QuestionMy husband has been having severe neck pain and pain shooting down his arm for the past 6 weeks. We just picked up the MRI report.
He has multilevel stenosis due to a combination of developmental and degenerative disease. Stenosis is worst at c 5-6 where there is moderate to severe narrowing of the central canal and broad based posterior spondylitic ridging with disc osteopohyte complex effacing the ventral thecal sac with flattening of the ventral aspect of the cord. The cord is bowed posteriorly at this level. There is bilateral unvcoverterbral joint hypertrophy with bilateral neural foraminal narrowing. There is moderate narrowing of the central canal at C 3-4 and mild to moderate stenosis at C 4-5 and C 6-7
Given a profile like this, is my husband a candidate for less invasive treatments such as chiropractic treatment or physical therapy or is he past less invasive treatments and a surgical candidate? How would chiropractic treatments help when bone spurs are compressing the chord?
Answercervical stenosis , neck pain , arm pain ,
Hello Amy,
Sorry to hear of your husband's condition. I am sure he is very uncomfortable. Stenosis is a very difficult condition to treat.
Thank you for your detail of the MRI report.
"....is my husband a candidate for less invasive treatments such as chiropractic treatment or physical therapy or is he past less invasive treatments and a surgical candidate? How would chiropractic treatments help when bone spurs are compressing the chord?...."
Even with this severe an MRI report, conservative chiropractic could certainly be tried.
Chiropractic, even the 'traditional' manipulative maneuvers that people picture- the 'cracking' of the neck and back, is far less invasive than surgery, and safer than most medications. Just look at the malpractice rates for different treatment approaches, look at the morbidity and mortality rates for pharmaceuticals. Chiropractic is conservative from the get-go.
Given your husband's condition, I would be even more conservative.
Your husband does have severe findings. Chiropractic is conservative, safe, natural, non-invasive,,,, and within chiropractic there are the MORE conservative approaches, and the less conservative.
I recommend particular websites for further information:
http://www.askdrjohnson.com/about.php
http://www.lifechangingcare.com
Dr. Michael L. Johnson DC, chiropractic neurologist- author of the best-selling book, What Do You Do When the Medications Don抰 Work?桝 Non-Drug Treatment of Dizziness, Migraine Headaches, Fibromyalgia, and Other Chronic Conditions.
Many Doctors of Chiropractic treat 'orthopedically', 'structurally', and this is an excellent approach, leading to excellent results in most conditions. Vigorous manipulation (adjustment), I think, is- at least initially- contra-indicated in your husband's condition.
Dr. Johnson and Chiropractors similar to him usually treat 'neurologically'- focusing on the nervous system, rather than the bones and muscles. The aforementioned websites and book could be helpful to you, the doctors who take this approach could be helpful to your husband's condition. These Doctors of Chiropractic start of with an excellent evaluation, and then a very conservative approach utilizing various Chiropractic and non-chiropractic (physical therapy modality, nutrition, neurologically based approaches and treatments) approaches.
CONSERVATIVE chiropractic could include SOT maneuvers for the cervical spine, activator technique, unilateral adjustment, exercise with oxygen therapy, whole body vibration, non-invasive spinal decompression traction, adjunctive physiotherapy modalities, anti-inflammatory nutrition, and more.
YES, the right Doctor of Chiropractic could help your husband, even at this advanced stage. I may not just go to the Doctor around the corner and simply get adjusted initially with the traditional approach. Slow and steady wins the race. Appropriate treatment at the appropriate time, progressive treatment depending upon the stage of the problem.
I would look into the above websites. I would look for a Doctor of Chiropractic with additional credentials (ie: Sports injury like myself (DACBSP = http://www.ACBSP.com , or additional credentials in Orthopedics, Rehabilitation, Neurology, or perhaps even Radiology (would be helpful in re-evaluating the old MRIs and examining any new MRI). Chiropractic does have 'specialties' and additional credentials within the profession, just as medicine, dentistry, or nursing does. (((( for chiropractic specialty boards: http://www.amerchiro.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf ))))
Please utilize the above recommendations.
In my Staten Island Chiropractic office I often hand out information sheets to my patients. This is a hand out I give to Stenosis patients- compiled from various medical and chiropractic sources:
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Spinal Stenosis :
Spinal Stenosis is a highly VARIABLE condition.
Some people run marathons and lift weights with stenosis.
Some people cannot get out of bed with stenosis.
Stenosis is a narrowing of the spinal canal. There is not a lot of room in the spinal canal. Take a nickel coin and a dime coin, place the dime upon the nickel- if the nickel is the canal (the space that the spinal cord/ spinal nerves have to run through), the dime is the spinal cord/ spinal nerves. There is not a lot of space left in reserve,,, not a lot of space to 憄lay with? (note difference: spinal CANAL vs. spinal CORD ).
A condition due to narrowing of the spinal canal which can cause nerve pinching which can lead to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity (to avoid the pain).
The Silent Epidemic
The most common indication for surgery in persons aged over 60 in the United States is Lumbar Spinal Stenosis (LSS). Currently, it is estimated that as many as 400,000 Americans, most over the age of 60, may already be suffering from the symptoms of lumbar spinal stenosis [The American Association of Neurological Surgeons (AANS) and The Congress of Neurological Surgeons (CNS)] and this number is expected to grow as members of the baby boom generation begin to reach their 60s over the next decade.
According to the U.S. Census Bureau, people over 60 will account for 18.7% of the domestic population in 2010 versus 16.6% in 1999. According to the United Nations' Population Division, Department of Economic and Social Affairs, the trend is global with the number of persons aged 60 years or older estimated to be nearly 600 million in 1999 and is projected to grow to almost 2 billion by 2050, at which time the population of older persons will be larger than the population of children (0-14 years) for the first time in human history. The majority of the world's older persons reside in Asia (53 per cent), while Europe has the next largest share (25%).
Exercise: The Miracle Cure
It seems the more options you give people, the more they demand. Exercise, for example, is well known for its dramatic and wide-reaching physiological effects. Yet when you counsel a patient to exercise, they generally say something like, "Yeah, doc, I know all about exercise and diet, but what can I really do to help?" Often it appears that things with which you are very familiar are automatically either ignored or discounted (married people understand this concept well).
Among the many benefits of exercise that have been scientifically documented:
? exercising three days a week raises basal metabolic rate so that even on the days you don't exercise, you are burning 300 more calories each day;
? Finnish study found exercise relieves knee pain more than anti-inflammatory drugs or rest;9
? provides long-term relief of spinal stenosis symptoms
? lowers cholesterol levels;
? improves balance and coordination, even in the elderly;
? strengthens bones;
? fights insomnia;
? reduces the effects of mental stress;
? relieves depression;
? helps control type II diabetes;
? dissolves or prevents blot clots,11 possibly explaining exercise's protective effect against heart attacks;
? decreases breast cancer risk by up to 60 percent
? cuts the risk of gastrointestinal bleeding in the elderly in half
? postpones many effects of aging;
? increases resistance to infections.
Spinal Stenosis is a narrowing of the spinal canal. This can create irritation of the spinal cord or the spinal nerves. Stenosis can come about from many different causes. Just saying 搮stenosis厰 does not say much. Stenosis can be due to big bad things like a cancer or a tumor that irritates or puts pressure on the spinal cord. Stenosis can be due to a bulging or herniated disc. Tests should include MRI, Xray, perhaps CT scan to visualize the stenosis and the cause of the stenosis.
Many times stenosis can be handled through noninvasive conservative care such as Chiropractic.
Unfortunately, sometimes after conservative care has been tried unsuccessfully, more invasive treatments must be tried: medications (with attendant side effects), injections (with inherent risks), all the way up to invasive surgery.
One of the common causes of Spinal Stenosis is Degenerative Joint Disease (also known as Degenerative Disc Disease, Spondylitis, Spondylosis, or OsteoArthritis).
Degenerative Disk Disease
DDD = Degenerative Disc Disease; DJD = Degenerative Joint Disease; = similar/ same OsteoArthritis.
Degenerative Disc Disease (old term = DJD) is actually a quite common condition. However, the course of the condition is highly variable. Some patients with DJD literally cannot walk, yet other patients with similar X-ray/ MRI findings may be able to run marathons or lift heavy weights. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Although the course is highly variable, there are certain steps that are always helpful to follow: Ice the area when painful- 10/ 15minutes on, 30/ 45 minutes off; avoid certain postures and movements; bend the knees when coughing or sneezing; bend the knees when lifting anything; do not extend legs straight out when sitting, laying down, lifting, or driving. Avoiding certain movements and postures will prevent aggravation of the condition. Practicing good postures and movement patterns will help the condition heal and be less painful. DDD, DJD, OsteoArthritis, - deteriorating discs (disk) is/ are often caused by, or often concurrent with the Vertebral Subluxation Complex. VSC is a misalignment which hastens deterioration of the joints involved, and can 憄inch?the space available for our nerves.
Vertebral Subluxation Complex (a.k.a. 憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of joints, and can cause osteo-arthritic degeneration, Degenerative Disk Disease, degenerative joint disease, etc.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
Subluxation is a serious condition identified by its five parts:
Spinal Kinesiopathology:
This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
Neuropathophysiology:
Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
Myopathology:
Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
Histopathology:
A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Inflammed Discs can easily bulge, herniate, tear, or degenerate. Other soft tissues may also suffer permanent damage.
Pathophysiology:
The VSC contributes to OsteoArthritic degeneration. Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, Disk Degeneration, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
Certainly; safe, effective, cost effective, noninvasive, conservative Chiropractic care should be utilized, if even for a few weeks- before proceeding to risky medication or risky, invasive surgery. Visit your local family Doctor of Chiropractic for an evaluation and treatment which may be necessary.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine
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PAIN
Pain is a 憆ed light on the dashboard?
Pain is your body telling you that something is wrong.
That RED LIGHT on the dashboard of your car- -- do you ignore it until the car breaks down, or do you get it checked and correct the problem?
Pain,
pain in your body- -- do you ignore it until your body breaks down, or do you get it checked and correct the problem? Pain, do you cover up the pain by taking a painkiller? Take a painkiller, mask the pain, and allow a problem to progress in your body?
NOTICE ON PAIN RELIEVERS:
Label changes ORDERED by FDA; the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news 206- 207; 12-9-06) ;
The American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement 2-26-07).
NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse. These medications cover up the pain, and cause the problem to worsen.
Pain can often be the result of the Vertebral Subluxation Complex.
Vertebral Subluxation ( 慥SC?, 憇ubluxation? )
Vertebral Subluxation is actually a quite common condition.
Doctors of Chiropractic look for pathological conditions which may require referral to other specialties, and also look for 慡ubluxation? Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system (the master control system- ALL health disciplines learn this). VSC- 慡ubluxation??can be the cause of many symptoms and conditions.
Only a Doctor of Chiropractic will evaluate and treat for VSC, as well as other pathology.
Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights. Some patients immediately develop symptoms related to the VSC, some patients take years to develop symptoms. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Some people recover in days, some take months or years, depending upon severity of the condition.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine
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I hope this information helps.
I will do something few other Doctors of any type do,,,,
I will admit my bias.
I am a Doctor of Chiropractic. Do I think that Chiropractic, properly applied by a well credentialed, DC will help most conditions?
Yes.
Am I biased?, probably. I admit it,,, unlike other Doctors.
But I look at invasive alternatives, see risk/ benefit ratio, see morbidity and mortality, see complications, see the good the bad, the ugly,,,,, and
I think that Doctors should "....First, do no harm...."
I translate that to conservative, non-invasive, safe, effective, cost-effective treatments. Chiropractic is all of that.
Give Chiropractic, applied by the appropriate Doctor of Chiropractic a trial regimen in your husband's case. Properly applied, Chiropractic should help.
If the conservative approach fails,,,,,,, then you can always proceed to the more invasive procedures.
I hope the above helps. If further info is needed, do not hesitate to re-contact me here at AllExperts.com
( http://allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm )
Thank You, Good Luck,
Dr. Victor Dolan, DC
http://drvictordolan.chiroweb.com (email newsletter)
