Tuesday, January 29, 2008

Spinal Decompression using the DRX 9000

I was recently contacted and asked about the safety of the DRX 9000 spinal decompression machine. In my NYC spinal decompression practice I carefully screen patients for contra-indications and if they are not a candidate for the procedure I do not put them on the machine. In addition to spinal decompression using the DRX 9000 I also combine use of the Cox technic. This technic has been proven to open the IVF or intervertebral foreamen by 28%.
Call (212)645-8151 for spinal decompression in NYC or visit www.drshoshany.com
This past weekend I attended a post graduate seminar on the Cox technic.
I recently added the seventh generation Cox table to my practice.
I wanted to add some information on my blog about what I learned and a description of why I think this techic will improve patient outcomes.
Cox® Technic (aka flexion-distraction or F/D) relieves back and leg pain and neck and arm pain. Disc herniation and/or stenosis may be the cause of pain. Or simple arthritis or a back sprain may be the culprit.

Cox® Technic is a gentle, non-surgical, chiropractic spinal manipulation adjustment procedure.

95% of back pain and neck pain patients DO NOT require surgery.

Cox® Technic is a safe alternative to back surgery. It is also appropriate for failed back surgery patients who still suffer after surgery.

Cox® Technic is a well-researched (with research studies completed and underway), well-referenced (with over 90+ articles in medical and chiropractic journals) chiropractic spinal adjusting manipulation

Cox® Technic drops intradiscal pressures to -192 mmHg and increases the foraminal area by 28%.

Cox® Technic stops pain, realigns the spine and restores ranges of motion inherent to the spine while reducing low back pain, especially in radiculopathy (extremity pain--leg pain or arm pain) patients, better than active exercise therapy.

Innovated by James M. Cox, DC, DACBR, in the 1960's, Cox® Technic is a marriage of osteopathic and chiropractic manipulation principles. It is an accepted and widely used form of spinal manipulation.


The Biomechanics Study

Federally Funded Research has thus far proven the following about Cox® Flexion Distraction:

Reduces intradiscal pressures (on nerve roots to relieve pain)

Increases intradiscal height

Increases foraminal size up to 28% (more room for nerve roots and spinal cord)


The following is presented as a general overview of the treatment.

Cox® Technic is DOCTOR-APPLIED, DOCTOR-CONTROLLED, HANDS-ON, SPECIFIC CONTACT, PATIENT-FOCUSED care. During a treatment on this instrument, the patient lies prone while the treating physician concentrates on one vertebral motion segment at a time. The goal is to reduce stenotic effects by dropping intradiscal pressure to allow disc reduction, increasing the size of the intervertebral foramen, and lowering pressure on the dorsal root ganglion and the exiting nerve roots. While concentrating on the low back, the doctor may use the instrument's caudal (the part the legs lie on) section to allow lateral and circular motion which returns normal motion to the spine with reduced pain. The cervical spine can be treated similarly using a specially designed table.

The Lumbar Spine Adjustment

After undergoing a thorough examination which leads the doctor to a diagnosis of the back condition to be treated, the patient lies on a table that is built to traction the spine and also to produce motions that are normal for the spine. To attain these motions, the table goes "up and down" (flexion and extension), goes "side to side" (lateral flexion), or moves in a circular motion (circumduction). All movements are slow.

The doctor will hold a spinous process (the back part of the vertebra that feels like a "bump" on your spine) to isolate a single segment for treatment. The distraction manipulation is applied manually by the doctor to the patient's low back at the levels of the spine to be treated or that are painful. Tolerance testing is performed prior to the application of distraction manipulation to be sure it causes no pain to the patient. This technic is designed to help patients with low back pain and leg pain.

The Cervical Spine Adjustment

The patient will lie prone (face down) on the table whose headpiece moves in motions that are normal for the cervical spine (Flexion, Extension, Rotation, Lateral flexion, and Circumduction). This headpiece also allows traction to be applied to the cervical or thoracic spines alone or while these motions are being administered. The doctor will hold the appropriate spinous process (back of the vertebra) of the cervical spine to isolate the level of pain or the level of vertebra to be adjusted.

This recent study was posted on the DRX 9000 site.

Treatment of 94 Outpatients With Chronic Discogenic Low Back Pain with the DRX9000:

A Retrospective Chart Review

Alex Macario, MD, MBA**Departments of Anesthesia and Health Research & Policy, Stanford University School of Medicine, Stanford, California; Alex Macario MD, MBA, Professor of Anesthesia and Health Research & Policy, Department of Anesthesia H3580, Stanford University School of Medicine, Stanford, CA 94305-5640, U.S.A. Tel: +1 650 498 6810; E-mail: amaca@stanford.edu. ; Charlotte Richmond, PhD††Biomedical Research & Education Foundation, LLC, Miami Beach, Florida; ; Martin Auster, MD, MBA‡‡Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, ; Joseph V. Pergolizzi, MD§§Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.*Departments of Anesthesia and Health Research & Policy, Stanford University School of Medicine, Stanford, California; †Biomedical Research & Education Foundation, LLC, Miami Beach, Florida; ‡Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, §Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Alex Macario MD, MBA, Professor of Anesthesia and Health Research & Policy, Department of Anesthesia H3580, Stanford University School of Medicine, Stanford, CA 94305-5640, U.S.A. Tel: +1 650 498 6810; E-mail: amaca@stanford.edu.
Reprints will not be available from authors.

■ Abstract

Background: This study's goal was a retrospective chart audit of 100 outpatients with discogenic low back pain (LBP) lasting more than 12 weeks treated with a 2-month course of motorized spinal decompression via the DRX9000 (Axiom Worldwide, Tampa, FL, U.S.A.).

Methods: Patients at a convenience sample of four clinics received 30-minute DRX9000 sessions daily for the first 2 weeks tapering to 1 session/week. Treatment protocol included lumbar stretching, myofascial release, or heat prior to treatment, with ice and/or muscle stimulation afterwards. Primary outcome was verbal numerical pain intensity rating (NRS) 0 to 10 before and after the 8-week treatment.

Results: Of the 100 initial subjects, three withdrew their protected health information, and three were excluded because their LBP duration was less than 12 weeks. The remaining 94 subjects (63% female, 95% white, age = 55 (SD 16) year, 52% employed, 41% retired, LBP median duration of 260 weeks) had diagnoses of herniated disc (73% of patients), degenerative disc disease (68%), or both (27%). Mean NRS equaled 6.05 (SD 2.3) at presentation and decreased significantly to 0.89 (SD 1.15) at end of 8-week treatment (P < 0.0001). Analgesic use also appeared to decrease (charts with data = 20) and Activities of Daily Living improved (charts with data = 38). Follow-up (mean 31 weeks) on 29/94 patients reported mean 83% LBP improvement, NRS of 1.7 (SD 1.15), and satisfaction of 8.55/10 (median 9).

Conclusions: This retrospective chart audit provides preliminary data that chronic LBP may improve with DRX9000 spinal decompression. Randomized double-blind trials are needed to measure the efficacy of such systems. ■

Users who read this article also read:
Intervertebral Disc: Anatomy-Physiology-Pathophysiology-Treatment
P. Prithvi Raj, MD, FIPP, ABIPP
Pain Practice, Volume 8, Issue 1, Page 18-44, Mar 2008, doi: 10.1111/j.1533-2500.2007.00171.x
Abstract| References| Full Text HTML| Full Text PDF (1300 KB)
Intra-articular Application of Pulsed Radiofrequency for Arthrogenic Pain—Report of Six Cases
Menno E. Sluijter, MD, PhD, FIPP; Alexandre Teixeira, MD, FIPP; Vicente Serra, MD; Susan Balogh, MD; Pietro Schianchi, MD, FIPP
Pain Practice, Volume 8, Issue 1, Page 57-61, Mar 2008, doi: 10.1111/j.1533-2500.2007.00172.x
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The Prevalence of Facet Joint-Related Chronic Neck Pain in Postsurgical and Nonpostsurgical Patients: A Comparative Evaluation
Laxmaiah Manchikanti, MD; Kavita N. Manchikanti, BA; Vidyasagar Pampati, MSc; Doris E. Brandon, CST; James Giordano, PhD
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Late Whiplash Syndrome: A Clinical Science Approach to Evidence-Based Diagnosis and Management
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Pain Practice, Volume 8, Issue 1, Page 65-89, Mar 2008, doi: 10.1111/j.1533-2500.2007.00168.x
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A Review of the Epidemiology of Painful Diabetic Peripheral Neuropathy, Postherpetic Neuralgia, and Less Commonly Studied Neuropathic Pain Conditions
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Pain Practice, Volume 8, Issue 1, Page 45-56, Mar 2008, doi: 10.1111/j.1533-2500.2007.00164.x
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So in conclusion I am confident in my ability to provide patients that have herniated discs, failed back surgery and chronic low back pain a effective means to end their pain and return them to a pain free lifestyle.

Monday, January 21, 2008

Spinal decompression therapy is it safe?

Spinal decompression therapy has taken the treatment of the herniated disc to a new level. This non-invasive, non surgical technique has helped thousands of patients get their lives back from chronic back pain.
Is this technique for everyone and is it safe?
These are the two questions that I often get asked, I will addresses the first.
Spinal decompression is not for everyone, In fact it is my opinion that by correctly examining and selecting patients that are the ideal candidates your success as a practitioner will go up. I am very selective with who I accept into my NYC spinal decompression practice.
In my practice in Manhattan, I do not accept patients that are morbidly obese, have had metal implants in their spine(such as titanium rods), or if they have severe osteoporosis or if they have sustained a recent vertebral fracture.
Outside this other factors that will not result in satisfactory results include patients with sequestered disc or a free fragment should not be considered for treatment on a Spinal decompression machine.
If a patient has a bulging or herniated disc and is accepted as a candidate for the spinal decompression protocol follow signs and symptoms carefully throughout treatment.
The act of unloading or decompression of the spine reduces tension on the disc and allows the disc to draw in fluid like blood and nutrients and moisture from the surrounding tissue.
Patients can and usually do complain of soreness in the area that is being treated, That is why patients should be on Ice and electrical stimulation like H-wave for at least 10 minutes after a session followed by a lumbar support to brace the area and prevent movement for at least three hours.

If a practitioner follows all of these protocols and is careful to select and qualify the patient the chances of injury are extremely low in comparison the possible side effects from an unsuccessful back surgery can include permanent impairment, loss of sensation and loss of motor control. This is why more and more patients are turning to a non surgical approach to addresses the Disc herniation.
The patient is also in complete control during the procedure, In my NYC practice I utilize the DRX 9000 which has a safety switch that can stop the pulling if it does become uncomfortable, most patients are sleeping half way through the session because they feel so comfortable.
I like the DRX 9000 machine because the pull is so smooth it allows the muscles to completely relax which allows the spine to be repositioned without tension and without setting off the "lock down" propioceptor response.
So to answer the question from earlier, Is it safe? Yes absolutely! Will it help everyone? No, but if you chose the patient carefully you can offer them a safe and affective non-surgical solution to a difficult problem and allow them improve their lives my taking away the pain without surgery.