Canadian doctors are trying to predict which patients will benefit the most from spinal surgery for degenerative disc disease. Here is a startling finding: the worse the patient’s symptoms are – the less likely the surgery will succeed. Equally – it seems that the amount of disc herniation does not affect surgical outcomes negatively or positively.
What does this mean? It is not the discs causing the problem.
Back pain can be caused by many reasons.
One of the challenges in fact in treating back pain is making an accurate diagnosis.
Disc degeneration is seldom the pain cause – but frequently the reason for surgery.
Many doctor now believe that pain is not coming from the disc problem :
• Pain on either side of the spine not on the midline
• Sensation is intact
• Muscle strength is fine
• Pain upon lying down
• Pain is not worse with sitting
• Pain is not worse with bending over
• Numbiness (tingling down the arm but sensation is ok)
All of the above symptoms suggest ligament laxity of spine or sacroiliac ligament problems. Disc problems are more indicative if the person has low back pain for instance that is:
• Sitting makes it worse
• Standing (compared to lying) makes it worse
• Bending over while standing increases the central pain.
Spinal ligaments as main culprit behind back pain
The many complexities of the spine and the spinal ligaments can be seen at the intervertebral joints – where vertebrae connect to each other.
Here the interspinous ligament weaves between the spinous processes connecting the back of the vertebrae bony processes.
The supraspinous ligament connects the spinous processes. Running towards the cervical spine it forms the nuchal ligament.
The inter transverse ligaments connect the adjacent transverse processes, and the ligamentum flavum connects the laminae of adjoining vertebrae.
It should be clear that the spinal ligaments are key factors in spinal stability and instability which can lead to degenerative disc and possible nerve compression at the facete joints in flexion or extension, and at the lower back ligaments of the sacroiliac joints, in other words, back pain can be due to an unstable disc problem, facet joint locking, or sacroiliac dysfunction caused by problems of the spinal ligaments.
The spine relies heavily on the supporting ligaments to hold itself together the ligaments of the spine as the key to degenerative disc disease, the researchers suggest that it is hard for doctors and MRIs to figure outthe pain sources in low back pain, and that even when people have it, there are no symptoms for it, yet eventually it will develop into worsening low back pain and disc problems.
But, these researchers also say that there are “patterns” of discdegeneration that may provide insight into where the pain is coming from and that by addressing these patterns – further disc degeneration can be managed, What do doctors need to address?
Specifically, individuals with contiguous multi-level disc degeneration have been shown to exhibit higher presence and severity of low back pain as compared to patients with skipped-level disc degeneration (i.e. healthy discs located in between degenerated discs).
Here is the reason: Stresses on the surrounding ligaments, facets, and pedicles (the area of the vertebrae where many spinal procedures begin) at vertebral levels where there was no degeneration of the spine were generally lower than where degeneration occurred.
That should be obvious that stable ligaments equal stable spines –unstable ligaments – unstable spines.
Prolotherapy’s role in Degenerative Disc Disease
• This injection therapy can help stabilize weak ligaments. It is very effective in tightening and making to ligaments stronger. This will make the tensegrity of the spine bio-mechanically more functional.
• Joints become more stable producing less back pain because the ligaments, small muscle and joints are also regenerating with healing using prolotherapy solution and injections.
• Prolotherapy injections produce an inflammatory response, which can augment collagen fibre and ligament structure regeneration, resulting in tightening and strengthening of spinal ligaments, thereby reducing the incidence of discogenic low back pain by improving intersegmental stability
• By correcting the instability of the lumbar spine at an early stage, Prolotherapy will cause less stress to be imposed on the disc and less degeneration to occur at the disc.
Dr. Stephen Cavallino M.D.
Vice President – SIPRO
Director of Prolotherapy Education
Director of European School of Prolotherapy