Spinal Decompression

What is a slip disc?

A disc is said to be slipped when it bulges or tears out of its protective ring of connective tissue. It is also called bulging disc, ruptured disc or herniated disc.

Slip Disc Treatment

The pain can most often be treated by addressing the causes that led to this condition.

1. Self treatment

Simple home treatment like hot and cold applications accompanied by rest can often relieve the pain caused by minor cases of slip disc. The patient may also take over-the-counter anti-inflammatory medication and pain killers like Tylenol and Advil. Simple exercises that strengthen and stretch the back may provide a lot of relief. Physiotherapy and massage may also help, if required. 95% of the people are cured by these simple steps.

2. Change in life-style

Overweight people may also suffer from slip disc. The excessive flesh around the waist causes strain on the lumber spine which supports the entire weight of the upper body. When the discs in the vertebrae come under pressure, they tear out of their boundary and press against the nerve roots. Obesity often occurs due to lethargic lifestyle and uncontrolled eating habits. Eating vegetables and fruits, taking physical exercises regularly and positive thinking can go a long way in reducing the weight and pressure upon the lower back.

Medicines

If the do-it-yourself efforts fail to treat the slip disc, the patient may take non-steroidal anti-inflammatory drugs and narcotic pain killers. This may be accompanied by muscle relaxants if the person is suffering from spasmodic pains in the back.

Injections

If the oral medicines do not work, patient may have to take steroid injections into the lower back area where the slipped disc has occurred. These injections generally have to be taken once in every three months. The medicines or injections should only be taken at the advice of the doctor.

Surgery

Surgery should be considered only as the last option when every other method has failed. It should be confirmed through tests that the slip disc will cause a potential damage to the nerve roots. Even in surgery, there are several options. You can consult the spine specialist which option will work best in your condition.

One of the many degenerative diseases that are evident in old age is Cervical Spondylosis. This condition attacks the cervical bones responsible for bending and rotating the neck by forming bone spurs or osteophytes. Sometimes, the condition is also termed as Neck Arthritis. The earliest clinical manifestations of the disease are headaches, neck pain and stiffness. Some people's disease manifestations, however, do not show clinical signs of development until it is elaborately diagnosed with a simple neck x-ray.

Severe cases of Cervical Spondylosis show neurologic and physiologic symptoms that may already alter body functions. Some of these severe manifestations include neck pain that is not relieved by drugs and other homeopathic remedies. Difficulty in swallowing, medically termed as dysphagia, can be dangerous and is observed when the developed osteophytes in the neck area compress the esophagus. Loss of balance may also be an issue when standing and moving about. Bowel and bladder incontinence can be disturbing as it affects excretion of toxins from the body.

Surgery can be the final option when the neck pain persists and radiates in the arms and back. However, some older people believe that this does not work up until advised by experts. Primarily, surgery is done if neurologic symptoms such as falling, weakness and numbness are observed. Your surgeon has the discretion of how to approach the spinal cord which has three areas: the front, rear and side. Usually, some portions of the cervical disc are excavated along with some osteophytes.

The type of surgery that will be used can vary depending on the underlying origin of pain and nerve damage including a narrowed spinal canal or a slipped disc. Here are each of the surgeries and overviews of each of the processes. Laminectomy is one of the most common procedures where a small incision is made at the back of the neck removing bone pieces contributing to spinal cord compression. Foraminotomy, on the other hand, is done by cutting a nerve root at the back of the neck. When a whole osteophyte or bone lump is removed, discectomy is performed.

A new kind of surgery, the Prosthetic Intervertebral Disc Replacement, is performed by removing a worn-out spinal disc and replacing it with an artificial disc to do the same function. This procedure has brought promising results to patients. However, there are still no data on how well it works on a long term basis.

The sciatic nerve, which is the largest nerve in the body, originates from your lower back and travels under the buttock muscles all the way down the legs and feet. When it is being pressed on, it gets inflamed or irritated which may give rise to painful symptoms. This pain is called sciatica.

Most people obtain relief from sciatic nerve pain without resorting to surgical treatments. In addition, they are able to return to their usual activities after a few weeks of having nonsurgical spinal decompression. Even more, many patients who underwent disc decompression experienced very good results.

Sciatic Nerve Pain

Sciatica is a painful symptom caused by an irritation of sciatic nerve. The pain is usually felt at the back of the thigh. Herniated disc, which is the most common cause, presses the nerve and cause it to get irritated or inflamed.

Symptoms

The pain from sciatica may vary from infrequent and irritating to severe and debilitating. Sometimes the sensation is like a jolt or electric shock. It may get more painful when coughing or sneezing. Symptoms may aggravate if you are sitting for a long period. Usually, only one lower extremity is affected.

Common symptoms of sciatica include:

• Pain in the rear or leg that becomes worse when sitting
• Burning or tingling sensation down the leg
• Weakness, numbness, or difficulty moving the leg or foot
• Constant pain on one side of the rear
• Shooting pain that makes it difficult to stand up

Herniated Disc

A spinal disc problem, herniated disc is the most common cause of sciatica. Spinal discs are pads of cartilage located between the vertebrae. Filled with a gel-like material, they maintain flexibility of your spine. The discs cushion your vertebrae to absorb stress when you move.

However, if the disc's outer covering tears or herniates, the gel may ooze and press on a nerve root. Constant pressure irritates the nerve and can cause swelling and inflammation and the symptoms will start to occur.

Nonsurgical Disc Decompression

Nonsurgical spinal decompression is a type of motorized traction that therapeutically helps in correcting disc-related problems. It works by gently stretching the spine, taking off pressure from spinal discs. The negative pressure of decompression retracts the bulging or herniated disc, eliminating the pressure from the affected nerves. The negative pressure also draws in nutrients, water, and oxygen into the disc to promote hydration and healing.

Using only drugs or injections to treat the chronic pain does not promise long-term relief. They only work to mask the pain instead of treating the cause itself.

Because spinal decompression therapy works directly on the cause of the problem, it offers long lasting relief in comparison to drugs and injections. Also, this treatment method is a safe alternative to drugs and surgery.

If a person is a good candidate for spinal decompression therapy, there is a good chance that he/she may get the real cause treated and experience long lasting relief from sciatica.

When a patient has an epidural steroid injection for pain management, the procedure involves placing a needle into the area around the spinal cord (or its remnant called the dural sac) and the nerve roots.

This needle can at times inadvertently enter into the covering around the spinal cord (called the dural sac) and cause some of the cerebrospinal fluid to leak out. This is an infrequent occurrence and typically the tiny little hole generated will heal up uneventfully.

There are also procedures such as a CT myelogram where the interventional radiologist will actually place the needle into the covering around the spinal cord to place dye. These tiny little holes into the covering which is called the dural sac will usually heal up uneventfully as well. After this type of procedure the nurses will typically have the patients lie flat for an hour or two to make sure.

A small percentage of the time, this little hole in the covering around the spinal cord does not heal up properly and cerebrospinal fluid (CS) continues to leak.

Symptoms of a post dural puncture leak are often times severe and problematic for patients. They may include severe headaches while standing upright, photophobia which is where exposure to light causes patients significant headaches and pain, or significant nausea and vomiting may result. The headaches that can result are referred to as spinal headaches and what is typically seen is that the headaches will subside when the patient is laying down and get very bad when the patient is either sitting upright standing or walking.This is due to gravity permitting more CSF to leak while standing upright.

One thing that should be made clear is that a person's body is very active in making cerebrospinal fluid. Studies have shown humans replace their CSF every 4 to 8 hours. This is good news, as a dural leak can cause a significant amount of cerebrospinal fluid loss and it's good to know that comes back so readily.

Initial treatment for a dural leak is to have a patient spend a few hours laying down in bed. This may entail bed rest for a full day, but thankfully patients usually do not need to be admitted to the hospital. If the bed rest does not take care of the problem, it may become necessary for a doctor to perform what is called an epidural blood patch.

An epidural blood patch is a procedure that is done as an outpatient by the doctor taking some blood from the patient's vein, and then re-injecting that blood into the spinal cord itself, through the dural sac. The blood then filters through the area and somehow attaches to the area of the leak and will often stop the leaking by sealing over that area.

This procedure can be done as an outpatient and is often extremely effective in association with bed rest after the procedure to alleviate the symptoms of an epidural leak.

It is typically very unusual for patient to end up needing a subsequent surgery to fix the leak. In extreme circumstances this may end up be coming necessary.

When a patient comes into the office and says, "Doctor I have a lot of back pain and the only thing that works is Oxycontin, I've tried everything else," how does the doctor know if the patient is legitimate or not?

Unfortunately there are few tools to objectively measure a patient's pain to know whether it is legitimate or if the patient is faking. Usually, patients are asked to give a pain score on the Visual Analog Scale which is pain on a scale of 0 to 10. There is also a scale which uses facial expressions for pain severity, which is great for children.

A widely held estimate is that 15 to 20% of patients are malingering (faking) their symptoms in order to obtain drugs illegitimately. They are either abusing them or selling them (or both), and faking an illness is the most effective way of obtaining their inventory. Another reason for faking is to obtain disability, which provides for a nice paycheck to patients while everyone else in society pays for it.

Opioids are now the second leading cause of accidental death in the US, only behind car crashes. While the Institute of medicine is reporting that pain is often undertreated, the Office of National Drug Control Policy reported that narcotic prescriptions are up 48% since 1999.

There are some well known red flags to patients who are "drug seekers". Patients who call in saying they are from out of town and cannot obtain their medical records from their previous pain doctor are suspicious. Also, if a patient states they do not have insurance and want to pay cash for their treatment may be utilizing their insurance at another pain doctor and trying to hide that by skipping their insurance plan payments.

Over 35 states have instituted statewide prescription registries, where doctors can see if patients are receiving narcotics from other doctors. There are a few problems with the system, including the delay in prescriptions registering, incomplete participation, and the fact the systems cover only that individual state. A nationwide system, signed into effect by President Bush in 2005, has not been fully implemented due to lack of funding.

About 80% of pain issues are handled by primary care doctors. And it can be very tricky. Even the best of tools available to fellowship trained, board certified spine doctors show that over 50% of the time an exact diagnosis evades medical specialists. Figuring out the pain generator can be elusive, hence figuring out whether a patient is faking can be tough to discern.

It's not just inner city drug addicts who sell or abuse their prescriptions. Retired folks do it, executives do it, and even legitimate chronic pain patients take too much of their medications, effectively abusing them.

So what to do? Well, there are no go-to methods for detection that are foolproof. A few helpful tools include urine or oral drug testing (screening), pain management agreements, and as mentioned the prescription registry monitoring system. Otherwise, keep your radar up for red flags.

It's no secret that pain management medications are a considerable problem in the United States, and the problem will not be going away anytime soon. We know from a recent study published by the Institute of Medicine that there are over 110 million people in United States suffering from acute or chronic pain, with a total annual cost of over $530 billion.

We also know from the same study that even though the cost of pain management in United States is well over $530 billion per year, the amount spent on research studies is between $200 and $300 million, which is less than 1/10 the amount of the cost of the problem. So it is obvious that more research needs to be performed to help find new ways of managing pain in United States.

Unfortunately one of the things that is being seen in numerous states now are onerously strict new pain management rules that are leaving patients without care at all. Unfortunately one of the stereotypes that gets thrown to pain management patients is that they are all drug seekers. In fact we know this is simply not the case, as there are certain patients who have conditions that are not amenable to either surgery or interventional pain management procedures any more.

Once a pain management doctor or a primary care doctor is duped by a few patients, it becomes very difficult and also very disappointing for that doctor to continue to prescribe pain medications not being able to delineate between real pain patients and fakers. So what may occur is that as states turn to more restrictive policies on prescribing pain medication, that physician may turn around and say "I'm just not going to prescribe any narcotics at all anymore".

In most states back in the 1980s, pain medications were under prescribed and patients were being undertreated. As a result of this there was a push to start treating pain appropriately, and this turned into a period of lax opiate prescribing which then caused a spike in overdoses. With the new statistics that are out for pain medication prescriptions showing a 100% increase over last five years across the country, a lot of states like Washington are now passing laws making it very difficult to effectively prescribe medications to patients in need.

The result is typically that emergency rooms, specialists, or primary care doctors who are extremely busy decide that it's too much trouble to treat patients with the opiate medications and simply just stop prescribing them all together. The result? This will lead to an even worse problem where scores of patients now have no treatment for their pain, and end up having to seek out new providers who do not know them at all and have reason to be suspicious because it often times is unclear why that patient is having to seek out a new provider.

There is no doubt that with the onset of pill mills in United States and the growing epidemic of pain in this country there are a significant number of patients who are faking their situation. However, what could eventually happen is that with such strict rules regarding pain medication prescriptions that a significant amount of providers will just simply stop prescribing any narcotics, which will then leave a substantial amount of patients under treated again which was the problem back in the 1980s this event you let this problem to begin with.

What is Stenosis?

Spinal Stenosis is a medical condition in which the spinal canal narrows and compresses the spinal cord and/or exiting nerve roots. Stenosis is from the Greek word meaning "a narrowing". Central canal stenosis is a narrowing of the channel in the center of each vertebra through which passes the spinal cord on its way down the spine. Foraminal stenosis is a narrowing of the channel on either side of the vertebra where the spinal nerve roots exit on their way to various parts of the body such as down the arms or legs. The vertebral foramen is a small opening or hole for the exiting spinal nerve root that is formed where the downward notch in the bone of a vertebra meets the upward notch of the vertebra below it. Spinal stenosis may affect the cervical, thoracic or lumbar spine. Lumbar spinal stenosis results in low back pain and can radiate down the nerves into the buttocks, hips, thighs, legs, or feet. Cervical spinal stenosis results in neck pain and can radiate down the nerves into the shoulders, arms, wrists, and hands.

What Causes it?

Although it is true that some individuals congenitally have larger or smaller canals than do others, the cause of the narrowing is usually a combination of 3 different degenerative factors present in varying degrees in different patients. First, when a disc herniates the bulge takes up space narrowing the nerve channel. Second, as the involved disc dries out and loses height (a process known as desiccation) it causes the vertebra to become closer together further narrowing the nerve channel. Third, as the stress on the joint compounds and osteoarthritis begins to result, bone spurs (osteophytes) form and ligaments thicken (hypertrophy) gradually narrowing the channel even further. These 3 factors in various combinations and degrees of severity compromise the space in the channel and conspire to compress (pinch) the spinal cord or nerve root. These 3 factors may also be referred to as Degenerative Disc Disease, the most common cause of spinal stenosis.

Spondylolisthesis and scar tissue formation as a result of prior surgical fusion are other factors that can contribute to spinal stenosis. Spondylolisthesis describes the anterior displacement of a vertebra or the vertebral column in relation to the vertebra below. Also, rarely, various bone diseases such as Paget's Disease or tumors in the spine are responsible for the narrowing. An MRI can rule in or rule out a wide range of possibilities rare though they may be.

A Non-surgical Solution

Spinal Decompression Therapy, first approved by the FDA in 2001, has since evolved into a cost-effective treatment for herniated and degenerative spinal discs, and the resultant spinal stenosis; one of the major causes of back pain and neck pain. It works on the affected spinal segment by significantly reducing intradiscal pressures. The vacuum thus created retracts the extruded disc material allowing more room for the pinched nerve, and will many times additionally increase the spacing between the vertebra as the involved discs are rehydrated, allowing even more room for the nerve. Furthermore, as the disc rehydrates its shock absorbing capabilities are restored reducing mechanical stress on the related structures (facet joints and supporting ligamentous tissues) slowing or halting the osteoarthritc damage. This is a non-surgical conservative procedure for patients suffering with bulging or herniated discs, degenerative disc disease, posterior facet syndrome, sciatica, failed back surgery syndrome, and non-specified mechanical low back or neck pain resulting in spinal stenosis.

1. Board Certified or Fellowship Trained Doctors

2. More services than writing prescriptions

3. Patients make an appointment

4. Mostly Insured Patients

5. Use of Narcotic Agreements and other Surveillance Methods

Comprehensive pain centers are considerably different from "pill mills". Unfortunately the two get linked together in the public's mind. Pill mills are pain clinics that are predominantly in the singular business of providing narcotic prescriptions. Because the country is in the midst of a narcotic prescription epidemic, pill mills have received a bad rap, and deservedly so. Unfortunately though, legitimate pain centers have been dragged down into that public perception as well.

Pain management clinics frequently have board certified or fellowship trained physicians who have received extensive training in both interventional pain treatment along with medication management. This is typically vastly different from pill mills, who tend to use physicians without specific pain training.

Pill mills typically just write prescriptions. In contrast, pain management centers usually provide more services, such as interventional treatments, physical therapy and chiropractic.

At a pill mill, patients are often able to simply walk in rather than making appointments. At the more legitimate pain centers, however, patients need to call and make an appointment. Usually if it's a new appointment with a referral, medical records are received from the referring doctor's office.

At typical comprehensive pain management centers, the patients have medical insurance and utilize it for their care. Pill mills often work outside the insurance system. This means either having patients with no insurance paying cash, or having patients with insurance simply not using it.

Comprehensive pain management centers utilize pain narcotic agreements, typically called "pain contracts." These contracts help to ensure patients comply with such treatment protocols as pill counts, urine drug screening, and pharmacy board prescription monitoring.

These 3 treatment protocols are a fantastic trio that helps prevent diversion. It is well known that over 20% of patients will divert their pain medications, and that diversion spans all socioeconomic and ethnic groups. Pill mills may not have these various surveillance tactics, and it works to the detriment of preventing the rising epidemic of narcotic abuse in the US.

These factors together differentiate pill mills from comprehensive pain management centers. By combining all of these services and qualities, the more modern pain centers can actually help patients cut down their amount of narcotics being taken. This may stem the tide of narcotic abuse, and also help transfer some of the medications being written to those of the non-narcotic variety.

"Ambulatory spinal unloading" is the "new kid on the block" when it comes to treatment of acute and chronic low back pain. It is so new that many care givers are not yet fully aware of it.

Anecdotally we know that relieving pressure on the discs via traction, non-surgical spinal decompression or inversion tables etc relieves the pain, we also know that continued activity opposed to inactivity is beneficial and everyone knows that stabilizing the spine and allowing strained muscles to relax and heal are critical to the healing process.

But until ambulatory spinal unloading came along there was no way to offer a low back pain suffer the full treatment. This new treatment modality for low back pain allows sufferers the ability to regain mobility, flexibility and activity in a pain free or pain reduced environment, allowing discs to rehabilitate, muscles to realign and mend and damaged nerves to heal.

Ambulatory spinal unloading dramatically reduces the degenerative cycle and dramatically increases the rejuvenative cycle of the spine and is without a doubt one of the most beneficial and cost effective, non-invasive treatment modalities for acute and chronic low back pain available today.

Ambulatory spinal unloading can be used to extend the benefits offered by stationary treatments as well as chiropractic and physiotherapy treatments or can be used as a pre surgery bridge or a post surgery protection/prevention tool.

Typical indications for this new treatment modality are most forms of low back pain that have been caused by; degenerative disc decease, herniated or bulging disc, nerve impingement, stenosis, facet syndrome, spondylolisthesis, lumbar vertebrae compression fracture, sciatica, lordosis etc and for many "undiagnosable" causes of low back pain.

While it is common for traditional doctors to recommend spinal surgery to treat severe back problems, it is usually not the ideal treatment option. Several accounts have been recorded of patients experiencing pain after back surgery. This is known as Failed Back Surgery Syndrome or Post-Surgical Back Syndrome.

Spinal surgery can almost guarantee that no future back surgery is needed for an operated disc, however, the surgery can cause complications with new discs. These complications, if not caused by malpractice, are often due to recurrent herniated discs or scar rediculopathy. Another probable cause is the slow adjustment of the body with the change in anatomy caused by either the surgery or the injury. Failed Back Surgery Syndrome is characterized by lower back pain, which in some cases is worse than the pain before the surgery, incapacitation, nocturnal cramps, and distal paresthesia.

Rehabilitation and pain management are the usual treatments for Failed Back Surgery Syndrome depending on the degree of pain. A second back surgery, however, is not recommended as treatment.

Several alternative methods of treating spinal problems, which are of equal, if not greater effectiveness than surgery are also available. One of which is spinal decompression therapy, which uses a machine, the DRX9000, that applies a gentle pulling force that decompress the injured discs and vertebrae and results in relief of back pain. It works by elongating the spine to release the pressure from the compressed discs or vertebrae and allows healing to begin as oxygen and nutrients enter the injured portions.

Spinal decompression holds several advantages over surgery, the most important being the lack of side effects since it is just a very simple, and safe procedure that uses high-class technology.

Another advantage is the faster treatment time compared to surgery as it is non-invasive. No incisions were made, therefore, there is no healing process to be worried about. Finally, based on research, spinal decompression has been proven to be more effective than surgery in terms of relieving pain. A proof of this is the fewer amount of analgesics (pain killers) needed to be taken after the treatment as to when surgery is performed.