Thursday, December 18, 2008

Pain may be defined as either an acute or chronic condition that can interfere with an individual’s overall mental state and daily activities such as work, recreation, and relaxation.

Acute Back Pain

The National Institute of Neurological Disorders and Stroke defines acute or short-term low back pain as generally lasting from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back or from a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight.1

Chronic Back Pain

The Mayo Clinic defines chronic back pain as “nonspecific” long lasting, recurrent pain usually present for three months or more. Chronic back pain is nonspecific because in most cases the cause is unknown or difficult to pin down.2 The constant presence of chronic pain can not only affect a person’s physical well being, but may also affect a person’s emotional state. Chronic pain does not normally respond to the same treatments used for acute pain. Physical causes of chronic pain and symptoms such as sciatica can often be attributed to degenerative disc disease, herniated/bulging discs, and posterior facet syndrome.

1. “NINDS Back Pain Information.” National Institute of Neurological Disorders and Stroke. Last Updated: April 24, 2007. Date Retrieved: May 11, 2007.

2. “Back Pain Guide.” Mayo -Tools for healthier lives. Date Created: May 12, 2006. Date Retrieved: May 11, 2007.

The DRX9000 True Non-Surgical Spinal Decompression System™ provides relief of pain and symptoms associated with herniated discs, bulging or protruding intervertebral discs, degenerative disc disease, posterior facet syndrome, and sciatica. It is a non-surgical and non-invasive therapy. The DRX9000™ works by applying forces to elongate the spine without causing the muscles guarding the spine to contract. This force is referred to as Spinal Decompression. The spinal elongation is maximized when paraspinal muscles, the muscles that guard the spine from injury, are relaxed. When paraspinal muscles relax, the DRX9000 Spinal Decompression forces spread apart the bony vertebra of the spine .

This relieves pressure on nerves and intervertebral discs. Where this spinal elongation occurs, pressure drops within the disc which facilitates movement of fluid, carrying nutrients and oxygen inside the disc.

Furthermore, the reduction in pressure can help draw in herniated disc fluids, reducing the size of the herniation. The technology required to apply spinal decompression therapy is extremely advanced.

The DRX9000 True Non-Surgical Spinal Decompression System™ utilizes high-speed treatment computers to calculate the logarithmic spinal decompression treatment curve for each patient. A servo-motor / servo amplifier takes the logarithmic curve and applies the forces to the patient. The servo-amplifier constantly checks (several thousand times per second) and corrects the servo-motor’s movement. With measurement devices inside the DRX9000™, changes in decompression forces experienced by each patient is monitored.

All of this data is constantly fed back into the treatment computers. The treatment computers continually calculate corrections and ensure the therapy is true to each patient’s logarithmic curve. This constant monitoring, measuring, and correcting process is called a Nested Closed-Loop Feedback System. This methodology is one of the hallmarks of the DRX9000™ technology.

Chiropractor NYC- Manhattan Physical therapy

Wednesday, December 10, 2008

Spinal Decompression NYC

Spinal decompresion-DRX 9000 NYC-

I read this great article today, It has an interesting point about MRI's and patient care. I want you to comment below.
I find that a MRI can provide important diagnostic information for patients that do not want to have back surgery but wants to get more information about his or her problem.
The more information you have about a specific condition the easier it is to treat.
Before I was a Chiropractor I worked as a MRI lab technician and worked with a Neuro Radiologist.

It is basically like looking into someones body and understanding what is mechanically wrong, Why should a Clinician or a patient get treatment without insight into their condition?
I also feel Digital Radiographs provide valuable information in deciding the appropriate course of treatment.

Pain relievers are helpful for the short term but ignoring your bodys signals is paramount to driving your car with the "check engine light" on and covering the light with black tape.
I work with a MD that is a Pain Management Specialist and often times patient need pain relief from pain relievers like Vicodin, Percoset and other Medicine.
This is not a solution and many patient cannot tolerate the side effects that go along with these medications.
Chiropractor NYC

The Pain May Be Real, but the Scan Is Deceiving
Published: Tuesday, December 9, 2008 at 5:08 a.m.
Last Modified: Tuesday, December 9, 2008 at 5:08 a.m.
Cheryl Weinstein’s left knee bothered her for years, but when it started clicking and hurting when she straightened it, she told her internist that something was definitely wrong.

Click to enlarge
SEEKING ANSWERS Cheryl Weinstein at the M.R.I. laboratory at Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
Stephanie Kuykendal for The New York Times

It was the start of her medical odyssey, a journey that led her to specialists, physical therapy, Internet searches and, finally, an M.R.I. scan that showed a torn cartilage and convinced her that her only hope for relief was to have surgery to repair it. But in fact, fixing the torn cartilage that was picked up on the scan was not going to solve her problem, which, eventually, she found was caused by arthritis.

Scans — more sensitive and easily available than ever — are increasingly finding abnormalities that may not be the cause of the problem for which they are blamed. It’s an issue particularly for the millions of people who go to doctors’ offices in pain.

The scans are expensive — Medicare and its beneficiaries pay about $750 to $950 for an M.R.I. scan of a knee or back, for example. Many doctors own their own scanners, which can provide an incentive to offer scans to their patients.

And so, in what is often an irresistible feedback loop, patients who are in pain often demand scans hoping to find out what is wrong, doctors are tempted to offer scans to those patients, and then, once a scan is done, it is common for doctors and patients to assume that any abnormalities found are the reason for the pain.

But in many cases it is just not known whether what is seen on a scan is the cause of the pain. The problem is that all too often, no one knows what is normal.

“A patient comes in because he’s in pain,” said Dr. Nelda Wray, a senior research scientist at the Methodist Institute for Technology in Houston. “We see something in a scan, and we assume causation. But we have no idea of the prevalence of the abnormality in routine populations.”

Now, as more and more people have scans for everything from headaches to foot aches, more are left in a medical lurch, or with unnecessary or sometimes even harmful treatments, including surgery.

“Every time we get a new technology that provides insights into structures we didn’t encounter before, we end up saying, ‘Oh, my God, look at all those abnormalities.’ They might be dangerous,” said Dr. David Felson, a professor of medicine and epidemiology at Boston University Medical School. “Some are, some aren’t, but it ends up leading to a lot of care that’s unnecessary.”

That was what almost happened with Mrs. Weinstein, an active, athletic 64-year-old who lives in London, N.H. And it was her great fortune to finally visit a surgeon who told her so. He told her bluntly that her pain was caused by arthritis, not the torn cartilage.

No one had told her that before, Mrs. Weinstein said, and looking back on her quest to get a scan and get the ligament fixed, she shook her head in dismay. There’s no surgical procedure short of a knee replacement that will help, and she’s not ready for a knee replacement.

“I feel that I have come full circle,” she said. “I will cope on my own with this knee.”

In fact, Mrs. Weinstein was also lucky because her problem was with her knee. It’s one of only two body parts — the other is the back — where there are good data on abnormalities that turn up in people who feel just fine, indicating that the abnormalities may not be so abnormal after all.

But even the data on knees comes from just one study, and researchers say the problem is far from fixed. It is difficult to conduct scans on people who feel fine — most do not want to spend time in an M.R.I. machine, and CT scans require that people be exposed to radiation. But that leaves patients and doctors in an untenable situation.

“It’s a concern, isn’t it?” Dr. Jarvik said. “We are trying to fix things that shouldn’t be fixed.”

As a rheumatologist, Dr. Felson saw patient after patient with knee pain, many of whom had already had scans. And he was becoming concerned about their findings.

Often, a scan would show that a person with arthritis had a torn meniscus, a ligament that stabilizes the knee. And often the result was surgery — orthopedic surgeons do more meniscus surgery than any other operation. But, Dr. Felson wondered, was the torn ligament an injury causing pain or was the arthritis causing pain and the tear a consequence of arthritis?

That led Dr. Felson and his colleagues to do the first and so far the only large study of knees, asking what is normal. It involved M.R.I. scans on 991 people ages 50 to 90. Some had knee pain, others did not.

On Sept. 11, Dr. Felson and his colleagues published their results in The New England Journal of Medicine: meniscal tears were just as common in people with knee arthritis who did not complain of pain as they were in people with knee arthritis who did have pain. They tended to occur along with arthritis and were a part of the disease process itself. And so repairing the tears would not eliminate the pain.

“The rule is, as you get older, you will get a meniscal tear,” Dr. Felson said. “It’s a function of aging and disease. If you are a 60-year-old guy, the chance that you have a meniscal tear is 40 percent.”

It is a result that paralleled what spine researchers found over the past decade in what is perhaps the best evidence on what shows up on scans of healthy people. “If you’re going to look at a spine, you need to know what that spine might look like in a normal patient,” said Dr. Michael Modic, chairman of the Neurological Institute at the Cleveland Clinic.

After Dr. Modic and others scanned hundreds of asymptomatic people, they learned abnormalities were common.

“Somewhere between 20 and 25 percent of people who climb into a scanner will have a herniated disk,” Dr. Modic said. As many as 60 percent of healthy adults with no back pain, he said, have degenerative changes in their spines.

Those findings made Dr. Modic ask: Why do a scan in the first place? There are some who may benefit from surgery, but does it make sense to routinely do scans for nearly everyone with back pain? After all, one-third of herniated disks disappear on their own in six weeks, and two-thirds in six months.

And surgeons use symptoms and a physical examination to identify patients who would be helped by operations. What extra medical help does a scan provide? So Dr. Modic did another study, this time with 250 patients. All had M.R.I. scans when they first arrived complaining of back pain or shooting pains down their leg, which can be caused by a herniated disc pressing on a nerve in the spine. And all had scans again six weeks later. Sixty percent had herniated disks, the scans showed.

Dr. Modic gave the results to only half of the patients and their doctors — the others had no idea what the M.R.I.’s revealed. Dr. Modic knew, though.

In 13 percent of the patients, the second scan showed that the herniated disk had become bigger or a new herniated disk had appeared. In 15 percent, the herniated disk had disappeared. But there was no relationship between the scan findings at six weeks and patients’ symptoms. Some continued to complain of pain even though their herniated disk had disappeared; others said they felt better even though their herniation had grown bigger.

The question, though, was whether it helped the patients and their doctors to know what the M.R.I.’s had found. And the answer, Dr. Modic reported, is that it did not. The patients who knew recovered no faster than those who did not know. However, Dr. Modic said, there was one effect of being told — patients felt worse about themselves when they knew they had a bulging disk.

“If I tell you that you have a degenerated disk, basically I’m telling you you’re ugly,” Dr. Modic said.

Scans, he said, are presurgical tools, not screening tools. A scan can help a surgeon before he or she operates, but it does not help with a diagnosis.

“If a patient has back or leg pain, they should be treated conservatively for at least eight weeks,” Dr. Modic said, meaning that they take pain relievers and go about their normal lives. “Then you should do imaging only if you are going to do surgery.”

That message can be a hard sell, he acknowledged. “A lot of people are driven by wanting to have imaging,” Dr. Modic said. “They are miserable as hell, they can’t work, they can’t sit. We look at you and say, ‘We think you have a herniated disk. We say the natural history is that you will get better. You should go through six to eight weeks of conservative management.’ ”

At the Partners Healthcare System in Boston, spine experts have the same struggle to convince patients that an M.R.I. scan is not necessarily desirable, said Dr. Scott Gazelle, director of radiology there.

“The consensus is that you are a surgical candidate or not based on your history and physical findings, not on imaging findings,” he said.

Dr. Gazelle had a chance last year to test his own convictions. He had the classic symptoms of a herniated disk — shooting pains down his left leg, a numb foot and difficulty walking.

Dr. Gazelle went to see his primary-care doctor but, he said, “I didn’t get an M.R.I.” That decision, he added, “was the right thing to do.”

About three months later, he had recovered on his own.

In 1998, two medical scientists, writing in The Lancet, proposed what sounded like a radical idea. Instead of simply providing patients and their doctors with the results of an X-ray or an M.R.I. scan, he said, radiologists should put the findings in context. For example, they wrote, if a scan showed advanced disk deterioration, the report should say, “Roughly 40 percent of patients with this finding do not have back pain so the finding may be unrelated.”

It is an idea that only would work for back pain, because that is the one area where radiologists have enough data. But it made eminent sense to Dr. Jarvik. “It gives referring physicians some sort of context,” he said.

So, a few years ago, with some trepidation, his radiology group starting including epidemiological data in their reports. “We thought, ‘What’s going to be the reaction among referring physicians?’ ” Dr. Jarvik said. Their fear was that doctors would start choosing other places for M.R.I.’s and that Dr. Jarvik’s group would lose business.

Because of the way the university’s records are kept, it’s hard to know whether the new reporting system had that effect, Dr. Jarvik said. But he was heartened by the responses of some doctors, like Dr. Sohail Mirza, who recently moved to Dartmouth Medical School.

“We often see patients who have already had M.R.I. scans,” Dr. Mirza said. “They are fixated on the abnormality and come to a surgeon to try to get the abnormality fixed. They’ll come in with the report in hand.”

The new sort of report, Dr. Mirza said, was “very helpful information to have when talking to patients and very helpful for patients to help them understand that the abnormalities were not catastrophic findings.”

Others, like Dr. Modic, are hesitant about reporting epidemiology along with a patient’s scan findings.

“It’s an interesting idea,” he said. But, he added: “The problem isn’t what happens after they get their imaging. It’s that they get the imaging in the first place.”

That was what happened with Mrs. Weinstein.

When she started looking up her symptoms on the Internet, she decided she probably had a meniscus tear. “I was very forceful in asking for an M.R.I.,” she said.

And when the scan showed that her meniscus was torn, she went to a surgeon expecting an operation.

He X-rayed her knee and told her she had arthritis. Then, Mrs. Weinstein said, the surgeon looked at her and said, “Let me get this straight. Are you here for a knee replacement?”

She said no, of course not. She skis, she does aerobics, she was nowhere near ready for something so drastic.

Then the surgeon told her that there was no point in repairing her meniscus because that was not her problem. And if he repaired the cartilage, her arthritic bones would just grind it down again.

For now, Mrs. Weinstein says she is finished with her medical odyssey.

“I continue to live with this, whatever they call it, this arthritic knee,” she said.

Wednesday, December 3, 2008

What is Spinal Decompression?

What is Spinal Decompression?
By Thomas A. Gionis, MD, JD, MBA, MHA, FICS, FRCS, and Eric Groteke, DC, CCIC

The outcome of a clinical study evaluating the effect of nonsurgical intervention on symptoms of spine patients with herniated and degenerative disc disease is presented.

This clinical outcomes study was performed to evaluate the effect of spinal decompression on symptoms and physical findings of patients with herniated and degenerative disc disease. Results showed that 86% of the 219 patients who completed the therapy reported immediate resolution of symptoms, while 84% remained pain-free 90 days post-treatment. Physical examination findings showed improvement in 92% of the 219 patients, and remained intact in 89% of these patients 90 days after treatment. This study shows that disc disease—the most common cause of back pain, which costs the American health care system more than $50 billion annually—can be cost-effectively treated using spinal decompression. The cost for successful non-surgical therapy is less than a tenth of that for surgery. These results show that biotechnological advances of spinal decompression reveal promising results for the future of effective management of patients with disc herniation and degenerative disc diseases. Long-term outcome studies are needed to determine if non-surgical treatment prevents later surgery, or merely delays it.

With the recent advances in biotechnology, spinal decompression has evolved into a cost-effective nonsurgical treatment for herniated and degenerative spinal disc disease, one of the major causes of back pain. This nonsurgical treatment for herniated and degenerative spinal disc disease works on the affected spinal segment by significantly reducing intradiscal pressures.1 Chronic low back pain disability is the most expensive benign condition that is medically treated in industrial countries. It is also the number one cause of disability in persons under age 45. After 45, it is the third leading cause of disability.2 Disc disease costs the health care system more than $50 billion a year.

The intervertebral disc is made up of sheets of fibers that form a fibrocartilaginous structure, which encapsulates the inner mucopolysaccharide gel nucleus. The outer wall and gel act hydrodynamically. The intrinsic pressure of the fluid within the semirigid enclosed outer wall allows hydrodynamic activity, making the intervertebral disc a mechanical structure.3 As a person utilizes various normal ranges of motion, spinal discs deform as a result of pressure changes within the disc.4 The disc deforms, causing nuclear migration and elongation of annular fibers. Osteophytes develop along the junction of vertebral bodies and discs, causing a disease known as spondylosis. This disc narrows from the alteration of the nucleus pulposus, which changes from a gelatinous consistency to a more fibrous nature as the aging process continues. The disc space thins with sclerosis of the cartilaginous end plates and new bone formation around the periphery of the contiguous vertebral surfaces. The altered mechanics place stress on the posterior diarthrodial joints, causing them to lose their normal nuclear fulcrum for movement. With the loss of disc space, the plane of articulation of the facet surface is no longer congruous. This stress results in degenerative arthritis of the articular surfaces.

This is especially important in occupational repetitive injuries, which make up a majority of work-related injuries. When disc degeneration occurs, the layers of the annulus can separate in places and form circumferential tears. Several of these circumferential tears may unite and result in a radial tear where the material may herniate to produce disc herniation or prolapse. Even though a disc herniation may not occur, the annulus produces weakening, circumferential bulging, and loss of intervertebral disc height. As a result, discograms at this stage usually reveal reduced interdiscal pressure.

The early changes that have been identified in the nucleus pulposus and annulus fibrosis are probably biomechanical and relate to aging. Any additional trauma on these changes can speed up the process of degeneration. When there is a discogenic injury, physical displacement occurs, as well as tissue edema and muscle spasm, which increase the intradiscal pressures and restrict fluid migration.6 Additionally, compression injuries causing an endplate fracture can predispose the disc to degeneration in the future.

The alteration of normal kinetics is the most prevalent cause of lower back pain and disc disruption and thus it is vital to maintain homeostasis in and around the spinal disc; Yong-Hing and Kirkaldy-Willis7 have correlated this degeneration to clinical symptoms. The three clinical stages of spinal degeneration include:

Stage of Dysfunction. There is little pathology and symptoms are subtle or absent. The diagnosis of Lumbalgia and rotatory strain are commonly used.

Stage of Instability. Abnormal movement of the motion segment of instability exists and the patient complains of moderate symptoms with objective findings. Conservative care is used and sometimes surgery is indicated.

Stage of Stabilization. The third phase where there are severe degenerative changes of the disc and facets reduce motion with likely stenosis.

Spinal decompression has been shown to decompress the disc space, and in the clinical picture of low back pain is distinguishable from conventional spinal traction.8,9 According to the literature, traditional traction has proven to be less effective and biomechanically inadequate to produce optimal therapeutic results.8-11 In fact, one study by Mangion et al concluded that any benefit derived from continuous traction devices was due to enforced immobilization rather than actual traction.10 In another study, Weber compared patients treated with traction to a control group that had simulated traction and demonstrated no significant differences.11 Research confirms that traditional traction does not produce spinal decompression. Instead, decompression, that is, unloading due to distraction and positioning of the intervertebral discs and facet joints of the lumbar spine, has been proven an effective treatment for herniated and degenerative disc disease, by producing and sustaining negative intradiscal pressure in the disc space. In agreement with Nachemon’s findings and Yong-Hing and Kirkaldy-Willis,1 spinal decompression treatment for low back pain intervenes in the natural history of spinal degeneration.7,12 Matthews13 used epidurography to study patients thought to have lumbar disc protrusion. With applied forces of 120 pounds x 20 minutes, he was able to demonstrate that the contrast material was drawn into the disc spaces by osmotic changes. Goldfish14 speculates that the degenerated disc may benefit by lowering intradiscal pressure, affecting the nutritional state of the nucleus pulposus. Ramos and Martin8 showed by precisely directed distraction forces, intradiscal pressure could dramatically drop into a negative range. A study by Onel et al15 reported the positive effects of distraction on the disc with contour changes by computed tomography imaging. High intradiscal pressures associated with both herniated and degenerated discs interfere with the restoration of homeostasis and repair of injured tissue.

Biotechnological advances have fostered the design of Food and Drug Administration-approved ergonomic devices that decompress the intervertebral discs. The biomechanics of these decompression/reduction machines work by decompression at the specific disc level that is diagnosed from finding on a comprehensive physical examination and the appropriate diagnostic imaging studies. The angle of decompression to the affected level causes a negative pressure intradiscally that creates an osmotic pressure gradient for nutrients, water, and blood to flow into the degenerated and/or herniated disc thereby allowing the phases of healing to take place.

This clinical outcomes study, which was performed to evaluate the effect of spinal decompression on symptoms of patients with herniated and degenerative disc disease, showed that 86% of the 219 patients who completed therapy reported immediate resolution of symptoms, and 84% of those remained pain-free 90 days post-treatment. Physical examination findings revealed improvement in 92% of the 219 patients who completed the therapy.

The study group included 229 people, randomly chosen from 500 patients who had symptoms associated with herniated and degenerative disc disease that had been ongoing for at least 4 weeks. Inclusion criteria included pain due to herniated and bulging lumbar discs that is more than 4 weeks old, or persistent pain from degenerated discs not responding to 4 weeks of conservative therapy. All patients had to be available for 4 weeks of treatment protocol, be at least 18 years of age, and have an MRI within 6 months. Those patients who had previous back surgery were excluded. Of note, 73 of the patients had experienced one to three epidural injections prior to this episode of back pain and 22 of those patients had epidurals for their current condition. Measurements were taken before the treatments began and again at week two, four, six, and 90 days post treatment. At each testing point a questionnaire and physical examination were performed without prior documentation present in order to avoid bias. Testing included the Oswetry questionnaire, which was utilized to quantify information related to measurement of symptoms and functional status. Ten categories of questions about everyday activities were asked prior to the first session and again after treatment and 30 days following the last treatment.

Testing also consisted of a modified physical examination, including evaluation of reflexes (normal, sluggish, or absent), gait evaluation, the presence of kyphosis, and a straight leg raising test (radiating pain into the lower back and leg was categorized when raising the leg over 30 degrees or less is considered positive, but if pain remained isolated in the lower back, it was considered negative). Lumbar range of motion was measured with an ergonometer. Limitations ranging from normal to over 15 degrees in flexion and over 10 degrees in rotation and extension were positive findings. The investigator used pinprick and soft touch to determine the presence of gross sensory deficit in the lower extremities.

Of the 229 patients selected, only 10 patients did not complete the treatment protocol. Reasons for noncompletion included transportation issues, family emergencies, scheduling conflicts, lack of motivation, and transient discomfort. The patient protocol provided for 20 treatments of spinal decompression over a 6-week course of therapy. Each session consisted of a 45-minute treatment on the equipment followed by 15 minutes of ice and interferential frequency therapy to consolidate the lumbar paravertebral muscles. The patient regimen included 2 weeks of daily spinal decompression treatment (5 days per week), followed by three sessions per week for 2 weeks, concluding with two sessions per week for the remaining 2 weeks of therapy

On the first day of treatment, the applied pressure was measured as one half of the person’s body weight minus 10 pounds, followed on the second day with one half of the person’s body weight. The pressure placed for the remainder of the 18 sessions was equivalent to one half of the patient’s body weight plus an additional 10 pounds. The angle of treatment was set according to manufacturer’s protocol after identifying a specific lumbar disc correlated with MRI findings. A session would begin with the patient being fitted with a customized lower and upper harness to fit their specific body frame. The patient would step onto a platform located at the base of the equipment, which simultaneously calculated body weight and determined proper treatment pressure. The patient was then lowered into the supine position, where the investigator would align the split of table with the top of the patient’s iliac crest. A pneumatic air pump was used to automatically increase lordosis of the lumbar spine for patient comfort. The patient’s chest harness was attached and tightened to the table. An automatic shoulder support system tightened and affixed the patient’s upper body. A knee pillow was placed to maintain slight flexion of the knees. With use of the previously calculated treatment pressures, spinal decompression was then applied. After treatment, the patient received 15 minutes of interferential frequency (80 to 120 Hz) therapy and cold packs to consolidate paravertebral muscles.

During the initial 2 weeks of treatment, the patients were instructed to wear lumbar support belts and limit activities, and were placed on light duty at work. In addition, they were prescribed a nonsteroidal, to be taken 1 hour before therapy and at bedtime during the first 2 weeks of treatment. After the second week of treatment, medication was decreased and moderate activity was permitted.

Data was collected from 219 patients treated during this clinical study. Study demographics consisted of 79 female and 140 male patients. The patients treated ranged from 24 to 74 years of age (see Table 1). The average weight of the females was 146 pounds and the average weight of the men was 195 pounds. According to the Oswestry Pain Scale, patients reported their symptoms ranging from no pain (0) to severe pain (5).

The patients were further subdivided into six groups:

single lateral herniation 67 cases
single central herniation 22 cases
single lateral herniation
with disc degeneration 32 cases
single central herniation
with disc degeneration. 24 cases
more than 1 herniation
with disc degeneration 17 cases
more than 1 herniation
without disc degeneration 57 cases

According to the self-rated Oswestry Pain Scale, treatment was successful in 86% of the 219 patients included in this study (Table 2, page 39). Treatment success was defined by a reduction in pain to 0 or 1 on the pain scale. The perception of pain was none 0 to occasional 1 without any further need for medication or treatment in 188 patients. These patients reported complete resolution of pain, lumbar range of motion was normalized, and there was recovery of any sensory or motor loss. The remaining 31 patients reported significant pain and disability, despite some improvement in their overall pain and disability score.

Diagnosis MRI
Results on self-rated Oswestry Pain Scale after treatment.
In this study, only patients diagnosed with herniated and degenerative discs with at least a 4-week onset were eligible. Each patient’s diagnosis was confirmed by MRI findings. All selected patients reported 3 to 5 on the pain scale with radiating neuritis into the lower extremities. By the second week of treatment, 77% of patients had a greater than 50% resolution of low back pain. Subsequent orthopedic examinations demonstrated that an increase in spinal range of motion directly correlated with an improvement in straight leg raises and reflex response. Table 2 shows a summary of the subjective findings obtained during this study by category and total results post treatment. After 90 days, only five patients (2%) were found to have relapsed from the initial treatment program.

Percentage of patients that had improved physical exam findings post treatment.
Ninety-two percent of patients with abnormal physical findings improved post-treatment. Ninety days later only 3% of these patients had abnormal findings. Table 3 summarizes the percentage of patients that showed improvement in physician examination findings testing both motor and sensory system function after treatment. Gait improved in 96% of the individuals who started with an abnormal gait, while 96% of those with sluggish reflexes normalized. Sensory perception improved in 93% of the patients, motor limitation diminished in 86%, 89% had a normal straight leg raise test who initially tested abnormal, and 90% showed improvement in their spinal range of motion.

In conclusion, nonsurgical spinal decompression provides a method for physicians to properly apply and direct the decompressive force necessary to effectively treat discogenic disease. With the biotechnological advances of spinal decompression, symptoms were restored by subjective report in 86% of patients previously thought to be surgical candidates and mechanical function was restored in 92% using objective data. Ninety days after treatment only 2% reported pain and 3% relapsed, by physical examination exhibiting motor limitations and decreased spinal range of motion. Our results indicate that in treating 219 patients with MRI-documented disc herniation and degenerative disc diseases, treatment was successful as defined by: pain reduction; reduction in use of pain medications; normalization of range of motion, reflex, and gait; and recovery of sensory or motor loss. Biotechnological advances of spinal decompression indeed reveal promising results for the future of effective management of patients with disc herniation and degenerative disc diseases. The cost for successful nonsurgical therapy is less than a tenth of that for surgery. Long-term outcome studies are needed to determine if nonsurgical treatment prevents later surgery or merely delays it.

Thomas A. Gionis, MD, JD, MBA, MHA, FICS, FRCS, is chairman of the American Board of Healthcare Law and Medicine, Chicago; a diplomate professor of surgery, American Academy of Neurological and Orthopaedic Surgeons; and a fellow of the International College of Surgeons and the Royal College of Surgeons.

Eric Groteke, DC, CCIC, is a chiropractor and is certified in manipulation under anesthesia. He is also a chiropractic insurance consultant, a certified independent chiropractic examiner, and a certified chiropractic insurance consultant. Groteke maintains chiropractic centers in northeastern Pennsylvania, in Stroudsburg, Scranton, and Wilkes-Barre.


Eyerman E. MRI evidence of mechanical reduction and repair of the torn annulus disc. International Society of Neuroradiologists; October 1998; Orlando.
Narayan P, Morris IM. A preliminary audit of the management of acute low back pain in the Kettering District. Br J Rheumatol. 1995;34:693-694.
McDevitt C. Proteoglycans of the intervertebral disc. In: Gosh, P, ed. The Biology of the Intervertebral Disc. Boca Raton, Fla: CRC Press; 1988:151-170.
Bogduk N, Twomey L. Clinical Anatomy of the Lumbar Spine. New York: Churchill Livingstone; 1991. Cox JM. Low Back Pain: Mechanism, Diagnosis, and Treatment. 5th ed. Baltimore: Williams & Wilkins; 1990:69-70, 144. Cyriax JH. Textbook of Orthopaedic Medicine: Diagnosis of Soft Tissue Lesions. Vol 1. 8th ed. London: Balliere Tindall; 1982. Nachemson AL. The lumbar spine, an orthopaedic challenge. Spine. 1976;1(1):59-69. Ramos G, Martin W. Effects of vertebral axial decompression on intradiscal pressure. J Neurosurgery. 1994;81:350-353. Shealy CN, Leroy P. New concepts in back pain management: decompression, reduction, and stabilization. In: Weiner R, ed. Pain Management: A Practical Guide for Clinicians. Boca Raton, Fla: St Lucie Press; 1998:239-257.
Pal B, Mangion P, Hossain MA, et al. A controlled trial of continuous lumbar traction in back pain and sciatica. Br J Rheumatol. 1986;25:181-183.
Weber H. Traction therapy in sciatica due to disc prolapse. J Oslo City Hosp. 1973;23(10):167-176. Yong-Hing K, Kirkaldy-Willis WH. The pathophysiology of degenerative disease of the lumbar spine. Orthop Clin North Am. 1983;14:501-503. Matthews J. The effects of spinal traction. Physiotherapy. 1972;58:64-66.
Goldfish G. Lumbar traction. In: Tollison CD, Kriegel M, eds. Inter- disciplinary Rehabilitation of Low Back Pain. Baltimore: Williams & Wilkins; 1989.
Onel D, Tuzlaci M, Sari H, Demir K. Computed tomographic investigation of the effect of traction on lumbar disc herniations. Spine. 1989; 14(1):82-90.

Non surgical spinal decompression.