of a patient’s pain. 

Lateral epidondyitlits is a common source of elbow pain which often can be  treated successsfully with IMS and ultrasound guided PRP therapy.

When therapies fail to provide signficant and sustained relief, alternative explanations are sought.

BS is an athletic professional with severe bilateral elbow pain which had been unresponsive to conservative therapy.   PT, trial of NSAID, splints and injection with corticosteroids failed to provide significant relief.  She was referred for ultrasound guided PRP injections which provided modest improvement. Upon followup,  we performed a comprehensive evaluation and noted numbness in her fingers, neck pain and recreation of elbow pain with rotation of her neck.

BS”s MRI of the cervical spine was significant for disc bulges at several levels which narrows the central canal and compressed nerves.  She underwent x-ray guided cervical epidural injection completely relieved her elbow symptoms clearly identifying her neck as a major source of her debilitaing elbow pain.

BS’s MRI and a normal MRI are shown below.  They are side views (Sagital).  On the right is a normal MRI with the cervical discs outlined by red circles.  The spinal cord is the thick, dark structure that runs from the top of the image to the bottom and is bathed by white cerebral spinal fluid.(CSF).  BS’s MRI on the right is significant for several disc protrusion which narrows the cervical canal and irritates the exiting nerve roots.


November 3, 2009

Longus Colli: Unappreicated Yet Critical Neck Muscle

Filed under: Case Reports, Cervical, Cervical Spine — Tags: — stemcelldoc @ 11:10 am

A patient returned today after 6 weeks of specialized physical therapy(Egoscue).  She is a changed woman with significant reduction in pain and increase in motion. She asked that I share her story.

History:  4 year history of neck and right shoulder pain after a motor vehicle accident in which she was struck on the driver’s side door by a motorist who elected to disregard a red light.  She had no prior history of neck or shoulder pain.

Pain was constant in duration, progressive in nature, 6/10 in severity, involves both right and left side of neck with radiations into the right shoulder and scapula.  Aggravating factors involved lifting and turning her neck.

Treatment to date had included physical therapy, steroid injections, large doses of narcotics and muscle relaxants, Botox injections and surgical evaluation who recommended an urgent two level fusion at C5/6 and C6/7.

Physical examination was striking.  Patient was wearing a soft cervical collar which she had worn for the last 2 years.  Upon removal, the patient was unable to keep her head up.  Her head, like a rag doll, simply falling forward.  She had to place her finger underneath her chin to support the weight of her head. Rotation, flexion and extension were all severely limited.cervicalCollarFaceWeb 

Muscles  form our foundation.  The provide critical support.  This patient had an injury to her longus colli muscle.

longus_colli 2

The longus coli is located anteriorly and enables flexion and rotation of the spine.  It works in a complimentary fashion with the posterior neck muscles to stabilize the cervical spine.  Similar to the ropes that support a tent pole , if one of the ropes is cut the tent pole ( cervical spine) is no longer supported and typically falls to one side.

Understanding the importance of muscles and ligaments and their function is critical to understanding how injury occurs and what therapies are appropriate.  This is the standard at Centeno-Schult Clinic. For all those patients who have been in involved in a car accident and who have been told that it’s all their head there is hope.  It’s not in your head, its in your neck:)


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