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Spine Prolotherapy
Prolotherapy is a non-surgical treatment that uses injections to stimulate healing of injured ligaments in the spine. The injections cause a controlled inflammatory response that triggers the healing process and increases the body's natural production of collagen to strengthen ligaments over time. Studies show prolotherapy provides significant and sustained relief of neck and back pain for many patients, with up to 85-90% reporting good to excellent results. It is a safe and effective treatment option that can help avoid or reduce the need for surgery in many spinal conditions involving ligament laxity or injury.
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Introduction to spinal prolotherapy as an adjunct treatment in spine management, presented by Mohamed Mohi Eldin.
Discussion on neglected ligaments, their function, healing challenges, and outcomes of ligament laxity, including symptoms of pain and mobility issues.
Exploration of distinct symptoms from traumatic and degenerative ligament laxity affecting neck and low back, including muscle spasms and limitations.
Details on various ligament injuries affecting spinal structures, including scenarios of anterolisthesis and foraminal encroachment.
Explanation of prolotherapy and its phases, emphasizing inflammation as critical for ligament healing and support.
Presentation of prolotherapy as a safe, elegant treatment for spine pain, its evolution, and its modern applications.
List of conditions treated by prolotherapy with high success rates (85-90%), addressing ligament overload and pain.
Detailed treatment protocol including contraindications, post-procedure care, and results from treatment demonstrating significant pain relief.
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Spine Prolotherapy
- 1. Spinal Prolotherapy A goodAdjuvant in spine management Mohamed Mohi Eldin Professor of Neurosurgery, Cairo University, Egypt
- 2. The Neglected Ligaments Ego(Brain, Cord, Spine Surgery) !! No attraction Left unrecognized or untreated, Unfortunately, function of muscles is joint movement and only incidentally joint stabilization.
- 3. Spinal Ligaments arethere !! Stores of elastic energy, Plastic, semi elastic, interwoven “collagen” threads connecting bone to bone, form joints in some regions.
- 4. Ligaments Do not healwell ( lack of blood supply). Ligaments bend, but do not stretch. They have nerve endings sensitive to stretching, tearing, pressure, etc.
- 5. Ligament damaged by Trauma(Popping), Degeneration (cracking), or day-to-day wear & tear.
- 6. Ligaments Tear Ligaments healin elongated, disorganized fashion resulting in: excessively mobile joint, poorly supported by its ligaments and dependent on muscles to maintain stability.
- 7. Ligament Laxity Results inhypermobile joints and segments causing: Pain with activities Grinding sensation Numbness and pain in a non-dermatomal pattern Temporary benefit from bracing
- 8. Ligament Laxity Spinal orarthritic pain frequently has a component of ligament laxity.
- 9. Distinct clinical characteristics Posain Persistentpain on maintaining one position for a long time.
- 10. Distinct Referral Pattern Nulliness –a numb-like feeling – in the same distribution as posain – without neurologic deficit.
- 11. Traumatic Ligament Laxity Neck& Low back Scenario Tear from microscopic to total disruption Muscles goes into spasm, to protect the injured joint Resulting in aberrant positions, impairing circulation, limiting movement, Ending in pain.
- 12. Degenerative Ligament Laxity Neck& Low back Scenario With age, poor posture, injuries and degeneration Ligaments stretched and weak. With destabilization of the vertebral column, Muscles contract, locking the joints Joints displaced horizontally in a non-physiologic lock More pain, more spasm, PAIN.
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- 14. Interspinous and Supraspinatous LigamentInjury Fanning of the Spinous Processes
- 15. Anterior Longitudinal Ligament AnteriorDisc Space Widening ON EXTENSION
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- 18. Facet Capsule andMany Ligaments Foraminal Enchroachment
- 19. Prolotherapy…The Idea INFLAMMATION ANDHEALING Three overlapping stages 1. Inflammation phase: (4 days), 2. Granulation phase: (10-14 days), 3. Wound contraction phase: (3-6 Weeks)
- 20. Prolotherapy…The Idea Fibroblasts (Ligamentousbuilding blocks) New collagen fibers organized into ligaments, Winding, contracting, expressing fluid, becoming shorter Tightening the support of the joint. Typical Inflammatory Repair Response
- 21. Prolotherapy…The Definition A formof injection aimed at the ligaments, inviting inflammation, and aiming at healing (proliferate, stimulate growth, regenerate, and rebuild)
- 22. Prolotherapy…The Definition A naturalhealing stimulation of the body's own temporary, controlled, gentle low-grade healing ability; Through micro-injections of natural chemical and physical irritants, to stimulate repair of, and strengthen damaged or weakened tendons and ligaments With minimal discomfort.
- 23. Regenerative Tissue Therapy forstrained ligaments An elegant, Effective, Safe, Cost effective way to treat neck and back pain
- 24. Prolotherapy…The Target Ligaments returnedto their normal length and strength and the joint to its normal function. Reconstructive Ligament Therapy
- 25. Sacroiliac ligament biopsy (volunteers) Increasedcells and collagen deposited baseline 3 months post injection
- 26. Early Inflammation isneeded for Healing Hence for Prolotherapy Anti-inflammatory agents interfere with the healing cascade
- 28. Prolotherapy…The History First usedin ancient times Amenhotep III (Egypt) “…giving fire to his horses”. Hippocrates around 400 B.C. described the insertion of hot needles into tissue to create small amounts of scar tissue around.
- 29. Prolotherapy…The History • Evolvedin 1930s before modern surgical techniques • Dr. George Hackett, in 1950s, refined the procedure and described its use, causing a controlled rate of inflammation and healing.
- 30. Prolotherapy…The Name Old nameSclerotherapy evolved from Scar Therapy; However, Modern Prolotherapy does not provoke scars. Hypertrophy is achieved without scarring. It is now called, Reconstructive or Regenerative therapy.
- 31. Prolotherapy…Many Names Nonsurgical reconstructivetherapy, Prolotherapy, Proliferative therapy, Regenerative ligament therapy, Reconstructive ligament therapy
- 33. Reconstructive Ligament Therapy Doesn'tcorrect mechanical problems like spinal stenosis, Nor does it reverse arthritic changes.
- 34. Prolotherapy… Indications • Sacroiliacsprains or strains • Hyperextension or hyperflexion • Lumbar facet syndrome • Failed back syndrome • Straight back syndrome • Regional myofascial pain syndrome • Fibromyalgia • Spondylolysis • Spondylolisthesis • Compression fractures • Lumber enthesopathy • Whiplash injury
- 35. Published Clinical Benefits (inrespected medical journals) Spells RELIEF For more than sixty years With up to 85-90% good to excellent results that a degree of enthusiasm was generated. WHY NOT TO USE IT
- 36. We Believe That Ligamentscan hurt & are subject to overstrain Irreversible ligaments strain, and laxity are important parts of most spinal traumatic or degenerative pathologies. Prolotherapy is noninvasive with minimal risk, provide pain relief, and sometimes cure, for various forms of spinal pain.
- 37. Prolotherapy… as a Monoor Adjuvant Therapy
- 38. Prolotherapy… Treatment Protocol Ensurea true ligament insufficiency Stimulate a limited inflammatory response, Trigger the healing cascade Increase fibroblastic activity & collagen deposition Strengthen ligamentous structures Relieve pain
- 39. Prolotherapy… Contraindications • Immunocompromised, •Smokers, • Poor nutritional status, • Insufficient conservative treatment, • Needle phobia, • Allergy to proliferant solution.
- 40. Prolotherapy… Preparation No aspirin,anti-inflammatory or anticoagulant medications for 3 days. No pain medications prior to procedure. It is important to be in pain at the time of the procedure. Insulin & oral diabetes medications take usual dose. Patients taking cardiac or blood pressure medications may take usual dose.
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- 42. The Procedure… BlindTechnique One of the commonly used is high concentration dextrose. The injections may take many sessions.
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- 44. Prolotherapy… Post-Procedure No drivingafter the procedure. No anti-inflammatory drugs for 5 days after injections. Paracetamol is accepted. Light activity for 3 days Resume normal activities on day 4 following treatment Patient may have increased soreness and stiffness averaging 2 days post procedure.
- 45. Prolotherapy… Complications • Increasedpain • Dizziness and nausea • Numbness • No scaring • No infection • No abscess • No weakness • No spinal headache • No allergic reactions • No other disability
- 46. Prolotherapy… Results Significant andsustained reductions in neck & low back pain were observed for 1 year follow up: 50% reported 85% improvement, 24% reported 75% improvement, 20% reported 60% improvement, and 6% reported no improvement.
- 47. Prolotherapy… Conclusions A safeand effective treatment for spinal pain . A superior treatment option compared to drugs which interfere with the inflammatory pathways of healing. Should be considered a good tool in in the hand of spine surgeons.
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