1. 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

2. 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

3. 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

4. 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

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

6. Spine Structures

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

8. Arthritis

9. Disc Degeneration

10. Exam Under Fluoroscopy

11. Exam Under Fluoroscopy

12. 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

13. Facet Joint Injection

14. Lumbar Facet Joint Injections

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

16. Medial Branch Block

17. Facet Joint Medial Branches

18. Lumbar Radiofrequency Neurotomy

19. 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

20. 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.

21. 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

22. Case 2

23. Case 2

24. Case 2

25. Case 2

26. 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

27. Interlaminar Epidural Steroid Injection

28. Transforaminal Epidural Steroid Injection

29. 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.

30. Disc Herniations Unresponsive to Injections

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

32. Thank you!
Questions?