Spinal Injections for Functional Gastrointestinal Disorders

Abstract

Purpose: Several functional GI disorders have been successfully treated by injections into posterior spinal ligamentous structures. Cases of GERD, IBS, recurrent daily vomiting and esophageal spasm have all been resolved with injections of hypertonic solutions that induce an inflammatory repair of these ligaments. This stops somatic nociception which is known to sensitize spinal cord neurons to colonic distention. Methods: Interspinous ligaments and bilateral facet joint capsules of various thoracic and/or lumbar spinal segments were injected with 1–2 ccs of a 25% dextrose and 0.5% lidocaine solution using fluoroscopic guidance. Results: Case 1 GERD Hx Pt is a 54 y.o. female with a multi-year Hx of daily epigastric pain associated with reflux. Daily esomeprazole would mostly control these symptoms except when exacerbated by spicy foods or tomato based sauces. Severe epigastric pain ensued hours after missing a dose of esomeprazole. Upper and lower endoscopy revealed only mild esophagitis and gastritis. Tx Injected from T2 through T6 and between T10 and S1. Results Complete resolution of all symptoms for over three years. Case 2 IBS Hx Pt is a 43 y.o. female with a several year Hx of constipation predominant IBS. Several days after the previous bowel movement she would develop nausea, occasional vomiting, anorexia, cramping, bloating and abdominal pain relieved by passing hard stools followed by diarrhea. Tx Injected at L5-S1, both sacroiliac joints and between T4 and T10. Results Complete resolution of all symptoms for last three years. Case 3 Recurrent daily vomiting Hx Pt is a 55 y.o. male who would have bouts of vomiting two or three times per day with little warning for years. Extensive work-up including blood chemistry, upper and lower GI endoscopy were negative. Tx Twice injected at T1-T12 and all rib joints. Results Complete resolution of his symptoms for last 11 months. Case 4 Esophageal spasm Hx Pt is a 45 y.o. female who has a multi-year history of dysphagia associated with the sensation of food sticking substernally. After an initial swallow, she would sometimes regurgitate triggering coughing spells. Complaints of substernal pressure led to a negative cardiac, pulmonary and upper GI endoscopic work-up. Tx Injected between C2 and L1 all rib joints. Results Complete resolution of all symptoms for last 10 months. Conclusion: These case studies demonstrate a safe and effective treatment for various functional GI disorders. Additionally, these cases imply that the visceral symptom generation and adverse GI motility seen in the functional GI disorders may be induced by abnormal somatic posterior spinal afferentation. This may occur via viscerosomatic convergence that occurs normally in the spinal cord.