Monthly ArchiveJuly 2008



Writer's Block 27 Jul 2008 04:00 pm

Writer’s Block July 27

July 27, 2008

Are Herniated Discs Caused by Age?

Here’s a question about herniated discs I received the other day that touches on a hot button topic for many people…

Dear Dean,

Ever since my MRI came back showing herniated discs at L3-4 and L4-5 I’ve been reading everything I can find about disc degeneration.

[snip]

One article I read said that disc degeneration is just part of the aging process. If that’s true, why doesn’t everyone my age (over 50) have herniated discs?

What are your thoughts?

Sam

Hi Sam,

Thanks for writing.

You’ve raised a very interesting question.

Is aging a primary cause of herniated discs?

Since you didn’t mention a particular article, I took the liberty of hunting up a similar statement to use for the sake of illustration…

“Although daily activities may cause the nucleus to press against the annulus, the body is normally able to withstand this pressure. However, as the annulus ages, it tends to crack and tear.” [1]

Although the paragraph I pulled this quote from does not come right out and say that age is the cause of herniated discs, anyone reading the above could very easily make that assumption.

The average layman (such as myself) will undoubtedly conclude that cracking and tearing of the annulus (the outer ring of the disc) is strictly related to the aging process and therefore, aging must be the cause of herniated discs.

However, if you’re a natural born skeptic with a nasty habit of questioning everything you read, you may begin to wonder, “If age is the cause…”

  • Why doesn’t everyone past a certain age have herniated discs?
  • Why don’t all of our discs degenerate and rupture?
  • Why do some 20 year-olds have herniated discs while many 60, 70 and even 80 year olds do not?
  • And why is it that Nelson and others have produced research showing that discs can heal and the bulges resorb. [2]

Have these doctors found the fountain of youth? Or is the age explanation simply wrong?

My guess is the age assumption is not exactly wrong. It is merely an oversimplification. The above writer (or his editor) was probably attempting to be brief and simply picked what he thought was the best example (i.e., aging) from among the various causes of disc degeneration.

So, while the above quote may be technically correct, it is obviously incomplete and that makes it a bit inaccurate. There must be other factors involved.

For example, McGill writes…

“Herniations tend to occur in younger spines (Adams and Hutton, 1985) … Older spines do not appear to exhibit classic extrusion of nuclear material but rather are characterized by delamination of the annulus layer and radial cracks…” [3]

So we see that while age does seem to correspond to cracking and tearing — as our original quote indicated — this does not necessarily lead to disc herniation.

Instead, according to McGill, it is younger spines that are more inclined to rupture.

To further clarify things, McGill lists what I believe to be a more insidious cause of herniated discs (emphasis mine)…

“Epidemiological data link herniation with sedentary occupations and the sitting posture (Videman, Nurminen, and Troup, 1990). In fact, Wilder and colleagues (1988) documented annular tears in young calf spines from prolonged simulated sitting postures and cyclic compressive loading (i.e., simulated truck driving).” [3]

So, based on this additional information, it would seem that — while age does appear to take a toll on intervertebral discs — herniation appears to be caused by other more destructive factors such as prolonged sitting, compressive loading, and inactivity.

Summation and Hypothesis

Aging is obviously a factor in any degenerative condition. As people get older they begin to notice that their skin, hair, joints, bones and other tissues aren’t what they used to be.

So it stands to reason that older people, to a certain degree, are going to be more susceptible to disc degeneration.

However, I believe it’s incorrect to make aging the primary scapegoat.

Instead, I believe that inactivity and compressive loading are the real culprits and that age is merely a supporting cast member (along with other possibilities such as smoking, poor diet, and external trauma).

Suffice it to say, I believe we do ourselves a disservice to focus on age as the main cause of herniated discs, especially when there is research available that indicates otherwise.

We’re not through with this subject (i.e., the real cause of herniated discs). I intend to continue it in an upcoming post so stay tuned.

Till then,
Dean

References:

1. Orthogate, Lumbar Disc Herniation (eOrthopod) Friday, 28 July 2006

2. Nelson, B. The Herniated Disc: New Concepts and Treatments. Physicians Neck & Back Clinics [2005]

3. McGill, S. Low Back Disorders, Evidence-Based Prevention and Rehabilitation, 2nd Edition. (p. 44-47) Human Kinetics (2007)

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Med Bloggers 19 Jul 2008 07:36 pm

Writer’s Block July 19

July 19, 2008

Sciatica and the Epidural: Are You a Candidate?

Ever since my article on Sciatica and Epidural Injections, I’ve received a number of emails requesting more information on the subject. Therefore, I’ve decided to expand that original post into a series of articles to answer your many questions and to clear up some misconceptions.

And, since I’m not very creative, I’ve decided to just start with the two most common questions:

  1. What exactly are epidural steroid injections? and…
  2. How can I tell if they will work for me?

What is an Epidural Steroid Injection?

syringe2

Epidural steroid injections are a method your doctor can use to deliver a drug directly into an area of inflammation. These drugs (corticosteroids or glucocorticoids) are very similar to cortisal, a natural hormone produced by the adrenal gland.

These particular steroids act on the immune system to prevent it from overproducing the chemicals that cause inflammation in an injured area.

Inflammation is a by-product of the body’s defense mechanism. It is a natural process and not necessarily a bad thing. However, it can be a bit of a nuisance. Just ask anyone dealing with the numbness, tingling, loss of muscle control, pain and other symptoms we’ve come to know as sciatica.

Doctors and therapists have found that reducing this inflammation can greatly reduce your discomfort. While reducing the discomfort is not the same thing as a cure, for some, it can be the leg-up they need in order to proceed with a good rehabilitation program.

Are You a Candidate?

To determine if epidural steroid injections would help you, your doctor will first prescribe an oral steroid such as methylprednisolone. This medication is often used to treat inflammation and swelling associated with arthritis.

If you respond favorably to the oral steroid, it is very likely that you will have good results with the epidurals.

Typically the 4 mg tablets are taken over 6 days in decreasing dosages as follows:

pills

  • Day 1: 6 tablets
  • Day 2: 5 tablets
  • Day 3: 4 tablets
  • Day 4: 3 tablets
  • Day 5: 2 tablets
  • Day 6: 1 tablet

It may take from 4 to 6 days before you notice any results from the oral steroid and those results may be very slight. That’s okay. Even a minor improvement in your symptoms means the epidurals will probably work for you.

In closing…

Keep in mind that epidural injections don’t work for everyone and I’m not advocating for them one way or the other. That’s for you to decide after consulting with your doctor.

In the next installment, we’ll take a look at the difference between corticosteroids and anabolic steroids. Suffice it to say, they are not the same thing.

Till then,
Dean

References:

1. Singh V, Manchikanti L. Role of caudal epidural injections in the management of chronic low back pain. Pain Physician 2002;5: 133-48.

2. Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997;336: 1634-40.

3. Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low back pain and sciatica: a systematic review of randomized clinical trials. Pain 1995;63: 279-88.

4. Watts RW, Silagy CA. Meta-analysis and the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesthesia Intens Care 1995;223: 564-9.

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Writer's Block 11 Jul 2008 11:20 pm

Writer’s Block July 11

July 11, 2008

Neck Pain and Cervical Collars

cervical collar dog

Buddy here looks like he’s planning on bilking the insurance company out of some major coin.

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I’m sure it comes as no surprise that every once in awhile someone will write to me and ask about those cervical collars you occasionally see people wearing. For example, here’s a letter I received about a month ago…

Read more…

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