Sunday, July 27, 2008

More on the abuse of the Spinal Cord and Epidurals.

I would like to go a little further on procedures like the Epidural shot and the potential dangers that could come from it. I personally will never have another Epidural shot or test involving a needle inserted into my spine. While I am not a Doctor, my years of procedures and surgeries, sitting up late at night has given me a great deal of knowledge on pain, because I live with it day and night. One thing I have learned the hard way is just because the FDA approves something, does not mean it will help you with your problems. They are a panel of 5 Doctors and they are under a lot of pressure from congress, sometimes just one congressman to approve whatever product or medicine is involved. For example if the company that is going to be making the product falls in a certain congressional district this is where the lobbying kicks in.

You have heard me talk about Dr. Charles V. Burton, Neurosurgeon. I really hope you go this article on his site and read it in its entirety. All surgeons would do well to read his information.

"This illustration (from Noback CR: The Human Nervous System, McGraw-Hill, Inc., 1967) illustrates the human subarachnoid space surrounding the brain and spinal cord. 60% of spinal fluid is produced within the brain and 40% from the spinal subarachnoid space. It flows, as shown, and is absorbed by the venous arachnoid granulations. This spinal fluid is produced at the rate of 0.35cc/min, or 500-750cc/day. Turnover rate is 3-5 times/day. A normal adult has a ventricular volume of about 30cc and about 100+cc in the surrounding subarachnoid space. The subarachnoid space serves to be a hydraulic cushion for the floating brain, a source of nutrition as well neurotransmitters. This space is the most fragile and sensitive environment in the body.

When the subarachnoid space is subject to insult or inflammatory change damage and scarring occur. One of the primary difficulties in addressing the subject of neuropathologic change, particularly that of adhesive arachnoiditis is the great amount of confusion regarding nomenclature. Adhesive arachnoiditis is an advanced form of arachnoiditis and is most often confused with the latter. Some of the other terms by adhesive arachnoiditis has been referred to have been:

Serosa Circumscripta Spinalis
Intraspinal Granulomatosis
Obliterative Arachnoiditis
Chronic Arachnoiditis
Spinal Meningitis
Chronic Spinal Meningitis
Chemical Meningitis
Sterile Meningitis
Granulomatous Meningitis

Once one has gotten beyond the "Tower of Babel" part of the semantic issues it is important to look closer at the normal anatomy of the lumbar spinal column, the dural membranes, and the subarachnoid space. In the image, to the left, the nerve rootlets of the cauda equina, which are in motor and sensory pairs, are shown as single nerves for simplification. If a lumbar puncture were to be performed the needle would simply push the nerve roots, floating in cerebrospinal fluid, out of the way. If a similar procedure were attempted in a patient with Class III Adhesive Arachnoiditis, where the nerve roots were fixed to each other and to the dura mater, the needle could easily injure or sever the nerves."

Please go to

Saturday, July 12, 2008

Information on the Epidural shot

So just what is an Epidural shot. There is a group of Doctors who have carved out a nice "little niche" for themselves called Pain Management Specialists. What they do primarily, is inject steroids and other pain medicine into the epidural which is the outer layer of the spinal cord depicted in green in the photo to the left. Most of them like to do a series of 3 shots to the tune of about $2,000-$2,500 dollars. If this procedure gives any relief at all, it is for about 2 weeks. Most of these doctors are anesthesiologists and while a few of them will work with you with powerful pain medications, the majority send you back to your primary care physician for him to prescribe them to you. I know because I have been through it. The ones that only want to do the epidural shots are called "procedure mills".

They use the excuse that you might become addicted. First of all, they don't even have their terminology right. The correct word is "chemical dependency" which is a normal occurrence with opiates. If someone wants to continue taking these drugs after they no longer need them, or just try to get them for the so-called high, then they are addicts. Surveys have indicated that only 1% to 3% of chronic pain patients ever get addicted. To get off of these drugs, all you do is slowly reduce your dosage until you are off of them. I have done it 15 to 20 times myself. It is a hell of a lot easier to get off of opiates than getting off of nicotine. I can also say that from personal experience.

The epidural marked in green, looking down on a disc showing the spinal cord in the center where the blue dot is and the green is the epidural or the outer wall of the spinal cord. The other clusters are nerves that come out of the spinal cord and go to places all over your body. You will understand better if you read what Dr Burton has to say. Then go to his website to read the entire article. If you want to learn now is the time, especially if you have back problems like I do.
According to him the spinal cord is the most fragile, yet the most abused part of the human body. with the permission Of Dr. Charles V. Burton, a board certified neurosurgeon, who is the top spine surgeon in the USA. If you have any kind of spinal problems you need to go to his site, .

"The epidural space is an anatomic structure that surrounds the dura mater within the spinal canal and extends to the brain itself. In some areas it is a real space and in others only a potential space. The space itself consists of fat and blood vessels. Its importance is based on the fact that many physicians have selected this site as a depository for injected medications as a treatment for low back pain.

The illustration to the left represents a post-mortem axial section of a normal lumbar spinal canal. The vertebral body is shown at the top and the lamina of the vertebrae at the bottom. The epidural space surrounds the dural membrane. Only the posterior portion of the epidural space is outlined in green as this is the area of clinical interest.

The blue dot has been inserted intracathecally, that is, within the subarachnoid space. The subarachnoid space is one of the most fragile, delicate and sensitive areas of the human body. This space contains the brain, spinal cord and nerve roots of the cauda equina. It is filled with cerebro-spinal fluid which acts to support and nourish the nervous system. The subarachnoid space is very sensitive to insult while the epidural space is very resistant to insult. Unfortunately they are separated by only a thin membrane, the dura mater lined by an even thinner membrane, the arachnoid membrane.

In this diagram the site of the epidural space is highlighted with a green dot (which lies on the dura). In this representation the dura and the underlying arachnoid membrane are both shown. Note that the epidural space is separated from the subarachnoid space by only these thin membranes. When a needle is used to deposit substances, such as steroids, in the epidural space the procedurist (physician performing the injection) has the responsibility of accurately placing the material in the epidural space because only a slight inaccuracy permits the steroid entry into the subarachnoid space thus introducing the risk of adhesive arachnoiditis ".

Go to Dr. Burtons website to see the rest of his article.