Ross A. Hauser, MD.
Prolotherapy is referred to as a regenerative injection technique (RIT) because it is based on the premise that the regenerative/reparative healing process can rebuild and repair damaged soft tissue structures. It is a simple injection treatment that addresses very complex issues. Prolotherapy can be a successful treatment for some patients with cervical radiculopathy, particularly when the symptoms are thought to be related to ligament laxity or cervical instability rather than solely a herniated disc or severe foraminal stenosis.
The neurological manifestations of cervical spine instability and degeneration
When exploring non-surgical options, such as Prolotherapy injections discussed later, the understanding that the neurological manifestations of cervical spine instability and degeneration may be due to a variety of mechanisms is of great importance. These include:
- (1) cord compression (myelopathy),
- (2) nerve root compression (radiculopathy),
- (3) local irritation – irritation of mechanoreceptors and nociceptive nerve structures within the intervertebral motion segments (ligaments),
- (4) vertebral artery compromise, and
- (5) autonomic dysfunction – nerve damage along with autonomic neuropathy or dysautonomia.
It is important to understand the difference between these five mechanisms, as it helps one understand when Prolotherapy is an appropriate treatment option and when a surgical consult is recommended.
The non-surgical comprehensive Prolotherapy treatment methods for treating cervical radiculopathy: The medical history of two patients including my own.
In spinal stenosis, the altered tension on the spinal cord comes from the dura through the dentate ligaments. This “damaging” pulling of the spinal cord via the dentate-dural connection occurs with motion or specific positions, causing spinal cord signals to be blocked or altered, meaning there is a positional aspect to it. The reversibility of radiographic findings by motion is a key step in resolving symptoms and medical conditions through conservative treatments. When a digital motion x-ray demonstrates that even a posterior osteophyte complex encroaching on the spinal cord is reducible by improvement of the spinal curve, a successful treatment regimen can be instituted to permanently improve the spinal canal space by curve correction and Prolotherapy as needed.
What are we seeing in this image?
Impingement of spinal cord from posterior C4 vertebrae improved with curved correction:
- A. MRI scan
- B. X-ray in a neutral position as can be seen from the X-ray still the posterior portion of this person’s C4 vertebrae body (arrow) is narrowing the spinal canal and causing impingement on the spinal cord
- C. Initial x-ray after putting on chest weight impingement of this person’s spinal cord was significantly reduced by putting on a chest weight. Impingement of this person’s spinal cord was significantly reduced by putting on a chest weight that drastically improved their curve. This can be a prognostic indicator that the person’s spinal cord compression will resolve with the conservative care of curve correction and Prolotherapy.
Below are two case studies, my own and that of a 38-year-old male patient we documented in our medical research. While both studies are male subjects I want to point out in the research that women are more affected by cervical radiculopathy issues than men.
This was documented by Polish researchers who wrote of quality of life assessment in patients with spinal radicular syndromes:
“In the female patients suffering from spinal radicular syndromes, the pathological process was most commonly located in the cervical spine, . . . Ailments associated with spinal radicular syndromes affect the quality of life of the female patients studied in this research to a greater extent than the male patients, both in terms of mental and physical well-being. . . (Also) the intensity of pain associated with spinal radicular syndromes progresses with age.”(1)
Two case studies of treatment for cervical radiculopathy
Subject: A 38-year-old male complains of severe pain in his neck that radiated down his right arm with numbness of his right index finger and posterior wrist (C6 distribution). His pain began earlier that month after lifting a TV. Prior to this injury, he was an active person who was pain-free. The patient stated that his pain was at its worst when lying down (a 10 out of 10 pain), but is helped by wearing a neck brace while sleeping. He was taking Norco two to three times per day for pain, a Medrol dose pack, and Daypro at the time of his first visit. An MRI ordered by his primary doctor revealed a right-sided disc herniation at C5-C6 and C6-C7.
Upon initial exam, his right arm muscle strength was normal but had a slightly diminished sensation in the C6 dermatome (an area of skin that the nerves pass through, in this case, the C6 area. Upon extension of his neck and right lateral rotation, he had shooting pains down his right arm. The patient received Prolotherapy on his first visit to his entire neck and right scapular region. He was taken off Norco and Daypro and given Ultram for pain and Ambien to help him sleep.
He returned every 2 weeks for the same treatment and at the 3rd visit he reported a 50% improvement in pain. His pain was down to 5 out of 10. He still had numbness in his right index finger after lying down. He moved his appointments to every 3 to 4 weeks over the next few treatments and at his 5th visit he reported a 70% improvement in pain and that he no longer had pain unless he was lying down. His finger was unchanged at this time.
The patient continued Prolotherapy treatment every 6 weeks or so over the next few treatments and, at what would have been treatment #9, he reported that his neck was doing “really good.” He did not receive treatment at this visit to his neck but wanted to get his knees and feet treated for unrelated injuries because Prolotherapy had worked so well on his neck. He was on no pain medication for his cervical radiculopathy after his 8th visit and the sensation in his right index finger and posterior wrist was back to normal. He was also back to full activities including exercise. Six months after his last Prolotherapy treatment he continues to do well.
Caring Medical has published dozens of papers on Prolotherapy injections as a treatment for difficult-to-treat musculoskeletal disorders. We are going to refer to our 2014 study where we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments.
In 2015, our research team published our findings in our paper “The biology of prolotherapy and its application in clinical cervical spine instability and chronic neck pain: a retrospective study.” This peer-review research was published in the European Journal of Preventive Medicine. (2)
Here we wrote: “In an effort to facilitate the diagnosis and treatment of clinical cervical spine instability and chronic neck pain, we investigated the role of proliferative injection Prolotherapy in the reduction of pain and recovery of constitutional and neurological symptoms associated with increased intervertebral motion, structural deformity and irritation of nerve roots. . . 95 percent of patients reported that Prolotherapy met their expectations in regards to pain relief and functionality.”
Ross Hauser MD, Cervical Radiculopathy Patient
Here is my own story:
In January 2008, I had the best race of my life when I ran a 1:29:53 and placed 82nd out of over 12,000 people in the Disney Half Marathon. I made the podium for my age group (45 to 49).
The next day I paced my wife, Marion, to a 5:11 marathon. Within a few weeks after this, I noticed severe pain in my right scapula after a swim workout. I was unable to do my planned workouts over the next few days as the pain grew worse.
Eventually, it was completely disabling, causing me to keep my neck flexed and often my right arm raised with my palm on the back of my head to provide relief. The pain was severe on the right side of my neck, and right scapula and felt like a hot poker digging into the back of my right hand, between my thumb and index finger. The pain was making work very difficult, and despite pain medication, the pain continued.
I eventually had an MRI and X-rays of my neck. The MRI showed no surgical lesions but did show extension degeneration bilaterally, especially in the C5-C6 region. (See Figure 1.)
The neck radiograph showed a straight cervical spine with loss of cervical lordosis and a posterior, right, superior C6 vertebra. (See Figure 2.)
Trying to choose the most conservative treatment, chiropractic, physiotherapy, high-velocity manipulation, and some physical therapy was done. After several weeks and a 50% reduction in the pain, a videofluoroscopic analysis was performed. This still showed a posterior right C6, but the alignment and motion of the upper cervical spine were improved. I was treated with the Pierce Technique of chiropractic. This had me to 85% improvement, but after a bike accident (yes, I was still training), I regressed back to severe neck, scapular, and arm pain. At this point, a series of Prolotherapy treatments were started using stronger solutions in the left lower cervical region to help with spinal alignment. The first Prolotherapy alone produced definite improvement. Within a couple of weeks after the first Prolotherapy treatment, I was back on my bike and exercising almost daily. By early April, I was back to Ironman training.
In total, I needed four Prolotherapy visits but I am happy to say that in July 2008, I completed the Ironman in Lake Placid, despite it pouring rain the whole time. After swimming 2.4 miles and cycling 112 miles in the pouring rain I was still able to run a 4-hour 20-minute marathon.
In this video, DMX displays Prolotherapy before and after treatments that resolved problems of a pinched nerve in the cervical spine
- In this video, we are using a Digital Motion X-Ray (DMX) to illustrate a complete resolution of a pinched nerve in the neck and the accompanying symptoms of cervical radiculopathy. A discussion of the Prolotherapy treatment is below.
- A before digital motion x-ray at 0:11
- At 0:18 the DMX reveals completely closed neural foramina and a partially closed neural foramina
- At 0:34 DXM three months later after this patient had received two Prolotherapy treatments
- At 0:46 the previously completely closed neural foramina are now opening more, releasing pressure on the nerve
- At 1:00 another DMX two months later and after this patient received four Prolotherapy treatments
- At 1:14 the previously completely closed neural foramina are now opening normally during motion
Our published research
References
1 Haładaj R, Pignot J, Pignot M. Quality of life assessment in patients with spinal radicular syndromes. Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego. 2015 Jan;38(223):20-5. [Google Scholar]
2 Hauser RA, Steilen D, Gordin K. The biology of Prolotherapy and its application in clinical cervical spine instability and chronic neck pain: a retrospective study. European Journal of Preventive Medicine. 2015 Jun 16;3(4):85-102. [Google Scholar]