Osteonecrosis means death of bone which can occur from the loss of the blood supply or by some other means. It has been known by a number of other names including ischemic necrosis of bone, aseptic necrosis or avascular necrosis (AVN). AVN has been quite popular in its use because it is shorter to say and write. More recently the term ON (osteonecrosis) has been adopted.

Unfortunately many patients with ON have had the disease for quite some time before symptoms are present. The initial symptoms are usually felt during activity and include pain or aching in the affected joint. Symptoms usually begin slowly and may initially be sporadic. Sometimes, the pain may begin quite suddenly. As the disease progresses, the pain increases and is associated with stiffness and loss of motion of the involved joint. Limping becomes common. The hip is the most common joint affected, and the pain is usually felt in the groin.

There are no established pharmaceuticals (drugs) for the prevention or treatment of osteonecrosis. In order to treat the disease, we must first understand how the disease develops. In spite of considerable effort by researchers, we still do not know for sure what causes some forms of osteonecrosis (that is, the forms that are not a result of a fracture or radiation).

Bisphosphonates

Bisphosphonates are a class of drugs that have been used to treat osteoporosis – a disease that is characterized by a low bone mass. Recently, in an effort to reduce bone loss, one bisphosphonate - alendronate has been evaluated in 60 patients diagnosed with osteonecrosis of the hip10. All patients had symptomatic improvement at one year. Although the follow-up time ranged from three months to five years, only six patients (ten hips) progressed to the point of needing surgery. It is important to note that these patients were also instructed to avoid bearing weight on their affected hip. Recently, concern has been raised relating to a possible association between bisphosphonate therapy and an increased incidence of osteonecrosis of the jaw11,12. Further study is needed to clarify this possible complication.

http://www.nonf.org/nofbrochure/nonf-brochure.htm

Symptoms include, but are not limited to:
•pain, swelling, or infection of the gums or jaw
•gums that are not healing
•loose teeth
•numbness or a feeling of heaviness in the jaw
•drainage
•exposed bone

Most cases of osteonecrosis of the jaw associated with bisphosphonates have been diagnosed after dental procedures such as tooth extraction; however the condition can also occur spontaneously. Also, invasive dental procedures, such as extractions or other surgery that affects the bone can worsen this condition.

Because osteonecrosis of the jaw is rare, researchers can not yet predict who, among users, will develop it.

If you receive intravenous bisphosphonates (or received them in the past year) and experience any of these or other dental symptoms, tell your oncologist and your dentist immediately.

More rarely, osteonecrosis of the jawbone has occurred in patients taking oral bisphosphonates.

Because osteonecrosis of the jaw is rare, researchers can not yet predict who, among users, will develop it. To diagnose osteonecrosis of the jaw, doctors may use x-rays or test for infection (taking microbial cultures).

The consensus is that good oral hygiene along with regular dental care is the best way to lower your risk of developing osteonecrosis.

http://www.ada.org/public/topics/osteonecrosis.asp

—————

The concern, does the taking of oral bisphosphonates to treat osteoporosis outweigh the risk for osteonecrosis of the jaw? Given that it is apparently rare.

It is my understanding to be effective spinal injections should provide pain relief for six months or more.

I found the following online article.

Lumbar epidural lysis: a cranio-caudal lateral intralaminar approach

The standard approach for epidural lysis is reaching to the problematic area through the caudal canal. If the symptoms do not cease and no improvement is seen, a cranio-caudal approach can be tried. In a patient with back pain due to failed back surgery syndrome for six months, epidurography was performed using caudal approach under fluoroscopy in the first intervention. A catheter was progressed to fibrotic tissue for epidural lysis. But the pain regression was not satisfactory at the L4 dermatome. After 3 weeks, a second intervention was planned with the lateral cranio-caudal approach at the L3-4 level and a catheter was placed around the fibrotic tissue and lysis was applied. The patient’s back pain totally disappeared and neurological symptoms started to decrease at the end of the first week. We suggest that, for patients with low back pain due to failed back surgery syndrome, a cranio-caudal approach may be applied after caudal epidural lysis.

http://www.ingentaconnect.com/content/maney/tpc/
2005/00000017/00000002/art00017

My CSF Protein value of 57 which was flagged as abnormally Out Of Range of the MG/DL 12-45 Within Range levels.

I found the following research.

* Total protein levels in CSF are normally very low, and albumin makes up approximately two-thirds of the total. High levels are seen in many conditions, including diabetes, bacterial and fungal meningitis, tuberculosis meningitis, multiple sclerosis, polyneuritis, cancer, tumor, injury, or any inflammatory or infectious condition.

* Lumbar disc herniation with sciatica may be associated with increased CSF total protein.

* Inositol and creatinine were reduced in patients with disc herniation.

My previous blood lab reports have indicated my creatinine levels flagged as abnormally low.

http://www.back.com/articles-trial.html