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PROLOTHERAPY AS AN ALTERNATIVE TO SURGERY
FOR RADICULOPATHY
Ross Hauser, M.D.
A patient came to the office discouraged. He had
already had one
back surgery
and now because of lumbar
radiculopathy
the doctor wanted to another one. He heard about
Prolotherapy
and came in to
Caring
Medical in Oak
Park for a visit. The patient agreed that his
EMG did show radiculopathy but he
had a lot of tenderness around his right
sacroiliac
joint. It was explained to the patient that we would like to just do Prolotherapy to his
degenerated discs
and previous surgery sites, but believed his primary symptoms are stemming from
injury to his right sacroiliac joint. If his leg pain didn’t improve then other
treatments such as
nerve blocks or
Neural Therapy would be done
at the next visit. He received eighty
Prolotherapy injections
on the first visit. When he came for follow up he definitely noticed a decrease
in his back and leg pain. He received a total of five Prolotherapy sessions
over the course of the next five months. He was able to get off of all of his
pain medications. He is now back to exercising regularly and believes that
chronic back and leg pain is in his past!!!
Another patient had severe back of
shoulder, neck,
and arm pain. Her
MRI
showed a herniated disc at C6-7 and
bulging discs at a couple of other
locations. On physical examination she had significant tenderness in her right
shoulder
Rotator
Cuff area and in the back of shoulder/upper back region where
the first few ribs attach to the vertebrae. She was very guarded in her whole
neck though the right side was worse then the left. Her muscle strength and
sensation was intact. She was told she had a ‘pinched nerve’ and needed
surgery. We disagreed. She received Prolotherapy to her whole neck, upper
back and right shoulder. She felt about 15% better so she was seen in two
weeks because she still had a lot of pain. She needed a total of six visits
over the course of 4 months to get resolution of her symptoms.
How does Prolotherapy help radiculopathy?
Radiculopathy by definition means a nerve is being compromised leading to
symptoms in the extremity. We find that 90% of people coming in with the
diagnosis of radiculopathy don’t have a nerve getting pinched. The majority of
these people have
referred pain down the extremity (leg or arm) from a
ligament
injury in their pelvis, lower back, neck, or upper back. Three to six Prolotherapy sessions and the majority of these pains subside. For the other 10
percent that have a true radiculopathy the following is typically present:
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Crippling pain. The person is in obvious
awful pain
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The person is desperate. The pain is there 24
hours/day. The person is not
sleeping and needs help fast!
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The MRI shows an acute herniated disc.
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The MRI finding is consistent with the persons
symptoms and exams
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The EMG collaborates the MRI
In such an instance what we typically do at CMRS
is get the person some pain control while the Prolotherapy is working. The
person with a true radiculopathy needs to decrease the inflammation of the disc
material pressing on the nerve while the Prolotherapy is helping to stability
the herniated areas.
The best approach, in my opinion, is to give a
steroid injections right around where the
disc herniation is located. We do that in our offices in Oak Park. This is
called a nerve block. Sometimes an
epidural is done, but we like putting the
medication directly where the problem is located. The person is also prescribed
muscle relaxers and rarely oral
steroids. Yes the steroids block some of the Prolotherapy effect, but the person needs immediate pain relief. A medication
to help sleep is also warranted sometimes. Obviously, the person also gets Prolotherapy to the areas. The person is seen in follow-up in one week. At
this time if they still have a lot of pain, then another steroid injection is
given to the painful area. Up to three of these are done. At the two week
point, sometimes another Prolotherapy session is done. Up to four Prolotherapy
sessions are sometimes needed.
The above approach has been used at Caring Medical
for the last 15 years. It has kept a lot of people out of surgery. In our
experience the above approach even with herniated discs is around 90%
successful. Of course, we have our handful of cases that have needed surgical
consultation and surgery. We are grateful the surgeons are there for back-up. But read that again they are their for back-up. Even for an
acute herniated
disc the surgeon is second line therapy. or the person with a pseudo- or true radiculopathy the treatment of choice is Prolotherapy!
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