Stemcelldoc's Weblog

February 10, 2010

Theraupatic Lumbar Discogram?

Lumbar discography is procedure in which a needle is placed into the disc at two or more levels to determine whether of not a specific disc is the  source of pain.  Is the pain coming from the L4/5 disc or the L5/S1 disc?  The procedure is performed with intermittent x-ray.  Once the needles are in the center of each disc,  contrast is injected into the disc.   A patient’s response is graded as follows:

P0:  no pain:  a common response in a healthy disc

P1:  painful, but not identical in quality or location to the patient’s daily pain.

P2:  painful, identical in character, quality and location.

Discograms are strictly a pre-surigcal procedure which tells the surgeon which level to operate.  They have no therapeutic benefit.  I have had two discograms and they HURT!

A recent study demonstrated that lumbar discograms accelerate disc degneration.

Patients are often  misinformed about discograms.

AJ was a 23y/o with 6 month history of low back pain following a rear-end motor vehicle injury.  Pain was constant in duration, 6/10 in severity, progressive in nature and  localized in her lower back, right =left with radiations into her buttocks.  MRI was significant for mild degeneration of the L5/S1 disc. Physical examination was significant for tenderness in the lower lumbar spine with extension and rotation.  She had no treatment to date:  no physical therapy, chiropractic care, trial of good quality fish oil, massage or evaluation by a pain specialist.  Her PCP referred her to a surgeon for evaluation of her back pain.  She was scheduled for a discogram which she thought was going to help here back pain.

 Evaluation of all possible sources of pain is essential.  For lumbar back pain common causes include:

myofascial: dysfunctional muscles 

facet dysfunction:

ligamental dysfunction: treated with proloterhapy

SI joint dysfunction:

Disc dysfunction.

The Centeno-Schultz Clinic is committed to identifying the cause of a patient’s pain and designing an proper treatment plan utilizing state of the art therapies.

January 11, 2009

Back Pain Relief

Back pain relief starts with making an accurate diagnosis.  At the Centeno-Schultz Clinic we are committed to identifying the source or “generator”  of one’s back pain so that the appropriate treatments can be applied.

There are many sources of back pain but the major 4 are muscular, facet, sacroillac joint and lumbar disc.

The facet is an  cartilaginous joint in the spine and according to Dreyfuss is  responsible for 15-40% of chronic lower back pain.

lumbar_adr_anatomy04

If you have fact joint problems, back pain relief is obtained by injecting the joint with local anesthetic and very low dose steroids.  If back pain relief is only temporary long term back pain relief can be obtained from facet joint radiofrequency (cauterizing  the nerves that provide sensation to the facet joint) or injection of stem cells into the joint.  Regenexx affords the patient the ability to inject their own stem cells into the joint to regenerate the damaged cartilage and provide long lasting relief.

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