cortisone injections to C5

akcarmean, LPN · Jan 12, 2005

Hi,
My brother's back Dr. is advising him to have surgery for a protruding disc at C5. The disc is "causing pressure on his cord and pinching the root nerve". Dr wants to completely remove his disc and replace it with an artificial one. He was also given the option of cortison injections for short term relief.
I told Mike to take his MRI and first go see what a chiropractor would advise (someone who is NOT trained only to cut). If nothing else, this could be a second option. I am not one of those people who think chiropractors can cure the world, but I am very anxious about surgery. I known many patients that regret back surgery for the rest of their life (and my brother is only 30).
My question about the cortison injections: are there CRNAs/MDAs that do this in a pain management practice? I would feel much better with a CRNA doing the injections (mainly because of the location - C5), but how feasible is this?
If anyone has info as to whom you would recommend in the DALLAS/FW area, please PM me. He is going to the Tx. Back Institute. I would appreciate any info regarding chiropractors and anesthesia providors (even if you don't know who to recommend, if you know who to stay away from, that would help also).
Please share any other thoughts on the subject and thanks in advance!

In the past month I have had 2 steroid injections in my L5. They were both done my an anthestiologist; not the back surgeon. I have also gone to chiropractor both. Right now muscle are to tense even if the chiro. put my spine back in place the muscle would pull it right back out. Hope this helps.

Angie

Tenesma · Jan 12, 2005

depends on the symptoms.... fewer and fewer operations are being done for disc herniation today due to unchanged outcomes. I agree with you that getting different/2nd opinions is always the route to go... especially prior to neck surgery. I think a good resource in the dallas area is UT Southwestern - they have a good orthopedic and neurosurgical dept (they both do spine surgery) and have a good reputation.

1) chiropractors are a great resource for certain back problems - however if he has nerve compression due to stenosis or impingment from the disk, further manipulation may not be the safest thing in the world - especially in the neck. Of course most chiropractors would disagree with that (i am related to a few).

2) "cortisone" shots: in the neck are a tricky issue. THEY SHOULD ALWAYS BE DONE FLUOROSCOPICALLY (meaning with live x-ray)!!! or else it is useless if not more dangerous. They shouldn't be done transforaminally due to risk of vertebral artery injection or intrathecal injection. They should be done translaminar only... They should be done by a board certified pain physician... Another approach is to do a thoracic epidural catheter - thread up to C5 fluoroscopically and inject the steroid. The advantage of the injection is that it would alleviate pain for a short period of time (a few weeks to a month or two at most) and will need to be repeated a handful of times per year...

3) why would you feel more comfortable with a CRNA doing a C5 injection???

4) a good pain clinic may have other treatment options that may provide more long term pain relief. Dr. Konen may be a resource in Dallas

KrisRNwannabe · Jan 12, 2005

I have a similar problem at L3. I go to a pain clinic for treatment. I went to a chiropractor who refused to touch me. he was worried about causing more pain and permanant nerve damage. I agree that most chiropractors would not have refused me. which is scary becasue where would be? I am now considering a nerve block to help deal with the pain. my dad had the same problem and had the surgrey and now has lots of nerve damage so I am reluctant to get it since i am only 27.

Kris

kcrnsue · Jan 12, 2005

I had this surgery right after I turned 30. I had c-5 & c-6 fused. Never had the cortisone shots though. The surgery was the best thing I could have done. I had weakness down my right arm and my right thumb was numb. The reason for my surgery was stenosis caused by a bone spur. I have full range of motion in my neck and full function and feeling back in my right arm. If your brother has any numbness or tingling I would be very wary of seeing a chiropractor.

Tenesma · Jan 12, 2005

couldn't agree more - if you are having symptomatic radiculopathy then surgery is usually the best option. and steroid shots might not be the best option in that circumstance.

lifeLONGstudent · Jan 13, 2005

3) why would you feel more comfortable with a CRNA doing a C5 injection???

If I said CRNA, I typed wrong... I meant anesthesia provider. Why - familiarity and advanced education (A&P) with the region and/or procedure...since they have experience doing blocks, etc. I thought that this might be your (MDA/CRNA) area of expertise. Your skills are continually refined each time you do a block. Maybe I am off base, but this is why I am asking. I value your knowledge and I am thankful that you are willing to share.

Thanks for all the input. My bother has since found out that disc replacement is considered "experimental"...aka. insurance won't cover it. He has been to the chiro (but has not helped the problem and he even went to another chiropractor - the chiro did help with his lumbar region).

martymoose, BSN, RN · Jan 13, 2005

I've had a hx of DDD L5-S1, and went the pain mgmt route. Did the steroid inj., then nerve blocks, then had RF ablation done on the nerve. Worked for me mostly last 2 years. Also helped that I stopped doing factory work. I am now having a bone spur on C5, and that has been helped tremendously by chiropractic. We have been doing traction, stim, and heat and massage, and my sx of numbness to my thumb and outer arm and diminished by 75 %, and I can finally turn my head from side to side. I had to be patient tho, as this probably took around 6-8 weeks of chiro 2-3x/wk, also took advil, tylenol, and ultram (at nite only) as needed.( Not all drugs at the same time.) I think the biggest help was the traction. It seems to stretch the spine off of the disc. I always walked out of office much looser. Good Luck to your brother.

deepz · Jan 13, 2005

..I think the biggest help was the traction. ...

Two years ago, in close sequence, I had a numb finger C-5 (resolved with traction and NSAIDs) and then a blazing sciatica, which slowly has improved 90+% with physical therapy. Google Robin Anthony McKenzie.

Chiropractors I personally avoid, but PTs -- they know SOME STUFF!

deepz

(Nobody else goes to such great lengths to avoid Cold Steel Therapy as a gaspasser.)