[Lisadavis]

#7411

My insurance even though I have it does not cover prolotherapy . The treatments are about 350 to 1200 for the first visit ,but it fixed my label tear in my leg so I could run the Chicago marathon

[Lisadavis]

#7412

Dextrose & sarapin are in prolotherapy .i know sarapin is aplant based substance but I don’t know about dextrose ?

[Donald Corenman, MD, DC]

#7425

Boy- there is a lot to cover here. I’ll try to be as brief as I can.

You have a fear of spinal surgery that may be warranted after you have listened to various patients troubles but as in anything, spine surgery included, you must weigh the fear against the actual reality.

You have an instability of C1-2. The “head” of C2 has been sheared off (the dens) and your neck is unstable (os odontoidium). C1 now moves too much and has put the cord in jeopardy. However, you have a fear of a stroke with surgery to correct this instability.

Yes, the fusion surgery you mention is uncommon. I personally have performed only about 25 of these C1-2 fusions compared to the thousands of other fusions I have performed. The reason is that this condition is very uncommon. Stroke is possible (the vertebral artery is close by) but I have never seen that problem and even with discussions with all of my colleagues, I have never heard of that complication

You mention you don’t want your “quality of life” to suffer for fear of a stroke but I have to point out that by your report, you have already developed a spinal cord injury from your instability; “had an accident that rendered me unable to walk straight due to poor balance, dizziness…”.

BMP (bone morphogenic protein) is not the terrible evil that you think it is. I use it for many fusions and it is a very useful tool to allow fusion to occur. The posterior C1-2 or C1-3 surgery that you have had proposed is a perfect example of where this protein would be most useful. You have read one study that purports increased risk but there is a new study that refutes this and I personally have seen no increased risk.

Your understanding of fusion is incorrect. Most times, a solid fusion will eliminate pain and not cause it.

Prolotherapy is not the panacea that you purport. First, the indications have to be appropriate. Prolotherapy injects a toxic substance that is designed to injure local tissue leading to scar formation response. Many reported indications in my opinion are not appropriate. You generally do not want to destroy normal ligaments, tendons or muscles to “treat them”. Injecting these toxic substances into the upper neck is strictly contraindicated. What happens if this substance accidentally infiltrates into the spinal canal? Injury to the cord would be irreversible. Even infiltration around the greater occipital nerve would leave your head numb and possibly painful.

Stability of the C1-2 level cannot be gained by prolotherapy. This is NOT a ligament problem but a fracture of a bone that did not and will not heal. If you truly have what you reported here, you need a fusion of this level. If you re-injure the cord in this area, paralysis or death can be the result. I highly encourage you to face your fears of surgery and visit a spine surgeon soon.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[HaloHelp]

#7566

Hello Again Dr. Corenman,

It’s not so much the “fear” of surgery for my Os Odontoideum, it’s my being able to live a fulfilling life as normal as possible—that’s what’s most important. I currently am not in a huge amount of pain, except for headaches at times. It took a 3rd whole hospital institution to find, after my outright insistence, that my cord must have been bruised from my accident. But all the rest still contend to this day that there’s nothing wrong, though I saw the contusion on my MRI now and though I had to regain my balance and such after the accident and use a walker.

Being caught under pain and hooked on pain meds is most daunting: I lived a huge portion of my childhood, strung out on medications for seizures. I was oblivious and actually thought to be mentally “slow” until my parent’s decided to not listen to the doctors anymore and took me off all medications.

Miraculously, I never had a seizure again after getting rid of the “saving” meds, which I’m now suspicious were partly causing my problems.

It was discovered immediately that I was a normal kid, but medications drowned out that reality. A friend of mine wasn’t so lucky, he had the same issue as I did but his parents kept him on his medications. His heart stopped at the age of 16, thanks to his being overmedicated. His parent’s never forgave themselves.

The thought of having to go under the looming pain medications following spinal fusion at C1-C2, for who knows how long, is not inviting Doctors tell my patients they will be out of work for maybe 4 weeks (knowingly and annoyingly underestimating)…3 months later they finally are able to attempt work and often realize they may not be able to handle working ever again or will be able to–but in agony and drugged if they can even afford their pain meds.

Surgery can cause great pain and enduring pain. Fusion is especially difficult to recover from, and for the C1-C2 it’s such a huge life changer with the mobility quickly taken away. Fusion may be okay for a short while or long while, but when it degrades neighboring structures—it’s all agony and more surgery to fuse more and remove scar tissue. The internet is riddled with story after story of people not doing well after their fusion, or being sent to pain management clinics where they are treated like an addict.

Here’s a quote from a Bloomberg.com article:
In a U.S. study in Spine in 2007, surgeons reported fusion was successful in only 41 percent of 75 patients suffering from lower-back disc degeneration. Success measures included pain reduction. Two years earlier in the same journal, surgeons found a 47 percent success rate among 99 patients, 80 percent of which were taking narcotics for pain two years later. Both studies compared fusion to artificial disc replacement in trials submitted to the FDA.

When pain management isn’t reached, patients turn to abusing other drugs or alcohol. It ruins their life, where they often even end up prematurely in nursing and rehab facilities—essentially wasting away as they become less and less mobile and medications cause them other health problems.

I went to Johns Hopkins, and this is where I was told I was at risk for the vertebral stroke due to my small pedicles. Many surgeons usually are not so forth coming with even basic questions I’ve asked in the past like, “What’s the procedure called you’ll do–‘Harms’?” I literally got a shoulder shrug as the answer from that top doc. So, for this doctor to tell me this, it had to be important. He said, “It’s rare that someone is at such a high risk for vertebral artery stroke. But you are, so I’m recommending we skip C2 and fuse C3!” I didn’t know how a skip could be done or how that’d even help make it any better (do you?), but that was his word choice not mine.

I think sometimes extending life at all cost isn’t always the best cause. To be honest, if I injure my C1/C2 good enough where I don’t have immediate help, I’ll die since I won’t be able to breathe on my own. I’m not afraid of dying, I’ve already been there and it’s not a bad place to be.

Weighing my options is still on the table, and so far Prolotherapy is my choice for now. The doctor I go to only uses natural substances, and I haven’t had any issues with it. My ligaments wore out over the years and then fully gave way due to the accident causing this instability. Things held together fine for so long, and I was super active where my neck should have snapped a thousand times over.

So, this is why I’m confident in the Prolotherapy to try and get my ligaments back to how they worked so well before. Doctors wouldn’t EVEN tell me for years that I had this Os Odontoideum, so they seemed to think my ligaments were doing the job for me, too. Like it was the job of my ligaments and not my vertebra, to hold my head on…so they said nothing…4 doctors! After reading my MRI reports and seeing it as the second dx right in front of them, and they skipped over it…really stunned and ticked me off to be honest that I HAD TO ask about it!

So, yes…unfortunately I’ve got an Os Odontoideum and it’s causing me twitches all over, makes my head feel like it’s going to fall off as itl iterally wobbles…and yet I had to leave my hospital of choice in a major city at the #1 hospital because they said though my neck is measurably unstable—I don’t have any muscle weakness yet and I would surely not want that type of fusion surgery. They even said my head wobble might be from stress—right after I got injured and they continue to think that. Though my arm went numb, top of head went numb, I stuttered, blurred vision and horrible balance to boot!

A few doctor searches and I finally got one to pull up my MRI and showed me that I had a spinal contusion…it was clearly visible! So, you could say that I more than have a bad taste in my mouth about quite a few things, but I am overall very practical and calm in most cases…even this. So, racing to a surgeon isn’t my choice, but I understand your advice.

How would you say your patients did after their C1-C2 fusion? Did they all get completely off pain meds—never to complain again? How would you know if it ever turned sour for them if they moved or went to another doctor later or even went to one with a different specialty to help with their ongoing issues? If they came back due to pain and their fusion was holding and it looked good, would you just refer them to the pain clinic?

Thanks for your time in reading this lengthy letter Dr. Corenman.

Here’s in reference and in warning in the use of BMP:

BMP usage is causing harm:
The US. Committee is now after Medtronic for paying physicians who authored the BMP research and left out the cancer causing facts ($210 million dollars was paid to them—public knowledge). Full article that the government has outright evidence of them hiding their direct knowledge of MANY scary side effects with cancer being ONLY one of them.

You mentioned that BMP is safe to use, because there was only one report saying it was dangerous. If a company like Medtronic has to falsify information about their product that should make everyone nervous. It was more than proven that the results of the use of BMP was corrupted and biased as shown in thE New York Times article.

And this quote would convince me to never use it:
“The researchers had information showing that at two and three years after being implanted with the genetically engineered protein, significantly higher numbers of Amplify patients were being diagnosed with cancer, but they did not report it on their paper.
The authors mentioned the cancer link only in a table accompanying the paper. The text itself never addressed the concern of whether BMP-2 might fuel cancer.
“As a physician, you go by what your colleagues publish,” said Charles Rosen, an orthopedic surgeon and president of the Association for Medical Ethics. “It’s an abuse of trust.”

If there is even the slightest chance of causing harm, after so much good is aimed for, it should be at least considered. I know people who go into these fields, go into for all the right reasons. But I do also know how the system is corrupted with kickbacks for useage of say, Medtronic devices.

This is taken from additional research: “This risk of adverse events associated with rhBMP-2 is 10 to 50 times the original estimates reported in the industry-sponsored peer-reviewed publications.”

There’s an article where BMP has been found to injure the nervous system:

There’s research showing how “BMP enthusiast” overstate the morbidity of harvesting bone to ensure patients on the use of BMP instead:

The increased fusion rate isn’t by that much to want to risk a patient, I personally feel. What does it help to fix their back, only for them to get a killer cancer later or other serious complications that hinders their living a complete life?

I HAD TO REMOVE THE LINKS TO THE ARTICLES SINCE THEY WEREN’T BEING ALLOWED OTHERWISE I’D HAVE THEM HERE.

[Donald Corenman, MD, DC]

#7567

I understand that you carry a heavy burden as you have had poor experiences with the medical system and do not trust doctors.

Cord injury many times is irreversible. Leaving an unstable neck for fear of the surgery is not a good tradeoff in my opinion. Yes, surgery is a risk but the potential of paralysis or even death by your explanation of the disorder is not low.

Yes, in some studies, fusion for lower back pain has a poor record but I just finished a study of about 40 patients with a 90% satisfaction rate. You also know that your potential surgery is not fusion for lower back pain.

“Harms’ is the last name of the surgeon who developed one of the techniques to fuse C1 to C2. His name should in no way influence your decision as a “totem”.

You have had very bad experiences with doctors and are looking for published bad results as a way to justify your ill feeling of the medical profession. Realize that the medical profession does publish these bad results instead of pushing them under the rug in an effort to be open and transparent. Many of the “bad results” papers I would disagree with as poorly designed studies or poor patient selection.

I do not think prolotherapy is a good idea in your case. I could bring up many articles regarding significant complications with prolotherapy. Every tool has usefulness and potential complications. It is up to you and the physician to discuss these and decide if the risk is worth the benefit.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[billybill02]

#7570

I have had several treatments from prolotherapy although not to the C1. Prolotherapy, which I will include Platelet Rich Plasma and Stem Cells at this point, which uses primarily dextrose and a cod liver oil extract are not what I consider toxic substances. Phenol was more popular in the past and was used on me, which can destroy nerve cells, did cause an irritation from C2-T1 when used and a stinging sensation that lasted for several months, therefore we stopped and started using dextrose (sugar) and a cod liver oil extract. The extracellular hypertonicity or chmemical irritation caused by injecting these solutions does cause cells to burst and initiates the inflammatory/healing cascade. Is this what you are referring to as cell destruction, or the use of phenol as a proliferant? But he is correct,cells bursting is “injury”. If cells don’t burst you don’t get inflamed or heal.

Also, prolotherapy does not work on everyone and everyone performing prolotherapy is not equal. I can attest to that. I agree that there is significant risk in treating the upper cervical area and at a minimum should be done by someone with much experience and under flouroscopy and with someone who has had success treating that area, who could explain the risks. But the arterial and nerve structures in that area dense and the risk just from poking around with a needle in my mind is great. It also takes multiple treatments, up to 6. If it isn’t working after 6 treatments it ain’t going to work. But that’s risking yourself 6 times to something that has a success rate less than that of surgery.
Just my two cents.

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