As a conservative spine care doctor, I often encounter patients with both lumbar and cervical disc herniations. These patients usually have an MRI, which is how they find out they have a disc herniation. Currently, the standard of care for a disc herniation is a trial of physical therapy, which lasts 6-8 weeks. In many cases, patients come to my clinic after physical therapy was deemed unsuccessful. What clinicians have to understand is that there is likely, based on medical research, an underlying inflammatory process that occurs with a herniated disc.
Treatments like non-surgical spinal decompression using the DRX-9000, an FDA-cleared technology, can be effective at decreasing the intradiscal pressure. In fact, it is the leading non-invasive procedure to heal the disc naturally without addictive opioids, risky epidural injections, or surgery. However, some patients can experience residual symptoms due to chemical irritation or inflammation. This is quite common with disc herniations and is difficult to quantify. The market for medical devices to address the issue of inflammation is loaded with many options. In my practice, I’m always looking for the latest and greatest treatment to help my patients. I also take into account the research that has been done on said device and if it has been cleared by the FDA or not.
Class IV laser therapy has been vital to my patients experiencing faster healing times and decreasing residual symptoms. There are several different types of non-invasice laser treatments on the market. Class IV lasers are the strongest non-surgical lasers available on the market today. I prefer to use Class IV lasers because I have found them to be the most useful. Without getting too technical, class IV laser therapy can help manage inflammation through the three primary mechanisms of action.
- Increase in ATP
- The main energy source for the majority of cellular functions is ATP
- This increases the cell’s ability to fight infection and accelerates the healing process
- Modulation of ROS
- This activates transcription factors which has a positive impact on cellular repair and healing
- Release of Nitric Oxide
- NO is a potent vasodilator
- This increses circulation, decreases inflammation, and enhances the transport of oxygen
While disc herniations, can be painful and concerning, it’s essential to understand the underlying processes and potential treatment options. In this blog post, you’ll come to understand the inflammatory process associated with lumbar disc herniations and how specific treatments, like Class IV laser therapy, can help manage this inflammation.
The Inflammatory Process in a Disc Herniation
A disc herniation in either the cervical or lumbar spine triggers a complex inflammatory response in the body. This inflammation naturally occurs whichncontributes to pain and discomfort. Let’s break down what happens:
1. Initial Injury: When the intervertebral disc herniates, it releases its inner contents (nucleus pulposus) into the surrounding area.
2. Immune Response: The body recognizes this as foreign material and initiates an immune response.
3. Inflammatory Mediators: Various inflammatory substances are released, including:
– Interleukins (IL-1β, IL-6, IL-8)
– Tumor Necrosis Factor-alpha (TNF-α)
– Prostaglandin E2 (PGE2)
– Matrix Metalloproteinases (MMPs)
4. Cellular Infiltration: Immune cells, particularly macrophages, infiltrate the area.
5. Pain Sensitization: These inflammatory mediators can sensitize nerve endings, increasing pain perception.
Inflammatory Biomarkers
Recent research has identified several critical inflammatory biomarkers associated with intervertebral disc herniation:
– **Interleukin-1β (IL-1β)**: This cytokine plays a crucial role in the inflammatory cascade and can contribute to disc degeneration[3].
– **Tumor Necrosis Factor-alpha (TNF-α)**: TNF-α levels have been found to correlate with post-operative pain severity in disc herniation patients[3].
– **Matrix Metalloproteinases (MMPs)**: These enzymes are involved in the breakdown of extracellular matrix components and are elevated in herniated discs[3].
– **Prostaglandin E2 (PGE2)**: This inflammatory mediator is associated with pain and can increase nerve sensitivity[3].
Class IV Laser Therapy and Inflammation Reduction
One promising treatment option for managing the inflammation associated with intervertebral disc herniations is Class IV laser therapy. Here’s how it works:
1. Photobiomodulation: The energy emitted from the 45 watt laser penetrates deep into the tissues, interacting with cells at a molecular level. The depth of penetration is significant with Class IV lasers. This will penetrate approximately 50 times (50x) deeper than a heating pad.
2. Reduced Inflammatory Mediators: Laser therapy has decreased the production of pro-inflammatory cytokines like IL-1β and TNF-α[1][2].
3. Enhanced Cellular Function: The laser energy stimulates mitochondrial activity, promoting cellular repair and reducing oxidative stress.
4. Improved Blood Flow: Laser therapy can increase local blood circulation, helping to remove inflammatory mediators and promote healing.
5. Pain Modulation: Laser therapy can decrease pain sensitivity by reducing inflammation and promoting tissue repair.
While more research is needed to fully substanstiate the effects of Class IV laser therapy on specific inflammatory biomarkers in intervertebral disc herniations, current anecdotal evidence shows it is a powerful tool in managing inflammation and promoting healing. I have seen the effectivness of this treatment firsthand. I started treating disc herniations in 2022. Though I was introduced to laser therapy during my training at Logan University in St. Louis, MO I didn’t have any hands-on, real-world experience. By the time I invested in this technology and brought it into my practice, I had already completed 2,500 Non-Surgical Spinal Decompression treatments utilizing the DRX-9000. As of this writing (September 2024), I have performed just over 6,000 Non-Surgical Spinal Decompression treatments. I can honestly say that since utilizing the Class IV laser, my patients now are feeling better quicker and experiencing less residual symptoms. Within 30 days of ordering my first Class IV laser, I ordered my second laser because I saw how much this would change my practice.
Remember, every patient’s situation is unique, and it’s essential to consult with a qualified healthcare professional to determine the most appropriate treatment plan for your specific condition.
Citations:
[1] https://pubmed.ncbi.nlm.nih.gov/9726337/
[2] https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-018-1743-4
[3] https://www.nyp.org/advances-orthopedics/investigating-inflammatory-cytokines-in-disc-herniation
[4] https://www.sciencedirect.com/science/article/abs/pii/S2529849620300101
[5] https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-022-02894-8
[6] https://www.aans.org/patients/conditions-treatments/herniated-disc/
[7] https://nyulangone.org/conditions/herniated-disc/treatments/nonsurgical-treatments-for-herniated-disc
[8] https://www.sciencedirect.com/science/article/pii/S0049017298800292
