Enhanced Spinal Therapy: Extracorporeal Shock Wave Therapy for the Spine.

Brian Fiani,Christina M Moawad,Daniel W Griepp,Cyrus Davati,Jason Lee,Elisabeth Pennington

doi:10.7759/cureus.11200

Abstract

Extracorporeal shock wave therapy (ESWT) is a non-invasive therapeutic method used for pain management and muscle strength improvement through the use of shock waves. In vitro studies have demonstrated that shockwave therapy induces fluctuation in redox reaction regulation and increases in Mitogen-Activated Protein Kinase (MAPK) signal transduction pathways, stimulating increased gene expression in the nucleus. ESWT has also been shown to upregulate angiogenesis and growth factors through activation of endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF). The use of ESWT in the treatment of various musculoskeletal disorders was widely adopted throughout Europe, South America, and Asia before being introduced in the United States in 2000. Within the past 20 years, the clinical application of ESWT in the treatment of musculoskeletal and bone disorders has grown. This paper provides a comprehensive narrative review of applications and outcomes of ESWT in clinical spinal pathology and assesses reported efficacy as it relates to the pathology. A review of the literature yielded studies describing the use of ESWT in degenerative osteoporotic neuro-spinal pathology, heterotopic ossification due to spinal cord injury, cervical spondylosis, scoliosis, sacroiliitis, and coccydynia. The efficacy of ESWT as an adjunct treatment in patients with spinal cord pathologies varied with the specific pathology, however, all pathologies discussed in this review provided evidence of potential benefits with minimal adverse effects. While the use of ESWT for pain management has widely been established, further literature should aim to identify the long-term benefits of ESWT.

Highlights

BackgroundExtracorporeal shock wave therapy (ESWT) is a non-invasive therapeutic method used for pain management and muscle strength improvement through the use of shock waves to promote revascularization [1]
The efficacy of ESWT as an adjunct treatment in patients with spinal cord pathologies varied with the specific pathology, all pathologies discussed in this review provided evidence of potential benefits with minimal adverse effects
ESWT for the treatment of pain secondary to heterotopic ossification due to spinal cord injury was found to be effective through continued use of ESWT, as indicated by decreased VAS scores reported by patients and decreased neurogenic heterotopic ossification (NHO) measurements

Summary

Introduction

Extracorporeal shock wave therapy (ESWT) is a non-invasive therapeutic method used for pain management and muscle strength improvement through the use of shock waves to promote revascularization [1]. ESWT in spinal cord injury (SCI) far has been targeted towards treating pain due to neurogenic heterotopic ossification (NHO), which is pathologic ectopic bone formation in soft tissues that sometimes follows central nervous system damage [21, 22] This often forms around the hip joint muscles, as in the two reported cases treated with ESWT, causing significant pain and hindrance of range of motion and mobility [23, 24]. This study demonstrated ESWT as an effective adjuvant treatment to achieve pain reduction, improved ROM, and lower NDI scores in patients with cervical spondylosis and calcification of the nuchal ligament. The authors of this review believe that these five studies on coccydynia show strong support for continued use of ESWT in coccydynia, continued research into the duration of ESWT effect should be pursued

Conclusions

Disclosures

Findings

Wang C-J