As seen on the Sally Show 4/17/2000
Herniated or degenerated disc treatment options
After years of providing individual's with information and physician referral's to back specialist's, we at Second Opinion feel that finding the best doctor for this condition is the most important step in receiving the best care possible.
Success rates and treatment options given vary with the competence and experience of the physician.
Not all physicians are familiar with all of these procedures, nor can they perform them.
A herniated disc that is too large for laser surgery with one doctor, may not be for a doctor that is better trained in the procedure. If you want to concentrate on non-surgical treatment options, you must locate a facility that specializes in non-surgical treatments. Seeking advice from a surgeon that specializes in surgeries will most likely increase your chances in having surgery.
Here are some brief explanations of treatment options for low back pain.
Verterbal Axial Decompression Therapy:
It is a new non-surgical medical breakthrough called VAX-D. It is a revolutionary new therapy that can actually take the pressure off the injured disc and soft tissue, allowing them to heal and relieving the pain.
VAX-D stands for Vertibral Axial Decompression. This unique machine was developed by a prominent Canadian Orthopedic Surgeon to treat difficult, chronic and even failed low back cases. The VAX-D does what nothing in medicine has been able to accomplish. It creates a "vacuum" which literally pulls new fluid back into the disc and the disc back into position, giving the disc healing nutrition and removing pressure from the nerves and spinal cord.
The VAX-D is effective in 85% of the disc injuries that need surgery, and an even higher percentage of the disc problems that don't. The VAX-D also handles other major lowback conditions, it is a very cost effective treatment for lumbar pain, sciatica, herniated disc, degenerative disc disease and failed back surgery.
Interesting website links about VAX-D
Reconstructive therapy - a simple biological technique that involves injection of fluid into the joint to stimulate the repair of tendons and ligaments - can elimate their suffering. What is more, its cost is far lower than the less effective surgical or pharmaceutical remedies it replaces.
Although used for over 40 years, until now this remarkable technique has been known to only a small group of innovative physicians. In this book you will read about the many successes that have resulted from its use. Its effectiveness is well documented, both in individual cases and in clinical studies. By using this holistic therapy, it is possible to correct the causes of musculoskeletal pain rather than merely masking it.
Intradiscal Electrothermal Annuloplasty works at least as well as fusion. The difference is that it takes about 15 minutes under local anesthetic. It costs $7,000 instead of $50,000. And patients walk out of the operating suite when it's over. Says one veteran, "It's not much worse than having a tooth filled."
To understand the new treatment, you need a sense of how spinal discs work. Think of a healthy disc as a car tire made of tightly woven ligaments and filled with soft putty. Sandwiched between two vertebrae, it makes a good cushion. Unfortunately, the ligaments encasing a disc can loosen and tear after several decades of service. And when that happens, outside blood vessels can invade the disc, accompanied by nerve fibers that don't belong in such a high-pressure environment. The problem is more complicated than a rupture, or "herniation," because the pain originates inside the disc, not in the adjacent nerves it touches. The standard treatment involves destroying the disc and using bone grafts to fuse the two vertebrae it separated.
IDET aims to achieve more by doing less. "We don't throw out the tire," says Dr. Jeffrey Saal, a Stanford spine specialist and coinventor of the technique. "We patch it." The secret is an instrument called SpineCath. Designed by Saal and his brother, Dr. Joel Saal, it consists of a six-inch needle and a fine catheter with a heating element on the end. After tracing a patient's pain to a particular disc, doctors insert the catheter through the needle and heat it to 194 degrees for 14 to 17 minutes. The heat not only kills the invading nerves but also tightens the surrounding ligaments, creating a new seal.
The technique is still in its infancy-only 700 patients have been treated-but the early results look promising. In small studies, roughly 80 percent of the recipients have enjoyed reduced pain and greater mobility, and half of those taking narcotic painkillers have ended up drug-free. No one knows how long the benefits will last; heat-treated discs may develop new tears over time. The beauty of IDET is that most patients would probably try it again.
NEWSWEEK MARCH 1999
There are over 200,000 laminectomies performed in the United States every year. It is often said that over one third of these operations are failures. There is nothing more distressing to the physician or the patient than to be faced with this unhappy dilemma. There are over l5 billion dollars spent on low back care every year in this country. We can no longer afford anything less than a good outcome. Can the failed back syndrome be avoided? Where are we going wrong? Why are there so many failed back surgeries? Is it the patient's fault? Is it the surgeon's fault? Or is it just the natural history of the disease? There are biologic variables doctors cannot control such as bone healing, cartilage degeneration, and patient behavior, all of which can affect outcome. We can, however, control ourselves and improve our own performance. The failed back syndrome is in part an iatrogenic problem which can be cured by selection of the right patient, the right level, and the right operation.
Ray Threaded Fusion Cage
The Ray Threaded Fusion Cage TM device is a hollow threaded cylinder with holes. The cage is made of titanium, which is compatible with the human body. At each end of the cage is an end cap made from plastic, also compatible with the human body. The devices are filled with bone taken from your spine or hip.
Which Patients Might Benefit?
In your lower back, there are five moveable bones or vertebrae that make up the lumbar spine. Between each vertebra is a cushion-like material called a disc. All bending, twisting and turning movements occur through the discs. Your discs can wear down (degenerate) or dry out and cause some of the disc spaces to collapse. This may produce back and leg pain.
Based on your examination, your doctor has found that you have low back pain due to a condition called degenerative disc disease (DDD) or spondylolisthesis. Your doctor may consider spinal surgery using the Ray TFCTM device. The purpose of this surgery is to stabilize and fuse one or two disc spaces of your spine and relieve your pain.
The Ray TFCTM device is approved for use in patients with DDD. Patients with DDD may also have limited forward slippage of one vertebra over the vertebra below. (Grade I spondylolisthesis). The Ray TFC device, filled with bone taken from your own body, may be implanted from the 2nd lumbar disc (L2) down to the sacrum. Only one or two disc spaces are to be fused. Patients being considered for this surgery should be skeletally mature and have had at least six months of non-operative (conservative) treatment.
You will have surgery in an operating room. You will be given general anesthesia and will feel nothing during the actual procedure. Your doctor will make a standard surgical incision in your back (posterior approach) and, after removing your worn disc(s), will place two Ray TFCTM devices in the disc spaces(s). These devices will them be packed with bone, which your doctor will take from your hip, or from the local area of surgery. Your bone material will be placed inside the Ray TFCTM device so that bone may grow through the holes in the devices to fuse your vertebra above with your vertebra below. Your doctor will place a plastic end cap on each of the devices. After closing the incision, the procedure will be finished and you will go to the recovery room.
Complications related to spinal surgery include, but are not limited to, problems from anesthesia, circulatory problems, blood clots, heart attach, stroke, death, pneumonia, spinal fluid leaks, blood vessel damage/bleeding, infection, leg pain, bruises, bladder problems and nerve complications. The potential risks of this procedure aresimilar to those of other spinal surgeries.
A 2-year clinical study of 236 patients implanted with the Ray TFCTM device was done at a number of hospitals in the United States. 92% of patients achieved successful fusion.
LASE -bridges the gap between conservative therapy and surgery for the treatment of contained herniated discs.
The LASE procedure is a cost-effective, minimally-invasive treatment for those patients who prefer to avoid conventional back surgery. LASE often provides relief from the pain and a fast return to routine activities. Because it is minimally-invasive, it is appropriate for many patients whose health or age may exclude them from more aggressive surgical intervention. Over 7000 LASE procedures have been done worldwide, with studies indicating 75–85% success.
What is the LASE procedure?
The LASE technique is designed to reduce the bulging nucleus enough to eliminate the pressure it is placing on the nerve. A miniature endoscope with a laser fiber is inserted into the disc. The incision through the skin is less than 1/4 inch. The LASE endoscope allows your doctor to see the bulging disc tissue and remove it with the laser fiber. By removing some of the nucleus from the disc, the pressure on the nerve is reduced or eliminated along with the pain.
Is the LASE technique a new procedure?
Surgeons have been removing part of the nucleus since about 1936. Endoscopes and lasers have been used for more than ten years. Joining the laser fiber and endoscope into one device represents state-of-the-art technology. More than 7,000 LASE procedures have been performed. Multiple studies have shown that four out of five properly selected patients with contained herniated discs benefit from this procedure.
Is the LASE procedure risk-free?
Any surgical procedure has risks. The LASE procedure is no exception, but with the proper technique, the risks are minimal because of the less invasive approach.
What if I'm one of the few who doesn't benefit from LASE?
If you are the one in five patients who does not benefit from LASE therapy, you have not eliminated any of your options. Your doctor will still be able to offer the same therapeutic options you have today.
Endoscopic lumbar discectomy, has been developed to help those who have a herniated lumbar disc, also known as a "slipped disc." The physician uses a thin, automated probe, less than 1/10 inch in diameter, equipped with a fiber-optic camera. Performed on an outpatient basis, the procedure is completed in minutes and offers minimum discomfort, a shortened recovery period and a reduced rate of post-surgical complications compared to other surgical methods. Due to the fact that the only opening made in the skin is the size of a freckle and requires no stitches, this is referred to as a "closed" procedure and should be distinguished from "open surgery" in which larger incisions are made.
The ultra-thin probe was developed by Surgical Dynamics, a provider of surgical instruments and devices for treating spinal disorders and is called Working Channel Endoscope.
Because it's performed on an outpatient basis with local anesthesia, and the recovery time is greatly reduced, the cost savings are significant when compared to traditional open surgery.
For those patients who have failed conservative therapy, i.e., physical therapy, chiropractic therapy, medications, injections, etc., this procedure enables the patient to get relief without undergoing a high-risk open operation, such as lumbar fusion. The candidates should have severe back pain without leg symptoms. The patient is given sedation by an anesthesiologist and his back is "numbed" with local anesthesia. Then a special thermal probe is inserted into the disc under fluoroscopic control. The probe heats the inside of the disc for aprox. 15 minutes. When this occurs, it is believed that the painful micro-fissures in the disc seal over and the tiny nerve filaments that supply the disc are de-sensitized. The procedure is outpatient, extremely low risk and the early results suggest that it is effective in a high percentage of cases.
Goal: reduce pain, swelling and inflammation
anti-inflammatory/pain medication if necessary
Goal: stabilize back through better flexibility, strength, and endurance
* education about lifting, sitting, etc.
* exercises to increase back and cardiovascular fitness
encouragement to achieve and maintain a healthy back
Adding Back Strength & Stability Exercises to Your Program Will Enhance Your Performance
An achy back, is no unusual experience. Regardless of the sport you practice, lower back pain is common among all of them. For the martial athlete, the lower back is highly manipulated by the movements indicative to the sport. Like gymnasts, martial athletes utilize rotation, flexion and extension of the back to generate power and to maintain superior technique throughout sport movement. Having personally experienced the torment of a back injury (2 herniated discs), I am concerned about over-use and neglect of the lower back in the martial arts school. Injuries to the spine are complex, even for trained sports-medicine professionals. However, there are a few key factors that you can watch for which may be helpful in identifying a back injury and would indicate the need for the care of a sports-medicine professional . The following is a list of some of these symptoms:
Tingling or numbness in the legs, inability to move normally due to stiffness or acheness, spasms, lower extremity weakness, increased lower back pain from standing or sitting.
Stability training is one fundamental method of exercise that can assist in preventing back problems from occurring. When throwing kicks, holding stances or jumping, the back acts as a stabilizer. If the abdominals are weak or fail to tighten during these types of movements, the back over-works and becomes fatigued. Furthermore, lower back pain may occur if the upper abdominals are significantly stronger than the lower abdominals. The lower back erectors (erector spinae), the quadratus lumborum and gluteals are groups of muscles that act not only as stabilizers, but are often primary movers in several martial arts moves (i.e. back/mule kick, any reverse kick). The strength imbalance that often occurs in the trunk (abs, back, gluts, hips) can be attributed to the lack of strength exercises incorporated in the training program of most martial athletes. Below are a couple back exercises that can easily be added to the martial arts class.
Doggy Bridge – Place both hands and knees squarely on the ground. While keeping your abs tight and your pelvis neutral (no excessive arching or sagging), slowly lift the opposite arm and leg off the ground. Extend both of them out while holding your head straight. While lifting the arm and leg, squeeze your glut and do not allow your hips to tilt. They should be square with the ground. Do slow reps (10) at 2 –3 sets, two or three times per week.
Supermans – Lay flat on the floor on your stomach. Fully extend your arms and legs. While keeping your forehead flat on the ground, slowly lift the opposite arm and leg off the ground. Do not bend the knee, imagine someone trying to pull your shoe off your foot as you lift the leg. Your hips should be pressed on the ground and your gluts should be tighten. Do not kick the leg up. (The movement is similar to the doggie bridges) Do 10 reps slowly at 2 – 3 sets, two or three times per week.
LTX 3000TM Lumbar Rehabilitation System
Following a decade of monitoring the clinical application of controlled antigravitational unloading devices being used for treatment and prevention at the Sister Kenny Rehabilitation Institute in Minneapolis a redesign of existing systems and their associated clinical programs began in 1987. William Stumpf and Associates of Minneapolis (recognized leaders in the field of ergonomic seating) assisted in studies intended to construct advanced controlled spine distraction devices. Laboratory testing confirmed the basic theories being researched and the ability of using the rib cage to support the spine in the sitting position and utilizing the force of gravity to serve as a "governor" so as to not exceed the compliance of normal body tissue. Shown here is a prototype of the LTX-3000 lumbar rehabilitation system. This system has been shown to be capable of inducing significant lumbar lengthening in biomechanical research study (Janke AW et al: The Biomechanics if Gravity-Dependent Traction of the Lumbar Spine Spine 22(3): 253-260, 1997).
Subsequently, the LTX-3000 lumbar rehabilitation system became incorporated into a 4 day outpatient clinical program designed by Spinal Designs International now in operation in a number of locations in the United States. The educational content of the program has been expanded, from the original Sister Kenny Institute model developed in 1976, to include nutrition, health habits, stress management and advanced exercise techniques such as stabilization exercises.
Applied Forces and Associated Physiologic Responses Induced by Axial Spinal Unloading With the LTX 3000TM Lumbar Rehabilitation System
Rian J. Podein, MS, Paul A. Iaizzo, PhD
Objective: To measure forces applied to the body and associated changes in physiologic responses during axial spinal unloading (gravity-dependent traction) using the LTX 3000TM Lumbar Rehabilitation System.
Design: Lumbar unloading was induced in 17 healthy subjects. The following parameters were measured:
(1) percentage of total body weight unloaded; (2) forces applied onto and below the rib cage and local changes in cutaneous blood flow; (3) alteration of the applied forces to the seat strap associated with lumbar lengthening; and (4) changes in respiratory rates, respiratory minute volumes, heart rate, and blood pressure.
Results: The average pressure applied to the rib cage for thoracic immobilization without unloading was 73 ± 26mmHg. Lumbar unloading caused these pressures to increase by approximately 30%, causing complete but temporary occlusion of cutaneous blood flow in this region. Significant, but normal, reactive hyperemia occurred upon release of the rib support pads (p .05). Axial spinal unloading using an LTX 3000TM induced changes in heart rate, blood pressure, and respiratory rates of magnitudes similar to those reported with the use of other traction devices.
Conclusion: The forces applied to the rib cage by the LTX 3000TM for proper lumbar unloading caused changes in physiologic responses, but these changes were reversible and can be considered clinically unimportant and thus should not be contraindications to the use of this device by the general population.
Exercise balls are effective in controlling back pain. Low back pain relif is possible without surgery. A doctor-approved rehabilitation exercise program is a significant factor in the treatment of low back pain patients. Exercises done with the revolutionary Gym Ball strenghen muscles while supporting the lower spine.
Electroacupuncture and Low Back Pain
This study evaluated the use of electroacupuncture treatment in comparison to TENS (transcutaneous electrical nerve stimulation) in the treatment of low back pain. A control group using sham electroacupuncture and exercise was employed in the study. 60 men and women participated in the study.
Patients reported immediate pain relief with the acupuncture, with a decline of pain scores of 82% in the acupuncture group versus 26% in the TENS group. There were non-significant declines in the control group. Acupuncture treatment improved activity and sleeping.
It is important to note that the acupuncture resulted in patients using 50% less oral pain killers while the other treatments produced no significant difference in the use of medications.
Percutaneous electrical nerve stimulation for low back pain:
A randomized crossover study. Ghoname EA et al, JAMA 1999 Mar 03; 281:818-823.
Another surgical option to treat a lumbar herniated disk is chymopapain injections that dissolve the disk. This procedure is less invasive than surgery, and has had varied success and popularity among surgeons. It has been available since the 1970’s, but comparison studies have indicated that a lumbar discectomy is a more reliable option.
A 10- to 14-year follow-up questionnaire of 146 patients treated for sciatica from a herniated nucleus pulposus by chymopapain (Discase) injection revealed a durable, satisfactory result in 66%. In the 102 patients rated as excellent or good, 5% required surgical discectomy 50-82 months after injection. One-, two-, and three-level injections were performed and the number of levels injected did not influence the success of the procedure or the subsequent need for open surgical intervention. There was no correlation shown between the incidence of job change or unemployment and the number of levels injected.
In this review of 35 patients who received repeat chymopapain injections, 41% had an excellent result, 37% had some improvement, and 22% showed no improvement. Of the 21 patients followed who had the same disc injected twice, 43% had an excellent result and 24% had no improvement. Of the three patients followed who had a different disc injected on the second occasion, one had an excellent result, and none showed no improvement. There was no significant difference between the two groups. Six patients (17%) had an anaphylactic reaction to the second injection. Five had a major reaction. Repeat chymopapain injection may be a valid treatment for a protruded disc but should not be performed until a definitive test for sensitivity is developed.
The concepts that led to the DRS (Decompression, Reduction, Stabilisation) system were developed by a neuroscience and engineering team. The goal of the project was the design of a computerized system that would allow pressure to be applied to the spine without any reflex contraction or spasm.
Dr. Norman Shealy M.D. Ph.d F.A.C.S., world renowned neuorosurgeon, further developed the original prototype devices with the addition of many patented harnessing & positioning modifications. The original testing and clinical trials were performed in the prestigious Shealy Institute. The result was a device that could continuously apply, monitor and adjust the pressure on the spine to achieve the decompression phenomena. The process is very comfortable and completely pain free. Three trials on the technology have been published in major journals. United States FDA and Canadian HPB have both cleared the technology as safe and effective for medical use. This treatment repairs damaged discs and reverses dystrophic changes in nerves, relieving pain and disability resulting from disc injury and degeneration, effective in clinical trials in 86% of cases of lumbar disc pathology, with no evidence of relapse on one-year follow up.
By lowering intradiscal pressures, DRS Therapy accelerates healing in the disc segment.
The following measures facilitate recovery of the disc and structures:
1) The application of infra red waves to the lumbar area.
2) Decompression using the DRS applied to the affected disc segment.
3) The application of cold packs to minimize tenderness.
4) A specially designed low level laser directed at the area.
The increase inflow of bio-nutrients, and energy from laser combine as a catalyst for rapid healing and regeneration. This process is gradual with the daily treatment time of 90 minutes, the first ten sessions performed daily. The treatment is safe and care is taken in the selection of the candidate. There are contra-indications such as connective tissue disease, spinal tumors, spondylolithesis, severe spinal instability, and spinal fractures. Patients are normally examined and assessed by their own physician before the treatment process. Another assessment by the physician is performed after treatment.
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