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Partial lumbosacral transitional vertebrae: 2 cases of unilateral sacralization – Corrected Proof

On March 7, 2012, in News, by Jeffrey M. Muir
Abstract: Objective: Lumbosacral transitional vertebrae (LSTV) are relatively common skeletal anomalies with a debated role in low back pain. There are few documented cases of conservative care being used to address LSTV-associated symptomatology. The …
Abstract: Objective: Lumbosacral transitional vertebrae (LSTV) are relatively common skeletal anomalies with a debated role in low back pain. There are few documented cases of conservative care being used to address LSTV-associated symptomatology. The current report discusses chiropractic management of 2 patients with unilateral sacralization.Clinical Features: Two patients with LSTV involving unilateral sacralization of L5, a Castellvi type IIIa variant, presented with back pain to a chiropractic clinic. Each case presented with symptomatology similar to piriformis syndrome.Intervention and Outcome: Manual therapy, including spinal manipulation soft tissue therapies and exercise/stretching, was used to address the presenting symptoms. Approximately 2 weeks after initial treatment, the first patient subjectively reported a 70% improvement in symptoms, with lumbar extension increased to full in active range of motion at the lumbar spine but with continued tenderness and hypertonicity at the left piriformis and gluteus medius. After 4 weeks of treatment, the second patient reported improvement in pain and perceived mobility, although prolonged standing remained an aggravating factor. Although both showed improvement, neither case resulted in complete resolution of symptoms.Conclusion: The presenting cases demonstrated partial resolution of symptoms after chiropractic management. It is proposed that sacralization is a possible cause of back pain in these cases.

CLINICAL STUDIES ON THE EFFECTIVENESS OF SPINAL DECOMPRESSION

On September 16, 2011, in Studies, by admin
“Eighty-six percent of ruptured intervertebral disc (RID) patients achieved ‘good’ (50-89% improvement) to ‘excellent’ (90-100% improvement) results with decompression. Sciatica and back pain were relieved.” “Of the facet arthrosis patients, 75% obtained ‘good’ to ‘excellent’ results with decompression.” C. Norman Shealy, MD, PhD, and Vera Borgmeyer, RN, MA. Decompression, Reduction, and Stabilization of the Lumbar […]

“Eighty-six percent of ruptured intervertebral disc (RID) patients achieved ‘good’ (50-89% improvement) to ‘excellent’ (90-100% improvement) results with decompression. Sciatica and back pain were relieved.” “Of the facet arthrosis patients, 75% obtained ‘good’ to ‘excellent’ results with decompression.”

C. Norman Shealy, MD, PhD, and Vera Borgmeyer, RN, MA. Decompression, Reduction, and Stabilization of the Lumbar Spine: A Cost-Effective Treatment for Lumbosacral Pain. American Journal of Pain Management Vol. 7 No. 2 April 1997

“Serial MRI of 20 patients treated with the decompression table shows in our study up to 90% reduction of subligamentous nucleus herniation in 10 of 14. Some rehydration occurs detected by T2 and proton density signal increase. Torn annulus repair is seen in all.”

Eyerman, Edward MD. Simple pelvic traction gives inconsistent relief to herniated lumbar disc sufferers. Journal of Neuroimaging. Paper presented to the American Society of Neuroimaging, Orlando, Florida 2-26-98.

“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.”

Gionis, Thomas MD; Groteke, Eric DC. Surgical Alternatives: Spinal Decompression. Orthopedic Technology Review. 2003; 6 (5).

“All but two of the patients in the study improved at least 30% or more in the first three weeks.” “Utilizing the outcome measures, this form of decompression reduces symptoms and improves activities of daily living.”

Bruce Gundersen, DC, FACO; Michael Henrie, MS II, Josh Christensen, DC. A Clinical Trial on Non-Surgical Spinal Decompression Using Vertebral Axial Distraction Delivered by a Computerized Traction Device. The Academy of Chiropractic Orthopedists, Quarterly Journal of ACO, June 2004

Wikipedia’s opinion about Spinal Decompression Therapy Effectiveness

In a small randomized study of 44 subjects, in which one author disclosed a proprietary interest in Vax-D, it was shown to have a clinical success rate of 68.4%. 11

A 2004 report by the State of Washington Department of Labor and Industries concluded “Published literature has not substantially shown whether powered traction devices are more effective than other forms of traction, other conservative treatments, or surgery.” 12 A 2005 review of VAX-D (including the Sherry study above) by the Workers’ Compensation Board of British Columbia concluded “To date there is no evidence that the VAX-D system is effective in treating chronic LBP associated with herniated disc, degenerative disc, posterior facet syndrome, sciatica or radiculopathy.” 13

A 2006 systematic review of studies of spinal decompression using motorized traction devices conducted between 1975 and October 2005 (including the two mentioned above) concluded that “…the efficacy of spinal decompression achieved with motorized traction for chronic discogenic low back pain [remained] unproved”, and called for “Scientifically more rigorous studies with better randomization, control groups, and standardized outcome measures … to overcome the limitations of past studies.” 14 A technology assessment conducted in 2007 by the Agency for Healthcare Research and Quality (for which the two studies cited above were included for analysis) said “Currently available evidence is too limited in quality and quantity to allow for the formulation of evidence-based conclusions regarding the efficacy of decompression therapy as a therapy for chronic back pain when compared with other non-surgical treatment options.” 15

A 2007 critique of research studies, including the two cited above, said:

There is very limited evidence in the scientific literature to support the effectiveness of non-surgical spinal decompression therapy. This intervention has never been compared to exercise, spinal manipulation, standard medical care or other less expensive conservative treatment options which have an ample body of research demonstrating efficacy. Considering the cost-benefit relationship, many better researched and less expensive treatment options are available to the clinician. 16

The truth about nonsurgical spinal decompression studies

More studies about spinal decompression

References

Spinal Decompression Studies

On September 27, 2010, in , by admin
Can Herniated Discs Reduce in Size or Resorb? by David BenEliyahu,DC,DACBSP,DAAPM In the past, it was believed that once a patient acquired a herniated disc, it was permanent. However, recent research with MRI and CT outcome studies has documented that this is fallacy. Herniated discs in the cervical and lumbar spine have been shown to […]

Can Herniated Discs Reduce in Size or Resorb?

by David BenEliyahu,DC,DACBSP,DAAPM

In the past, it was believed that once a patient acquired a herniated disc, it was permanent. However, recent research with MRI and CT outcome studies has documented that this is fallacy. Herniated discs in the cervical and lumbar spine have been shown to not only reduce in size after a period of conservative care, but in many cases regress and disappear upon reimaging.

Numerous medical studies and some chiropractic studies have been performed and published. In recent studies by Mochida et al., both cervical (CDH) and lumbar (LDH) disc herniations were studied in pre- and post-MR imaging conditions. In CDH cases, they demonstrated that in 40% of the time, there was a reduction in size or regression. In LDH cases, they demonstrated about a 60% reduction or regression in the size of the herniation. They also found that the larger the extrusion or sequestration, the better the rate of regression. They concluded that disc regression or resorption depended upon size, location and the phase of the injury. Discs tended to reduce in size early on after onset, and more so in the lateral or sequestered type of herniation than smaller or subligamentous herniations. It is interesting to note that most patients in Mochida’s study did well clinically with conservative care regardless of the MRI outcome.

In a different study, Mochida found that there is a large percentage of macrophages in excised herniated disc material, as well as evidence of neovascularization. As such, the reduction in size is most likely due to phagocytic or macrophagic digestion, since the body attacks the disc fragment as a foreign protein, much like any other antigen. Immunohistochemistry studies are being conducted at this time to elucidate the pathophysiology of disc herniation and regression.

In a similar study of LDH outcome by Bozzao et al., 63% of the patients treated nonsurgically with epidurals, medication, etc., demonstrated disc resorption upon repeat imaging. In a prospective study of patients with LDH, Ellenberg et al. documented that patients with CT evidence of herniated discs and EMG evidence of radiculopathy had a 78% rate of disc reduction. Matsubara found in a similar study that medical care involving medication, physiotherapy, traction and epidural steroid injections resulted in disc regression in 60% of the cases. In another prospective study, Bush et al. showed disc regression in 12 of the 13 cases studied. The period of care averaged six months, with a range of 2-12 months for good clinical and anatomical MRI outcome.

In one of the few chiropractic care MRI studies, I published a prospective case series of 27 patients with either CDH or LDH. I obtained pre- and post-chiropractic care MRIs and found that in 63% of the cases, there was either a reduction in size, or the disc herniation resorbed completely. I also found that 80% of the cases had good clinical outcomes, and 78% of the patients returned to their preinjury occupations. Chiropractic care was shown to be amenable to the clinical management of the disc herniation not only on a clinical level, but on an anatomical level as well. In a study by Cassidy et al. on the effects of side posture manipulation on CT-documented herniated discs, the authors found that 13 of 14 patients had good clinical results. Of those, about half had a decrease in the size of the herniation on repeat CT followups.

Case Report

In a recent case that I treated, a 48-year-old female patient presented with acute low back and associated leg/extremity pain into the foot. She had evidence of radiculopathy with diminished sensation at the L4/5 dermatomes, and positive root tension signs with a positive straight leg raise at 35 degrees on the left and 45 degrees on the right. DTRs were within normal limits, and there was no significant motor weakness. An MRI of the lumbar spine revealed a large focal disc herniation centrally and to the left.

The patient began treatment on a three times per week schedule and was treated with lumbar flexion/distraction, interferential current and microcurrent delivered by pads and probes. Microcurrent therapy was combined with regular interferential therapy and helped reduce pain and increase circulation to enhance the healing process. Microcurrent was then delivered to the LS spine and lower extremity by probes, stimulating the acupuncture points of the bladder meridian as well as stimulation along the affected dermatome.

The microcurrent therapy helped afford the patient pain management and reduced the healing period. The patient improved significantly with the above mode of care, and repeat MRI imaging showed a reduction in the size of the herniation.

References

  • BenEliyahu DJ. MRI and clinical followup study of 27 patients receiving chiropractic care for cervical and lumbar disc herniation. JMPT 1996;19(9):597-606.
  • Bush K. Pathomorphologic changes that accompany the resolution of cervical radiculopathy. Spine 1997;22(2):183-187.
  • Matsubara Y. Serial changes on MRI in lumbar disc herniations. Neuroradiology 1995;37:378-383.
  • Komori H. Natural history of herniated Nucleus pulposus with radiculopathy. Spine 1996;21(2):225-229.
  • Saal J. Nonoperative management of cervical herniated disc with radiculopathy. Spine 1996;21(16):1877-83.
  • Mochida K. Regression of cervical disc herniation observed on MRI. Spine 1998;23(9):990-997.
  • Ellenberg MR. Prospective evaluation of the course of disc herniations in patients with radiculopathy. Arch Phys Med Rehab 74; Jan 1993, p. 3.
  • Bozzao A. Lumbar disc herniation: MR imaging assessment of natural history in patients treated without surgery. Radiology 1992;185:135-141.
  • Maigne JY. CT followup study of 21 cases of nonoperatively treated cervical soft disc herniation. Spine 1994;19(2):189-191.

Next page – Spinal Decompression Outcome Study

The facts about herniated discs

On September 27, 2010, in , by admin
If you have a herniated disc, you should carefully read the following: A health problem as serious needs to be taken care of by a competent health professional. Such a condition when poorly managed can have a disastrous effect on your health for the rest of your days. [flv:http://www.sosherniateddisc.com/wp-content/uploads/2010/09/Welcome-to-3Drx-HybridOnline.com_.flv] The facts about herniated discs: Herniated […]

If you have a herniated disc, you should carefully read the following:

A health problem as serious needs to be taken care of by a competent health professional. Such a condition when poorly managed can have a disastrous effect on your health for the rest of your days.

[flv:http://www.sosherniateddisc.com/wp-content/uploads/2010/09/Welcome-to-3Drx-HybridOnline.com_.flv]

Herniated disc

Herniated disc click to enlarge

The facts about herniated discs:

  • Herniated Discs are not all inherently painful
  • Most bulging discs are not symptomatic
  • A bulging disc may be as painful as an herniated disc
  • Surgery or non-surgical spinal decompression is required to correct an herniated disc
  • In most cases, surgery actually offers poor curative results for an herniated disc
  • Herniated Discs does notworsen with time but the disc does end up with degenerative disc disease.
  • Most herniated discs won’t resolve on their own. The pain may subside because of posture and structural compensation
  • Herniated discs cannot be diagnosed with an x-ray. You need an MRI
  • Herniated discs are not always due to injury
  • Herniated discs can happen because of a spinal rotational decompensation caused by a pelvis misalignment
  • Medical treatment is not necessary for most herniated discs
  • Many disc pain conditions are misdiagnosed

If I were to gather a group of middle age folks (45 average age) who have NEVER had back pain before and shoot MRIs on them all, here’s what we would find:

  • 38% would have disc bulges,
  • 37% disc protrusions (aka: contained herniations),
  • 11% disc extrusions (aka: non-contained herniations),
  • 0% disc sequestrations (aka: free fragments) and
  • 4% nerve root compression by the disc herniation.

A more shocking statistic is that 60% of asymptomatic middle aged people would have findings of disc bulge or worse (protrusion, extrusion) on MRI!

Disc herniation, the leading cause of lombosciatica, is a result of a long and silent degenerative disc which will decompensate more or less abruptly on the occasion of an effort, sometimes minimal.

The lombosciatica almost never an “accident” occurring on a perfectly healthy spine.

References:
1. Jensen MC, et al. “MRI imaging of the lumbar spine in people without back pain.” N Engl J Med – 1994; 331:369-373

2. Boden SD et al. “Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: A prospective investigation.” J Bone Joint Surg Am 1990; 72A:403-408

3. Weishaupt D et al. “MRI of the lumbar spine: Prevalence of intervertebral disc extrusion and sequestration, nerve root compression and plate abnormalities, and osteoarthritis of the fact joints in Asymptomatic Volunteers.” Radiology – 1998; 209:661-666

4. Boos N, et al. “1995 Volvo Award in clinical science: The diagnostic accuracy of MRI, work perception, and psychosocial factors in identifying symptomatic disc herniations.” Spine – 1995; 20:2613-2625

5. Powell MC, et al. “Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women.” Lancer – 1986; 2:1366-7

6. Boos N, et al. “Natural history of individuals with asymptomatic disc abnormalities in MRI: Predictors of low back pain-related medical consultation and work incapacity.” Spine 2000; 25:1484

7. Borenstein G, Boden SD, Wiesel SW, et al. “The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic individuals: A 7-year follow-up study. J Bone Joint [am] 2001; 83:320-34

8. Wiesel SW, et al. “A study of computer-associated tomography: I. The incidence of positive CAT scans in asymptomatic group of patients.” Spine 1984;9:549-51

11. Wood KB, et al. ‘Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individual s.’ J Bone Joint Surg Am. 1995 Nov;77(11):1631-8

20. Jarvik JJ, et al. “The longitudinal assessment of imaging and disability of the back (LAIDBack) Study.” Spine 2001;26: 1158-66.

25. Boden SD, et al. “Abnormal Magnetic-Resonance Scans of the Lumbar Spine in Asymptomatci Subjects.” J Bone Joint Surg [AM] 1990; 72:403-408

26. Fraser RD, Sandhu A, Gogan WJ. ‘Magnetic resonance imaging findings 10 years after treatment for lumbar disc herniation.’ Spine 1995 Mar 15;20(6):710-4. “The findings of this study indicate that long-term improvement of a patient’s symptoms after treatment of disc herniation may occur with or without resolution of the hernia. This and the similar morphologic findings in the different groups is consistent with the 10-year clinical results after the treatment of disc herniation reported by Weber.”

27. Masui T, et al. ‘Natural History of Patients with Lumbar Disc Herniation Observed by Magnetic Resonance Imaging for Minimum 7 Years.’ J Spinal Disord Tech. 2005 Apr;18(2):121-126. “Clinical outcome did not depend on the size of herniation or the grade of degeneration of the intervertebral disc in the minimum 7-year follow-up.”

517. Giuliano V, et al. ‘The use of flexion and extension MR in the evaluation of cervical spine trauma: initial experience in 100 trauma patients compared with 100 normal subjects.’ Emerg Radiol. 2002 Nov;9(5):249-53.

Next page – chronic back pain

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