Chiropractic & Pain Case Studies Advances In Interventional Pain Management Omid Ghalambor, MD, DABA, FIPP, DABIPP, DABPM Chiropractic & Pain Case Studies 7/28/16 Brett Stephens, DC Omid Ghalambor, MD

Case 1 44 year old male truck driver Complaining of low back pain of long standing constant low grade daily pain with recent gradual worsening Worse with sitting and bending Better with heat

Case 1 Previous treatments: Stretch, over the counter meds (NSAIDS, Tylenol) Exam suggestive of diffuse low back pain, neurological exam intact, good range of motion 8 session of adjustments

Case 1 Patient’s pain improved both in intensity, frequency and the area of pain was significantly reduced Motion of the spine upon palpation normalized However, patient continued to have pain in a focal area left low back

Case 1 Back Pain Affects 2/3 of adults 2nd most common reason for physician visit Most common reason for work disability

Spine Structures

Spine Structures Disc > Degeneration/ Herniation Joints > Arthritis Bone > Compression Fracture Ligaments and Tendons > Sprain/ Strain

Arthritis

Disc Degeneration

Exam Under Fluoroscopy

Exam Under Fluoroscopy

Case 1 Patient underwent left sided L3/4 and L4/5 lumbar facet injections Per patient request the procedure was done with local anesthesia only

Facet Joint Injection

Lumbar Facet Joint Injections

Case 1 Immediate post op response 100% pain relief 2 weeks later patient still has no back pain but continues to get adjustments

Medial Branch Block

Facet Joint Medial Branches

Lumbar Radiofrequency Neurotomy

Case 2 34 year old male coming from ER with diagnosis of sciatica Complaining of severe 8/10 VAS Low back right buttock and leg pain Started 3 weeks prior after playing softball. He was then also involved in a MVA a week prior to visit, which worsened symptoms

Case 2 Did complete exam. Disc Suspected Gave patient choice of daily chiro visits or to see pain and begin chiro once severe pain has decreased. He chose pain.

Case 2 Normal neurological exam Positive straight leg raise test at 15 degrees on the right side. Started on NSAIDs, muscle relaxant and low dose narcotics Ordered MRI

Case 2

Case 2

Case 2

Case 2

Case 2 L3/4 Right paracentral disc protrusion/extrusion as well as annular tear L4/5 Central to right paracentral disc extrusion as well as annular tear

Interlaminar Epidural Steroid Injection

Transforaminal Epidural Steroid Injection

Case 2 Patient reported 70% to 80% relief of pain from his first transforaminal epidural steroid injection; but continues to have tingling in the foot. He recently received his second epidural steroid injection. Based on his response to 1st injection, likely wouldn't need a spine surgeon involvement.

Disc Herniations Unresponsive to Injections

New Approach: Ultra Minimally Invasive The size of a #2 pencil

Thank you! Questions?