Another Strike Against Big Pharma

Zonegran, a commonly used medication for arm and leg pain secondary to nerve root irration was placed on the FDA medication watch list due to its significant life threatening side effects.  Updated clinical data has demonstrated that Zonegran can cause significant changes in acid-base balance (metabolic acidosis).  The list of medications with significant side effects continues to get longer.  In an earlier blog, I referenced the flouroquinolones, a class of antibiotics, which demonstrated the increase the risk of tendon rupture.  Sode et. al.,  demonstrated that the antibiotic tripled the risk of Achilles rupture.

Illustration of Nerve Root Irritation

Rather than masking the arm and leg pain associated with nerve irritation, at the Centeno-Schultz Clinic we are committed to identifying the cause of the pain and correcting it.  When a lumbar disc protrudes or herniates, often times there is compression of the nerve root with resultant lancinating electrical pain down the extremity. 

Nerve Root Irritation Due to Disc Herniation

 Treatment options include x-ray guided injections of local anesthetic and steroid in an attempt to decrease the pain and inflammation along the disc and nerve root. 

Epidural Injection Under X-Ray

 Another option is the injection of concentrated growth factors derived from a patient’s own platelets in an attempt to increase the blood supply to the damaged disc.  This therapy would aid in repairing the disc as opposed to simply decreasing the inflammation.

Before and 3 Months After Stem Cell Therapy

A novel new technique allows injection of expanded bone-marrow-derived mesenchymal stem cellsinto the disc to repair the damaged lumbar disc.  Please review MRI below of a patient who underwent injection of stem cells into his L5/S1 disc.   On the left, the arrow points the disc protrusion before treatment.  Three months after the Regenexx therapy there was a  reduction of his disc bulge as seen on image on the right, along with complete elimination of his leg pain.

Lumbar Disc Bulges and Leg Pain

Lumbar disc bulges are a common cause of lower back and leg pain.  Common therapies for lumbar disc bulgesinclude physical therapy, lumbar traction, inversion table therapy and lumbar epidural steroid injections.  The goal of therapy is to decrease the disc bulge and its compressive effect on the nerve root.  If nerve compression is left untreated, it can result in permanent leg pain and weakness.

Lumbar epidurals steroid injections should always be performed under x-ray to ensure accurate placement of the medication. The epidural space is the area immediately outside the spinal cord and is adjacent to the lumbar disc.

 

 

 If a lumbar epidural steroidis performed without x-ray there is no guarantee that the medication will get into the epidural space let alone on the irritated nerve root and disc.  At the Centeno-Schultz Clinic all lumbar epidurals are performed under x-ray.  Injection of contrast prior to the injection medication, ensures accurate placement. The x-ray below demonstrates contrast flowing along the right L5 nerve root with extension into the epidural space.

If conservative therapy or lumbar epidural steroid injections fail to provide sustained pain relief, patients now have the option of using their own stem cells to repair their lumbar disc bulges using the Regenexx procedure.  Regenexx is a simple needle in-needle out procedure which affords patients the opportunity to avoid the risks of surgery and anesthesia and repair disc bulges.

Review the video below on how stem cells can be used to treat disc bulges.

[youtube=http://www.youtube.com/watch?v=zI7TQzV

Lumbar Epidural Steroid Injections

Lumbar epidural steroid injections are a common therapy for patients with lower back and leg pain as  a result of a disc bulge or herniation.   If the disc is bulging or herniated it can compress the nerve root causing leg pain and or weakness.

The epidural space is a area around the spinal cord and is adjacent to the disc.

Injection into this space allows medication to bathe the irritated nerve root and disc.   One can think of an epidural steroid injection as putting water on a large fire.  At the Centeno-Schultz Clinic all epidural steroid injections are performed under x-ray to ensure accurate placement of medication.  Unlike other clinics,  we do not use the conventional high concentrations of steroids.  For example most epidural steroid injections use  4 or more milligrams of steroids.  At the Centeno-Schultz Clinic we use only nano-grams concentrations because it is closer to the dose that the body uses naturally.  It also avoids the adverse effects of steroids which include suppression of immune and renal function, itching, increase in epidural fat, deterioration of the outer annuls of the disc, insomnia and weight gain.  If steroid therapy is not effective or not attractive to the patient,  through Regenexx we have the ability to inject natural growth factors  such as platelet lysate of VEGF supernatant into the epidural space.  These factors not only provide an anti-inflammatory effect for the irritated nerve and disc but they also promote increased blood blow to the disc and therefore healing.

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