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Back Pain


Did you know that an estimated 75 to 85 percent of all Americans will experience some form of back pain during their lifetime? Most certainly low back pain can be quite debilitating and painful. Good news, most cases respond well with non-surgical treatment. However, it has been estimated that 50 percent of all patients who suffer from an episode of low back pain will have a recurrent episode within one year.

The costs associated with diagnostic procedures alone are estimated at $50 billion yearly. Back pain is one of the most common reasons for missed work. In fact, back pain is the second most common reason for visits to the doctor's office, outnumbered only by upper-respiratory infections. The personal costs are immeasurable from chronic pain alone, pain sometimes so great that it interferes with a healthy and satisfying lifestyle.

Also, it is recognized that most cases of back pain are mechanical in nature, and the pain is usually not caused by very serious conditions, such as cancer, fracture, infection, etc. The anatomy of the spine and the many conditions that negatively impact spinal health are complex. The following information provides a simplistic explanation of the causes for back pain: Did you know that an estimated 75 to 85 percent of all Americans will experience some form of back pain during their lifetime? Most certainly low back pain can be quite debilitating and painful. Good news, most cases respond well with non-surgical treatment. However, it has been estimated that 50 percent of all patients who suffer from an episode of low back pain will have a recurrent episode within one year.

The costs associated with diagnostic procedures alone are estimated at $50 billion yearly. Back pain is one of the most common reasons for missed work. In fact, back pain is the second most common reason for visits to the doctor's office, outnumbered only by upper-respiratory infections. The personal costs are immeasurable from chronic pain alone, pain sometimes so great that it interferes with a healthy and satisfying lifestyle.

Also, it is recognized that most cases of back pain are mechanical in nature, and the pain is usually not caused by very serious conditions, such as cancer, fracture, infection, etc. The anatomy of the spine and the many conditions that negatively impact spinal health are complex. The following information provides a simplistic explanation of the causes for back pain:

SOME COMMON CAUSES OF LOW BACK PAIN
On many occasions you first feel back pain just after you lift a heavy object, move suddenly, sit in one position for a long time, sustain an injury or have been in an accident. Prior to that moment in time, there was often a pre-existing weakness, or loss of tissue integrity in your spinal structures.

The specific structures in your back responsible for your pain are difficult to determine in many cases. Whether identified or not, there are several possible sources of low back pain:

  1. Bulging or herniated discs
  2. Injury or overuse of muscles, ligaments, facet joints, and the sacroiliac joints.
  3. Muscle spasm (very tense muscles that remain contracted)
  4. Degeneration of the discs
  5. Poor alignment or fixations of the vertebrae
  6. Spondylolisthesis
  7. Osteoarthritis
  8. Spinal stenosis (narrowing of the spinal canal)
  9. Small fractures to the spine from osteoporosis
  10. Strain or tears to the muscles or ligaments supporting the back
  11. Spinal curvatures (like scoliosis or kyphosis), which may be inherited and seen in children or teens
Less Common Causes of Low Back Pain
  • Ankylosing spondylitis, which is a form of joint inflammation (arthritis) that most often affects the spine
  • Prostate Cancer
  • Bacterial infection, in which bacteria are often carried to the spine through the bloodstream from an infection somewhere else in the body or from IV drug use. However, bacteria can also enter the spine directly during surgery or injection treatments, or as the result of injury. Back pain may also be the result of an infection in the bone (osteomyelitis) or in the spinal cord (most often in the material covering the spinal cord, called an epidural infection).
  • Spinal tumors, or growths that develop on the bones and ligaments of the spine, on the spinal cord, or on nerve roots.
  • Paget's disease, which causes abnormal bone growth most often affecting the pelvis, spine, skull, chest, and legs.
  • Scheuermann's disease, in which one or more of the bones of the spine (vertebrae) develop wedge-shaped deformities. This causes curvature of the spine (rounding of the back, or kyphosis), most commonly in the chest region.
You are at particular risk for low back pain if you:
  • Work in construction or another job requiring heavy lifting, lots of bending and twisting, or whole body vibration
  • Smoke, don't exercise, and/or are overweight
  • Are over age 30
  • Are pregnant
  • Have bad posture
  • Have arthritis or osteoporosis
  • Have a low pain threshold
Are non-surgical treatments a better option than surgery?

In most cases, non-surgical therapy done at Orchard Clinic is better than surgery. This is due to the fact that surgery physically alters the spine by removing all or part of the problematic disc. Although this can reduce the pressure on the nerve, and relieve the back pain, the surgery tends to place more stress on the healthy discs above and below

As with any operation, there are risks involved with spine surgery and complications can be severe. Possible complications include injury to your spinal cord, nerves, esophagus, carotid artery or vocal cords; non-healing of the bony fusion; failure to improve; instrumentation breakage and/or failure; infection; bone graft site pain.

Other complications may include phlebitis in your legs, blood clots in the lungs or urinary problems.

Surgery to relieve chronic lower back pain is usually no better than intensive rehabilitation and nearly twice as expensive.

We do not ignore the fact that there is a small percentage of cases that indeed require surgery or medication. Indeed, in certain cases, surgery can significantly help back pain sufferers. But surgery should always be a last resort, offered when conservative treatments have failed.

We recommend that you exhaust all other avenues before surgery, Try our non-surgical innovative devices!

Frustration over Surgery for Disc Disease – January 2005

At the annual meeting of the International Society for the Study of Lumbar Spine held in New York City in 2005, research discussions emphasized the fact that there is growing frustration over the lack of progress in the surgical treatment of degenerative disc disease. Despite a steady stream of technological innovations over the past 15 years – from pedicle crew systems to fusion cages to artificial discs – there is little evidence that patient outcomes have improved.
The BackLetter, Vol 20, No. 7 2005.

Sciatica


The sciatic nerve is a collection of several nerve roots that arise between your spinal bones (vertebrae). These nerve roots join together and form the largest nerve in the body, the sciatic nerve. This nerve travels down from the low back under the buttock muscles all the way down the legs and feet. Sciatica is a term to describe an irritation or pressure on the nerve, which is commonly caused by a herniated or bulging disc (also referred to as a ruptured disc, pinched nerve, or slipped disc) in the lumbar spine. The pressure or irritation leads to a complex of symptoms that include sharp, radiating pain, burning, and/or numbness and tingling. This is a very debilitating condition that affects thousands of people every year.

Generally, herniated or bulging discs are the cause of the problem. The herniated material of the disc will compress or contact the exiting nerve root producing the symptoms. Sometimes central canal stenosis, lateral canal stenosis, spondylolithesis, or degenerative disc disease can cause this nerve compression as well. The problem is often diagnosed as a "radiculopathy", meaning that one or more intervertebral discs have herniated or protruded from its normal position in the vertebral column and is putting pressure on the nerve root in the lower back, which forms part of the sciatic nerve. Sciatica occurs most frequently in people between 30 and 50 years of age. On many occasions this condition slowly develops as a result of general wear and tear on the structures of the lower spine and discs. Rarely is this condition surgical. Unless there is a progressive neurological deficit, or cauda equina syndrome, the majority of people who experience sciatica get pain relief with non-surgical treatments. Non-Surgical Spinal Decompression is very effective for these conditions. Physical therapy and Chiropractic can help sometimes as well.

UNDERSTANDING SCIATICA PAIN
First, everyone responds differently to pain. For some people, the pain from sciatica can be severe and debilitating. For others, the pain might come and go intermittently, and not be so intense. Usually, sciatica only affects one side of the lower body, and the pain often radiates from the lower back into the deep buttocks all the way through the back of the thigh and down through the leg. Sometimes the person experiences calf or foot pain. It is quite variable. One or more of the following sensations may occur as a result of sciatica:
  • Pain in the buttocks or leg that is worse when sitting
  • Burning or tingling down the leg
  • Weakness, numbness or difficulty moving the leg or foot , with the
  • Leg pain being a little worse than the back pain.

While sciatica can be very painful, it is important to keep in mind that the main problem may be with the intervertebral discs. Most likely the discs are dry and weakened due to “wear and tear” injuries. Treatment goals should be to minimize pain, minimize the disc herniation, re-hydrate and re-nourish the discs and nerve roots, and to strengthen and rehabilitate for permanency and prevention of re-injury. This is where spinal decompression therapy can be very effective. Symptoms that may constitute a medical emergency include progressive weakness in the leg or bladder/bowel or incontinence. As mentioned above, this may represent a rare condition called cauda equina syndrome. You should seek immediate medical attention if you are experiencing these signs. In general, patients with complicating factors should contact their doctor if sciatica occurs, including people who have been diagnosed with cancer; take steroid medication; abuse drugs; have unexplained, significant weight loss; or have HIV.

SCIATICA TREATMENTS
Since sciatica nerve pain is caused by a combination of pressure and inflammation on the nerve root, and treatment is centered on relieving both these factors, typical sciatica treatments should include:
Non-surgical sciatica treatments:
  • Non-Surgical Spinal Decompression Therapy
  • Physical Therapy
  • Chiropractic
  • Massage Therapy
  • Acupuncture

Non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen, or COX-2 inhibitors), or oral steroids can be helpful in reducing the inflammation and pain associated with sciatica.

Are non-surgical treatments a better option than surgery?

In most cases, non-surgical therapy done at Orchard Clinic is better than surgery. This is due to the fact that surgery physically alters the spine by removing all or part of the problematic disc. Although this can reduce the pressure on the nerve, and relieve the back pain, the surgery tends to place more stress on the healthy discs above and below

As with any operation, there are risks involved with spine surgery and complications can be severe. Possible complications include injury to your spinal cord, nerves, esophagus, carotid artery or vocal cords; non-healing of the bony fusion; failure to improve; instrumentation breakage and/or failure; infection; bone graft site pain.

Other complications may include phlebitis in your legs, blood clots in the lungs or urinary problems.

Surgery to relieve chronic lower back pain is usually no better than intensive rehabilitation and nearly twice as expensive.

We do not ignore the fact that there is a small percentage of cases that indeed require surgery or medication. Indeed, in certain cases, surgery can significantly help back pain sufferers. But surgery should always be a last resort, offered when conservative treatments have failed.

We recommend that you exhaust all other avenues before surgery, Try our non-surgical innovative devices!

Frustration over Surgery for Disc Disease – January 2005

At the annual meeting of the International Society for the Study of Lumbar Spine held in New York City in 2005, research discussions emphasized the fact that there is growing frustration over the lack of progress in the surgical treatment of degenerative disc disease. Despite a steady stream of technological innovations over the past 15 years – from pedicle crew systems to fusion cages to artificial discs – there is little evidence that patient outcomes have improved.
The BackLetter, Vol 20, No. 7 2005.

EPIDURAL STEROID INJECTIONS
The goals of non-surgical treatments should include both relief of sciatica pain and prevention of future sciatica problems. Injections are invasive and are usually only a temporary solution.

SURGICAL OPTIONS
When reading the medical literature, it is generally agreed upon that nearly all cases do well with non-surgical management. For severe cases that just don’t respond, the following options are available for surgery: Microdiscectomy or lumbar laminectomy and discectomy, remove the portion of the disc that is irritating the nerve root. This surgery is designed to help relieve both the pressure and inflammation and may be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments.

Leg Pain


Leg pain is a very broad topic with numerous potential causes. In this section we will only touch on a few things to consider regarding leg pain; as always, consult with your doctor for proper evaluation.

Leg pain can be very common; the causes can range from muscle strain to degenerative joint disease. The legs can be prone to pain as they, in combination with the hips, knees, ankles and feet, move the entire body's weight and provide support.

Exercise and repetitive stress and strain, improperly performed activity, or heavy lifting may cause strain in the legs. In addition, many conditions in the trunk of the body may produce symptoms that radiate into the limbs.

Leg cramps, one of the more common leg pain complaints, can result after exercise or can be due to an imbalance in the body's chemicals. Circulatory problems, such as blocked arteries and blood clots, are another cause of leg pain.

If you have been diagnosed with herniated or bulging discs, degenerative disc disease, or spinal stenosis, then your leg pain may be due to nerve compression or inflammation, resulting in radiculopathy that begins in the low back and frequently causes leg pain. If this is your case, many people have found relief with spinal decompression therapy. Although this treatment may not be right for everyone, patients who are considered candidates have very high success rates in healing their disc injuries and diminishing their leg pain. Spinal stenosis, which may cause compression of spinal nerves, can also manifest itself as pain in the legs. Leg pain may also result from neuropathies, such as from diabetes or chronic alcoholism.

A physical examination by your doctor is the first step in identifying the source of leg pain. An individual's physician may perform several tests to determine the potential cause of the pain. These tests may include orthopedic or chiropractic tests, x-rays, other imaging studies of the low back, nerve conduction studies, laboratory blood work, doppler ultrasound to test blood flow, or a special blood pressure measurement in the legs.

Relief of leg pain involves treating the cause. If the cause of your leg pain is from your lumbar spine and you have herniated discs, bulging discs, sciatica, or degenerative disc disease, then you may benefit greatly form non-surgical spinal decompression therapy.

Additional management may involve lifestyle modification to improve circulatory or nerve health, medications, and/or physical therapy. Lifestyle changes, such as maintaining a healthy weight, getting regular exercise as well as quitting smoking, may prevent the onset of certain painful leg problems.

Are non-surgical treatments a better option than surgery?
In most cases, non-surgical therapy done at Orchard Clinic is better than surgery. This is due to the fact that surgery physically alters the spine by removing all or part of the problematic disc. Although this can reduce the pressure on the nerve, and relieve the back pain, the surgery tends to place more stress on the healthy discs above and below

As with any operation, there are risks involved with spine surgery and complications can be severe. Possible complications include injury to your spinal cord, nerves, esophagus, carotid artery or vocal cords; non-healing of the bony fusion; failure to improve; instrumentation breakage and/or failure; infection; bone graft site pain.

Other complications may include phlebitis in your legs, blood clots in the lungs or urinary problems.

Surgery to relieve chronic lower back pain is usually no better than intensive rehabilitation and nearly twice as expensive.

We do not ignore the fact that there is a small percentage of cases that indeed require surgery or medication. Indeed, in certain cases, surgery can significantly help back pain sufferers. But surgery should always be a last resort, offered when conservative treatments have failed.

We recommend that you exhaust all other avenues before surgery, Try our non-surgical innovative devices!

Frustration over Surgery for Disc Disease – January 2005

At the annual meeting of the International Society for the Study of Lumbar Spine held in New York City in 2005, research discussions emphasized the fact that there is growing frustration over the lack of progress in the surgical treatment of degenerative disc disease.

Despite a steady stream of technological innovations over the past 15 years – from pedicle crew systems to fusion cages to artificial discs – there is little evidence that patient outcomes have improved.
The BackLetter, Vol 20, No. 7 2005.

Herniated Disc


ANATOMY OF THE SPINE
The intervertebral discs are located between each vertebrae in the spinal column. Of the vertebrae, there are 7 cervical (neck), 12 thoracic (mid-back) and 5 lumbar (low back) discs. The discs make up approximately 1/3 of the spinal column. They have three main functions: (1) "Absorb shock" from everyday wear and tear. (2) Allow movement of our spinal column. (3) Separate the vertebrae.

The intervertebral disc is actually a type of cartilaginous joint. Discs consist of an outer layer, annulus fibrosis, and an inner nucleus pulposus, which is a soft, jelly-like, substance. The disc is made up of proteins called collagen and proteoglycans that attract water. Normally, discs compress when pressure is put on them and decompress when the pressure is relieved. These discs do not have a blood supply; therefore, they exchange nutrients by a process called "imbibition". Imagine a sponge filled with water; when that sponge is compressed, the water is forced out of the sponge. When the compressive force is removed, the water is "sucked" back into the sponge. This is precisely how discs stay healthy and functional. Diseased discs can lead to degenerative disc disease that can then lead to: arthritis, herniated discs, bulging discs, facet syndromes, sciatica and spinal stenosis.

A herniation describes an abnormal condition of an intervertebral disc. Some refer to this condition as a "slipped", "ruptured", or "blown" disc. Most of the time it is not known what caused the disc to herniate, but it is thought to occur from repetitive stress due to occupation, poor spinal posture, and/or natural processes of aging and/or trauma.

A herniation begins when the inner nucleus pulposus bulges through the annulus fibrosis, causing a bulging or protruding disc. This bulge may push on a spinal nerve. This interferes with the natural blood supply to the nerve roots and sets up a condition known as intraneural edema. Basically, the nerve root microcirculation is compressed and can progress to the point where the nucleus begins to leak out of the disc. At this point the body begins to fight back by launching an autoimmune response to the disc material (nucleus pulposus). The reaction of this defense mechanism causes severe inflammation and progressive deterioration of the nerve root. If the herniation is located in the cervical spine (neck), the symptoms can range from neck pain, with or without arm pain, to numbness and tingling. Muscle weakness can be common as well. If the herniated disc is located in the lumbar spine (low back), the symptoms can range from low back pain, with or without leg pain, to numbness and tingling. Muscle weakness is also common. This type of pain and/or numbness in the legs or arms is referred to as a "radiculopathy". This happens because the nerves that exit your spinal cord innervate ("attach to") the skin in your arms and legs. They are responsible for sensation and for movement of the muscles in your arms and legs. They are also responsible for the reflexive movements as well. This is the reason some individuals with these conditions experience extremity (leg/arm) pain / numbness / tingling and/or weakness when they have a herniated or bulging disc. Be aware that, some individuals with herniated discs may report arm or leg pain only, with minimal neck or low back pain.

LEG PAIN
This pain is most commonly experienced at the outside of the thigh, the lower leg and/or the foot. Shooting pain that radiates down the leg is a common experience with herniated discs. Patients commonly report an electric shock type of symptom.

PARASTHESIAS
This is the medical word for abnormal sensations such as tingling, numbness, weakness or “pins and needles”. These symptoms may be the result of a herniated disc and may be experienced in the same regions as painful sensations.

MUSCLE WEAKNESS
Signals from the brain may be interrupted due to nerve irritation. This can cause muscle weakness, usually of the ankle. Nerve irritation can be tested by examining the reflexes of the knee and ankle.

BOWEL OR BLADDER PROBLEMS
These symptoms are important because they may be a sign of Cauda Equina syndrome. This condition is possibly caused by a herniated disc. This is a medical emergency! You must see a medical doctor immediately if you have problems urinating, having bowel movements, or if you have numbness around your genitals. All of these symptoms are likely caused by irritation to one of the nerves as a result from a herniated disc.

DIAGNOSIS
Diagnosis of a herniated disc (either neck or low back) can be made from a thorough physical examination including a detailed history, orthopedic and/or neurological evaluation. Some disc patients will present with an antalgic gait (lean away from the side of the disc lesion), extremity pain/numbness/tingling (abnormal sensation) in addition to neck or low back pain. Muscle weakness may be present in the more chronic cases as well as areflexia ("loss of reflex"). X-rays can be helpful in identifying degenerative changes of the vertebra, but MRI’s are the "gold standard" to identify the exact nature of the lesion. When the disc is herniated in the lumbar spine (low back), and it is compressing the spinal nerve roots causing pain and numbness down the buttocks, thigh and leg, it is often referred to as sciatica.

TRADITIONAL TREATMENTS
Traditional treatments for herniated disc includes physical/chiropractic therapy, epidural Injections, surgery and pain killers such as non-steroid anti-inflammatory medication (NSAID's).

Please keep in mind that NSAID's have an inherent risk of gastrointestinal (GI) ("stomach" and "intestinal") disorders such as: perforation, ulceration and hemorrhages. The New England Journal of Medicine reported that it has been conservatively estimated that 16,500 NSAID-related deaths occur every year in the United States, and conservative calculations estimate that approximately 107,000 Americans are hospitalized every year due to NSAID related GI complications. The number of deaths reported in the same study due to AIDS was 16,685. In addition to gastrointestinal disorders, drugs such as VIOXX have been known to cause serious cardiovascular (CV) events such as: heart attacks, strokes and heart failure. There have been similar complaints from other NSAID's such as: Bextra and Celebrex.

NON-SURGICAL SPINAL DECOMPRESSION
Non-Surgical Spinal Decompression offers to treat the root cause of the diseased or pathological disc based on the anatomical and physiological principles of Non-Surgical Spinal Decompression.

Non-Surgical Spinal Decompression relieves pressure from the disc, which, in turn, relieves pressure from the nerve.

Research has shown that Non-Surgical Spinal Decompression can create a negative pressure within the disc causing a "vacuum effect". This vacuum effect can "suck" the disc material back inside, thus relieving the pressure from the nerve.

According to the FDA 510k papers, the definition of decompression is “unloading due to distraction and positioning”, and additionally, “unweighting due to distraction and positioning”. This is important because the “unloading” of the injured area creates positive changes in the microcirculation of the disc and nerve roots. Therefore, Non-Surgical Spinal Decompression for herniated discs is based on the following principles.

  • Decompression of the involved disc creates a negative intradiscal ("within the disc") pressure which, in turn, creates
  • a vacuum effect which reduces ("sucks in") the size of the herniation, and which then takes pressure off the involved nerve root
  • Reduction or elimination of extremity (leg/arm) pain and/or numbness, while at the same time
  • The pumping motions, due to Non-Surgical Spinal Decompression, called, "imbibition", allows nutrients to be exchanged at the level of the disc and inflammation around the nerve root to be dispersed resulting in reduction or elimination of low back pain.
Are non-surgical treatments a better option than surgery?

In most cases, non-surgical therapy done at Orchard Clinic is better than surgery. This is due to the fact that surgery physically alters the spine by removing all or part of the problematic disc. Although this can reduce the pressure on the nerve, and relieve the back pain, the surgery tends to place more stress on the healthy discs above and below

As with any operation, there are risks involved with spine surgery and complications can be severe. Possible complications include injury to your spinal cord, nerves, esophagus, carotid artery or vocal cords; non-healing of the bony fusion; failure to improve; instrumentation breakage and/or failure; infection; bone graft site pain.

Other complications may include phlebitis in your legs, blood clots in the lungs or urinary problems.

Surgery to relieve chronic lower back pain is usually no better than intensive rehabilitation and nearly twice as expensive.

We do not ignore the fact that there is a small percentage of cases that indeed require surgery or medication. Indeed, in certain cases, surgery can significantly help back pain sufferers. But surgery should always be a last resort, offered when conservative treatments have failed.

We recommend that you exhaust all other avenues before surgery, Try our non-surgical innovative devices!

Frustration over Surgery for Disc Disease – January 2005

At the annual meeting of the International Society for the Study of Lumbar Spine held in New York City in 2005, research discussions emphasized the fact that there is growing frustration over the lack of progress in the surgical treatment of degenerative disc disease. Despite a steady stream of technological innovations over the past 15 years – from pedicle crew systems to fusion cages to artificial discs – there is little evidence that patient outcomes have improved.
The BackLetter, Vol 20, No. 7 2005.

EPIDURAL INJECTION Epidural injections ("injection within the epidural space of the spinal cord") with corticosteroids, lidocaine or opioids have no proven benefit in treating neck or upper back symptoms. In the instances that people find improvement, the effects are often temporary and require repeat injections, and several per year are not uncommon. There is also an increase in risk in contracting a spinal infection that can lead to meningitis. In fact, the results of a randomized, double-blind trial, published in the June 2003 issue of the Annals of Rheumatic Diseases indicated that an epidural steroid injection was no better than an epidural saline ("salt water") Injection (i.e. placebo) for sciatica. These findings are consistent with those of another definitive trial presented at the last American College of Rheumatology meeting.

Given that there have been advances in spinal surgery, the outcomes can still be very unpredictable. In failed back surgery, post-operative pain syndrome is a very disabling and troubling reality of surgical intervention. According to the 2002 Johns Hopkins White Paper on “Low Back Pain and Osteoporosis “* by John P. Kostulk, M.D. and Simeon Margolis, M.D., PhD., surgery "is not the treatment of choice for most people with back pain." The report goes on to say “fewer than 5% of people with back pain are good candidates for surgery”. "Surgery ought to be used when all other measures have been explored, and only if it appears that there is a strong probability that it will improve the condition." An article in Spine reviewed the outcomes and complication rates for surgical intervention in degenerative disc disease. Complication rates were as high as 55% and included: hematoma, neurologic adjacent segment degeneration, infection and hardware/instrument-related issues. Another study determined the effects of single-level (2 vertebrae) and 2-level (3-4 vertebrae) spinal fusion success rates reported 53% with "good" and "fair" results with single- level fusion and no "good" results with 2-level fusions.

Having read about the possible side effects relating to these “traditional” treatments, you might want to consider the drugless, non-surgical approach that Non-Surgical Spinal Decompression has to offer.
  • Wolfe, Michael MD et al. Gastrointestinal Toxicity of Non -Steroidal Anti-inflammatory Drugs. N Engl J Med. 1999 June 17; 340(24): 1888-1899.
  • Singh, G. Recent considerations in nonsteroidal anti -inflammatory drug gastropathy. Am J Med. 1998 Jul 27; 105(1B):31S-38S.
  • Soloman SD, McMurray JJ et. all. Cardiovascular risk associated with celecoxib in a clinical trial for colorectal adenoma prevention. N Engl J Med. 2005 Mar 17;352(17): 1071-80.
  • Kostulk, John P. M.D., Margolis, Simeon M.D., PhD Johns HopkinsWhite Paper on Low Back Pain and Osteoporosis 2002.
  • Glass, Lee MD. Occupational Medicine Practice Guidelines: American College of Occupational & Environmental Medicine. 2nd ed., OEM press.
  • Bono, Christopher MD, Lee, Casey MD. The Influence of Subdiagnosis on Radiographic and Clinical Outcomes After Lumbar Fusion for Degenerative Disc Disorders: An Analysis of the Literature From Two Decades. Spine. 30(2):227-234, 2005.
  • Knox BD, Chapman TM. Anterior Lumbar Interbody Fusion for Discogram Concordant Pain. J Spinal Disord 1993;6:242 -244.

Degenerative Disc Disease


WHAT IS DEGENERATIVE DISC DISEASE?

Degenerative Disc Disease is a gradual process that occurs as we age. Gradually the water and protein content of the body's cartilage changes. Sometimes this process is accelerated due to heavy occupational demands such as repetitive bending and twisting, heavy lifting, or accident and injury. These changes can result in weaker and thinner cartilage. Because both the discs and the joints (facet joints) are composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). This gradual deterioration of the discs between the vertebrae (back bones) is referred to as degenerative disc disease.

These changes usually occur long before you can see them on X-rays or other imaging techniques.
What is happening is the progression of wear and tear of the discs and the weakening of protein (collagen) of the outer band of the disc (annulus fibrosis) causing a structural and biomechanical change of the disc. Furthermore, water and proteoglycan (PG) content decreases. PGs are molecules that behave like super sponges and can bind and attract water hundreds of times their own molecular weight. “Disc desiccation” is a term used to describe the proteoglycan content decreasing and loss of water in the discs (dehydration). This very well may be a term you read on your MRI report.

This process severely affects the "shock absorbing" properties of the discs as they "compress" under normal pressure. These changes usually occur at the same time as the annulus fibrosis degenerates and generally leads to the disc’s inability to handle mechanical stress. Because the lumbar spine carries a large portion of the body’s weight, degeneration of the disc tissue makes the disc more susceptible to herniate and can cause local pain in the affected area. Disc degeneration can sometimes lead to disorders such as spinal stenosis (narrowing of the spinal canal), spondylolisthesis (forward slippage of the disc and vertebra), and retrolisthesis (backward slippage of the disc and vertebra).

LUMBAR DEGENERATIVE DISC DISEASE PAIN AND SYMPTOMS

Although symptoms are variable from person to person, most patients with lumbar degenerative disc disease will experience low-grade continuous but tolerable pain that will occasionally flare (intensify) for a few days or more. Pain symptoms can vary, but generally are:
  1. Centered on the lower back, although it can radiate to the hips and legs
  2. Frequently worse when sitting, as the discs experience a heavier load than when patients are standing, walking or even lying down.
  3. Exacerbated by certain movements, particularly bending or twisting.
Although degenerative disc disease is relatively common in aging adults, it seldom requires surgery. When medical attention is warranted, the majority of patients respond well to non-operative forms of treatment like chiropractic manipulative therapy, physical therapy, or Non-Surgical Spinal Decompression therapy.

Bulging Disc


In this section we will discuss some of the confusion in the terminology regarding bulging discs, herniated discs, protruding discs, etc. Many times, even doctors use incorrect descriptive terms. We will use some diagrams to help demonstrate our lesson.
The following information is from the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology.
The term ‘bulging disc’ is and should be used as a descriptive term, not a diagnostic term.

Here is a bird’s eye view looking down onto a disc. Notice in the diagram the outer ring, this represents a symmetrical bulging disc. The disc tissue is bulging out around the entire border of the vertebrae. This is a rare finding under MRI and CT scans.

Although ‘bulging disc’ is a popular term, it is usually not representative of what is really going on at the spinal level. It is used because it is easy to understand. Most people really have a herniated disc.

This again is a broad category, which further breaks down into two more diagnostic terms. This is explained using the following diagrams:

These two diagrams are very accurate in the description (or diagnosis?) of disc herniations. You will commonly find these descriptive terms on your MRI or CT reports from your doctor. By strict definition, a broad-based herniation involves between 25 and 50% of the disc circumference. A focal herniation involves less than 25% of the disc circumference. Herniated discs may take the form of protrusion or extrusion based on the shape of the displaced or herniated material. The following diagram illustrates this well:

The above information is designed to clarify the use of these terms. The simple fact is that if you have a herniated disc, the disc material can press on the nerve roots or central nerves running through the central canal where the spinal cord lives. This can produce serious back and leg pain, as well as, numbness, tingling, and muscle weakness. Occasionally, the disruption and injury in the annulus fibrosis can be the source of back pain. The outer 1/3 of the annulus fibrosis has a nerve supply, and if the center nuclear materials are migrating through the weakened annulus, this can cause pain.

This condition is sometimes referred to as internal disc disruption. This is very difficult to see on MRI or CT scans and is considered to be the early stages of a herniated disc, although it is still not visible on advanced imaging. This condition responds well to non-surgical spinal decompression, allowing blood, water, and nutrients to enter the disc and begin healing the damaged annulus fibrosis. Please see the diagram below.

This is a side view diagram. The left side is the front of the body and the right side is the back of the body.

Non-surgical spinal decompression can be very effective in treating these difficult conditions. The treatment results in an unloading of the offending disc structures, which in turn creates a negative intradiscal pressure inside the disc.
This facilitates water and nutrient exchange into the disc, thus, allowing the injury to heal. It also can cause a vacuum-like effect, allowing the displaced materials to return to a more centralized position.
Over time, this treatment allows collagen, one of the body’s healing proteins, to form. Collagen can then repair the cracks and fissures in the annulus fibrosis. In addition, the inner matrix material of the disc becomes healthier with the exchange of water and nutrients. Spinal stabilization rehab exercises should follow a common sense spinal decompression therapy program.

Are non-surgical treatments a better option than surgery?

In most cases, non-surgical therapy done at Orchard Clinic is better than surgery. This is due to the fact that surgery physically alters the spine by removing all or part of the problematic disc. Although this can reduce the pressure on the nerve, and relieve the back pain, the surgery tends to place more stress on the healthy discs above and below

As with any operation, there are risks involved with spine surgery and complications can be severe. Possible complications include injury to your spinal cord, nerves, esophagus, carotid artery or vocal cords; non-healing of the bony fusion; failure to improve; instrumentation breakage and/or failure; infection; bone graft site pain.

Other complications may include phlebitis in your legs, blood clots in the lungs or urinary problems.

Surgery to relieve chronic lower back pain is usually no better than intensive rehabilitation and nearly twice as expensive.

We do not ignore the fact that there is a small percentage of cases that indeed require surgery or medication. Indeed, in certain cases, surgery can significantly help back pain sufferers. But surgery should always be a last resort, offered when conservative treatments have failed.

We recommend that you exhaust all other avenues before surgery, Try our non-surgical innovative devices!

Frustration over Surgery for Disc Disease – January 2005

At the annual meeting of the International Society for the Study of Lumbar Spine held in New York City in 2005, research discussions emphasized the fact that there is growing frustration over the lack of progress in the surgical treatment of degenerative disc disease.

Despite a steady stream of technological innovations over the past 15 years – from pedicle crew systems to fusion cages to artificial discs – there is little evidence that patient outcomes have improved.
The BackLetter, Vol 20, No. 7 2005.

Spinal Stenosis


Spinal stenosis (or narrowing) is a common condition that affects many adults 50 yrs old and older. This occurs when the small spinal canal, containing the nerve roots and spinal cord, becomes constricted or compressed. This can lead to a number of problems, depending on which nerves are affected. In general, spinal stenosis can cause cramping, pain or numbness in the legs, back, neck, shoulders and/or arms; a loss of sensation in the extremities; and sometimes, in rare cases, problems with bladder or bowel function. In general, spinal narrowing is caused by osteoarthritis, or "wear and tear" arthritis, of the spinal column. This results in a "pinching" of the spinal cord and/or nerve roots.

People suffering from spinal stenosis may have trouble walking any significant distance, and usually must sit or lean forward over a grocery cart, countertop or assistive device such as a walker.

Typically, a person with spinal stenosis complains about developing tremendous pain in the legs or calves and lower back after walking. Pain occurs more quickly when walking up hills. This is usually very reproducible and is almost immediately relieved by sitting down or leaning over. When the spine is flexed forward, more space is available for the spinal cord, causing a reduction in symptoms.

WHAT CAUSES IT?
Spinal stenosis is usually caused by progressive degenerative changes in the spine. This is usually called "acquired spinal stenosis" and can occur from the narrowing of space around the spinal cord due to bony overgrowth (bone spurs) from osteoarthritis, combined with thickening or calcification of one or more ligaments in the back. Stenosis can also be caused by a bulge or herniation of the intervertebral discs. This must be differentiated from the stenosis caused by the bony overgrowth that can occur on the vertebral bodies, or facet joints. Spinal decompression therapy may not be appropriate in moderate to severe cases of spinal stenosis with many spurs and thickened ligaments. On the other hand, if the stenosis of the central canal is primarily from bulging discs, or herniated discs, then non-surgical spinal decompression may be very successful. Sometimes people are born with a smaller spinal canal. This is called "congenital spinal stenosis" and may become problematic at an earlier age.

WHO GETS IT?
The risk of developing spinal stenosis increases in those who:
  • Are born with a narrow spinal canal
  • Are female
  • Are 50 years of age or older
  • Have had previous injury or surgery of the spine
Conditions that can cause spinal stenosis include:
  • Osteoarthritis and osteophytes (bone spurs) associated with aging
  • Inflammatory spondyloarthritis
  • Spinal tumors
  • Trauma
  • Paget's disease of the bone
  • Previous surgery
HOW IS IT TREATED?
Typically, spinal stenosis is treated with conservative non-surgical therapies. One important therapy is exercise. Keeping the muscles of the hip, back, and legs toned allows for improved stability and will improve walking.

Medications such as nonsteroidal anti-inflammatories (NSAIDs) also may be appropriate and helpful in pain relief. Cortisone injections into the epidural space, the area around the spinal cord, may provide temporary relief to people suffering from this disorder.

Non-surgical spinal decompression therapy may help those with herniated or bulging discs, lateral canal stenosis, and facet syndrome.

Under severe and rare circumstances, surgery to correct this disorder may be appropriate. In these severe cases, nerves to the bladder or bowel may be affected, leading to partial or complete urinary or fecal incontinence. If you experience either of these problems, seek immediate medical care! Decompression laminectomy, which is the removal of a build-up of bony spurs or increased bone mass in the spinal canal, can free up space for the nerves and the spinal cord. However, adequate decompression of the neural elements and maintenance of bony stability are necessary for a good surgical outcome for patients with spinal stenosis.

Several studies report that surgical treatment produces better outcomes than non-surgical treatment in the short term. However, these results tend to deteriorate over time. In addition, lumbar decompressive surgery can be complicated by epidural hematoma, deep venous thrombosis, dural tear, infection, nerve root injury and recurrence of symptoms.

Treatment Plan
It is essential for both the staff and the patient to work toward the same objective when utilizing Non-Surgical Spinal Decompression Therapy. Spinal Decompression Therapy has a goal; and it is important that each patient understand both the objective and method that will be used to attain this goal. This will prevent any confusion and give clear expectations for the patient.

Non-Surgical Spinal Decompression Therapy produces the forces and positions required to cause decompression of the intervertebral discs. Decompression is the unloading due to distraction and positioning of the spine. This therapy produces negative pressure within the disc to allow the particular injury to heal naturally. Conditions that may be treated include: back pain, neck pain, herniated discs, protruding discs, degenerative disc disease, posterior facet syndrome and sciatica. Patients are treated fully clothed and are fitted with a pelvic harness that fits around their pelvis as well as a thoracic harness as they lie face down, or face up on a computer controlled table. The doctor operates the table from a computerized console, where a customized treatment protocol is entered into the computer. Each treatment takes about 30 to 45 minutes. The average treatment protocol is approximately 20 to 28 treatments within a five to seven week period of time, depending on the individual's case. The therapy may also include electric stimulation, ultrasound, thermotherapy (heat), and cryotherapy (cold) before, during, and/or after the treatment. Your doctor will use these therapies when appropriate. All of the above aid to accelerate the healing process.

Although there is no procedure that is 100% successful, non-surgical spinal decompression therapy has a high success rate with full compliance on the part of the patient. Your doctor will recommend that you refrain from certain activities and that you engage in a certain rehabilitation program either during or after your therapy. If you adhere to your prescribed therapy, you will enhance your chances of success.

Drinking at least a half-gallon of water per day will enhance the re-hydration process within the discs. Your physician will also recommend some nutritional supplements that will aid in the healing process.

The American Spinal Decompression Association is here to assist in your recovery. Please contact a leading specialist if you or someone you know has been suffering with neck or back pain. We can help to determine whether this therapy might be appropriate for you or your referral.

Headaches


Headaches can be caused by a number of conditions. One of the most common causes of headaches that do not originate in the head is called a "cervicogenic" headache which means it originates in the neck. The source of pain stems from structures around the neck which may be impinged or damaged. These structures can include joints, ligaments, muscles, and cervical discs, all of which have complex nerve endings. When these structures are damaged, the nerve endings send pain signals up the pathway from the nerves of the neck to the brain. During this process, the signals communicate or intermingle with the nerve fibers of the trigeminal nerve. Since the trigeminal nerve is responsible for the perception of "head" pain, the patient experiences the symptoms of a headache.

A chiropractor may be able to treat your headache which may be caused by a subluxation or more serious problems. If you answer "yes" to any of the following questions, chiropractic care may be a valuable treatment for your headache:
  • Have you ever been in a car accident?
  • Has your neck ever experienced trauma?
  • Have you ever played football or any other contact sport?
  • Have you experienced many 'minor' injuries?
  • Is your neck stiff or, at times, difficult to move?
If you answered "yes" to at least one of the questions above, chiropractic care may benefit you.