LCD Spinal Care System

Back Pain Information

CAUSES OF CHRONIC BACK PAIN

The following is a list of chronic back conditions that can respond well to non-surgical Spinal Decompression Therapy. For Information on your condition, please click on the condition(s) below. You can also click on the Animated Patient Education for an interactive detailed description.

Degenerative Disc Disease (DDD)

Herniated Disc/Sciatica

Facet Syndrome

Spinal Stenosis

Arthritis

Failed Back Surgery/Post Surgical Pain Syndrome

Degenerative Disc Disease

Anatomy
Condition: Degenerative Disc Disease (DDD)
Diagnosis: Degenerative Disc Disease (DDD)
Treatment: Degenerative Disc Disease (DDD)
Non-surgical Spinal Decompression: Degenerative Disc Disease (DDD)

Anatomy

The intervertebral discs are found between each vertebra in the human spine. Like 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. Their function is to: (1) “Absorb Shock” from everyday wear and tear
(2) allow movement of our spinal column and (3) Separate the vertebrae. The spinal disc is actually considered a type of cartilaginous joint. Discs consist of an outer annulus fibrosis layer and an inner nucleus pulposis, 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. Discs do not have a blood supply and exchange nutrients by a process called “imbibition”. Imagine a sponge with water, when you compress the sponge you release water. When you remove the compressive force, water is “sucked” back in the sponge. This is exactly how discs work and the importance of healthy discs. Diseased discs can lead to: Degenerative Disc Disease which can lead to: Arthritis, Herniated Disc, Facet Syndrome, and Spinal Stenosis.

Condition: Degenerative Disc Disease (DDD)

DDD can be caused by many factors: (1) Trauma, (2) repetitive stress due to occupation, poor posture or other external factors and the (3) natural processes of aging. Our discs lose elasticity, flexibility and shock absorbing ability due to the fact that collagen molecules weaken, and proteoglycan content decreases (which attracts water). As a result of the collagen molecules weakening, the discs become brittle, and as a result of the proteoglycan content decreasing, the discs lose water (they become dehydrated). This severely affects the “shock absorbing” properties of the discs and they “compress” under normal pressure. Although the discs do not have a blood supply, they do have a nerve supply. This nerve supply is responsible for the back pain the DDD patients often complain about. The most common symptoms are back pain and can be associated with leg pain and/or numbness in more severe cases.

Diagnosis: Degenerative Disc Disease (DDD)

Degenerative disc disease can be diagnosed from a physical examination, X-ray examination and/or an MRI examination. An X-ray examination will usually show a narrowing of the disc between the vertebrae which indicates that the disc has become weak or has collapsed. An MRI examination is not usually necessary to diagnose DDD but it will show a decreased signal intensity that represents a lower water content inside the disc.

Treatment: Degenerative Disc Disease (DDD)

Traditional treatment includes pain killers such as: Non-Steroid Anti-Inflammatories (NSAID’s), Physical/Chiropractic Therapy or Surgery (in extremely severe cases). NSAID’s have an inherent risk of Gastrointestinal (“stomach” and “intestines) disorders such as: ulcers, GI hemorrhage or perforation. In fact, an article in 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, NSAID’s such as VIOXX have been known to cause serious Cardiovascular (CV) events such as: Heart Attacks, Stroke and Heart Failure . There have been similar complaints from other NSAID’s such as: Bextra and Celebrex.

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 complaints, adjacent segment degeneration, infection and hardware/instrument related issues . Another study to determine 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 . This can lead to a loss of range of motion, further pain, further degeneration and a condition known as failed back surgery/post-operative pain syndrome which is a very disabling and troubling reality of surgical intervention.

Now that you have read about the possible side effects of what traditional treatments have to offer, you may want to consider the drugless, non-surgical approach that Spinal Decompression therapy has to offer.

Non-Surgical Spinal Decompression: Degenerative Disc Disease (DDD)

The following is the rationale, based on anatomical and physiological principles of non-surgical Spinal Decompression Therapy. Spinal Decompression therapy offers to treat the root cause of the disease – compression of the disc. Spinal Decompression Therapy relieves pressure from the disc and can facilitate a healthy exchange of nutrients (“Imbibition”) through its “pumping action” which can rehydrate the disc, allow proper spinal motion and prevent further deterioration of the spinal column by restoring proper biomechanics. Once the “compressing” force is relieved from the diseased disc, pain decreases and function increases.

Wolfe, Michael MD et al. Gastrointestinal Toxicity of Non-Steroidal Ant-iinflammatory 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.
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.

CAUSES OF CHRONIC BACK PAIN: Herniated Disc

Anatomy
Condition: Herniated Disc
Diagnosis: Herniated Disc
Treatment: Herniated Disc
Non-surgical Spinal Decompression: Herniated Disc

Anatomy

The intervertebral discs are found between each vertebrae in the human spine. Like 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. Their function is to: (1) “absorb shock” from everyday wear and tear
(2) allow movement of our spinal column and (3) separate the vertebrae. The spinal disc is actually considered a type of cartilaginous joint. Discs consist of an outer annulus fibrosis layer and an inner nucleus pulposis, 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. Discs do not have a blood supply and exchange nutrients by a process called “imbibition”. Imagine a sponge with water, when you compress the sponge you release water. When you remove the compressive force, water is “sucked” back in the sponge. This is exactly how discs work and the importance of healthy discs. Diseased discs can lead to: Degenerative Disc Disease which can lead to: Arthritis, Herniated Disc, Facet Syndrome, and Spinal Stenosis.

Condition: Herniated Disc

Herniation describes an abnormal condition of an intervertebral disc that is also referred to as a “slipped” disc, “ruptured” disc or “blown” disc. It is not known what causes the disc to herniate but it is thought to occur from (1) Trauma (2) repetitive stress due to occupation, poor posture or other external factors and the (3) natural processes of aging. The process of herniation occurs when the inner nucleus pulposis bulges through the annulus fibrosis causing a protruding disc which may push on a spinal nerve. It can progress to the point where the inner material (nucleus pulposis) leaks out of the disc. When this happens, the body mounts an auto-immune response to the disc material (nucleus pulposis) which causes severe inflammation and progressive deterioration of the nerve root. If the herniated disc is located in the cervical spine (neck), the symptoms can be neck pain with/without arm pain and/or numbness. If the herniated disc is located in the lumbar spine (low back), the symptoms can be low back pain with/without leg pain and/or numbness. This type of pain and/or numbness in the legs or arms is referred to as a “Radiculopathy”. This is due to the fact that the nerves that exit your spinal cord innervate (“attach to”) the skin in your arms and legs (responsible for sensation), muscles in your arms and legs (responsible for movement) and reflexes in your arms and legs. This is why some people with these conditions experience extremity (leg/arm) pain/numbness/tingling and weakness when they have a disc herniation. Surprisingly, people with herniated disc may only complain of extremity (arm/leg) pain with minimal neck or low back pain.

Diagnosis: Herniated Disc

Diagnosis of a herniated disc (either neck or low back) can be made from a detailed physical examination including a detailed Orthopedic & Neurological examination. Typical 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. In more chronic cases, muscle weakness may be present as may areflexia (“loss of reflex”). X-rays can help identify the level of the disc herniation but a MRI is the “gold standard” to identify the exact nature of the lesion. When the disc is herniated in the lumbar spine (low back), it is often referred to as Sciatica.

Treatment: Herniated Disc

Traditional treatment includes pain killers such as: Non-Steroid Anti-Inflammatories (NSAID’s), Physical/Chiropractic Therapy, Epidural Injections or Surgery. NSAID’s have an inherent risk of Gastrointestinal (“stomach” and “intestine”) disorders such as: ulcers, GI hemorrhage or perforation. In fact, an article in 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, Stroke and Heart Failure . There have been similar complaints from other NSAID’s such as: Bextra and Celebrex.

Epidural injections (“injection within the epidural space of the spinal cord”) with corticosteroids, lidocaine or opiods have no proven benefit in treating acute neck or upper back symptoms . In those that do improve, the effects are often temporary and require repeat injections, several per year, not to mention the chances of contracting a spinal infection which 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.

Although, there have been advances in spinal surgery, the outcomes can be very unpredictable, failed back surgery/post-operative pain syndrome is a very disabling and troubling reality of surgical intervention. 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 to determine 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 .

Non-surgical Spinal Decompression: Herniated Disc

The following is the rationale, based on anatomical and physiological principles, of non-surgical Spinal Decompression Therapy. Spinal Decompression therapy offers to treat the root cause of the disease – compression of the disc. Spinal Decompression therapy relieves pressure from the disc, which relieves pressure from the nerve. In addition, promising research has shown that Spinal Decompression therapy 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. Decompression also allows for strengthening of the outer ligament bands that hold the disc material in place and which become weak and stretched during the bulging effect. In cases where the disc has herniated causing an inflammatory auto-immune response, Spinal Decompression therapy can facilitate a healthy exchange of nutrients (“imbibition”) through its “pumping action” thus eliminating the inflammation at its source – the nerve root.

Thus, Spinal Decompression therapy for herniated discs is based on the following principles:

(1) Decompression of the involved Disc. Creating…
(2) A Negative intradiscal (“within the disc”) pressure. Creating…
(3) A Vacuum effect which…
(4) Reduces (“sucks in”) the size of the herniation which…
(5) Takes pressure off the involved nerve root which…
(6) Reduce/eliminates extremity (leg/arm) pain and/or numbness

While at the same time

(7) The pumping motions caused by Spinal Decompression Therapy
called “imbibition”…
(8) Allow nutrients to be exchanged at the level of the disc and inflammation around the nerve root to be dispersed causing…
(9) A reduction/elimination of low back pain.

Wolfe, Michael MD et al. Gastrointestinal Toxicity of Non-Steroidal Ant-iinflammatory 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.
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.

CAUSES OF CHRONIC BACK PAIN: Spinal Stenosis

Anatomy
Condition: Spinal Stenosis
Diagnosis: Spinal Stenosis
Treatment: Spinal Stenosis
Non-surgical Spinal Decompression: Spinal Stenosis

Anatomy

The vertebrae are the “bony elements” the surround the spinal cord. In an adult human, there are approximately 25 bones that make up the spine. 7 cervical (neck), 12 thoracic (mid-back), 5 lumbar (low back) and 1 sacral (“tailbone”). The vertebrae are composed of several elements: vertebral body, pedicles, lamina, transverse process, spinous process & superior/inferior articular processes (which make up the facet joint). The vertebral body is a“hourglass” shaped bone which we commonly associate with the spine. The pedicles and lamina make up the posterior “ring” of the vertebrae which is responsible for housing the spinal cord. The transverse processes are sites for muscle/ligament attachment and rib attachment (in the thoracic spine). The spinous process is the bony “bump” you can feel on your back, this is also a site for muscle/ligament attachment. The superior & inferior articular processes form the posterior joints called the facet joints. The facet joints help guide motions in our spine such as bending forward/backward, bending sideways and turning from side to side. Like any other joint in your body, the facet joints are covered with a layer of cartilage, surrounded by a joint capsule (made of ligaments) and bathed in a lubricating fluid called synovial fluid. In addition to all the “bony” elements commonly associated with the spine, there are many “soft tissue” elements that support the spine by both restricting motion (i.e. ligaments) and enabling motion (i.e. muscles). Some of these soft tissue elements (ligaments) can calcify (“turn to bone”) secondary to arthritis or degenerative disc disease and actually “pinch” the spinal nerves that exit from your spine and/or the actual spinal cord itself. When this occurs the end result is spinal stenosis.

Condition: Spinal Stenosis

Stenosis is a process describing “narrowing” of a structure. The most familiar example is Heart Disease where the arteries of the heart “narrow” which can result in a heart attack. Like arteries, spinal structures such as the ones that surround the spinal cord (called the “vertebral foramin”) or the ones that surround the exiting spinal nerves (called “intervertebral foramin”) are also subject to “narrowing”. This usually occurs secondary to arthritis or degenerative disc disease or it can occur congenitally (“from birth”). Arthritis causes biomechanic changes to your spine which result in bone growths called osteophytes (“bone spurs”) and calcification (“turning to bone”) of ligaments. These structures narrow the opening that contains the spinal cord and spinal nerves. The end result is “pinching” of these sensitive neural structures. The typical presentation is a patient in their late 50’s or older. The main complaints are back and leg pain. The pain is either in one leg or both and is not specific. Leg pain is often initiated during walking and is relieved after resting 15 to 20 minutes or bending forward at the waist (“hunched forward) also called flexion.

Diagnosis: Spinal Stenosis

Diagnosis of spinal stenosis depends on the region of the vertebrae that is being narrowed (“pinched”). Degeneration of the facet joints causes laxity (loosening) of the joint capsule which can lead to a type of spinal stenosis called lateral canal stenosis. Lateral canal stenosis can cause “pinching” of the spinal nerve at the intervetebral foramin where the spinal nerves exit your spinal cord to “innervate” or attach to the extremities (legs/arms) causing arm/leg pain and/or numbness/tingling. Further degeneration of the facet joints can cause bony outgrowths in the spine called osteophytes or “bonespurs”. This can lead to another type of spinal stenosis called central canal stenosis. When this occurs, it is not the spinal nerves that are “pinched” (as in lateral canal stenosis), it is the actual spinal cord. Central canal stenosis can cause a variety of symptoms depending on its location. As you can see, these bone spurs narrow the spaces that contain the spinal cord and nerves. Diagnosis of this condition can be made with an X-ray, a CT scan or MRI.

Treatment: Spinal Stensosis

Traditional treatment includes pain killers such as: Non-Steroid Anti-Inflammatories (NSAID’s), Physical/Chiropractic Therapy , Injections or Surgery. NSAID’s have an inherent risk of Gastrointestinal (“stomach” and “intestine”) disorders such as: ulcers, GI hemorrhage or perforation In fact, an article in 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, Stroke and Heart Failure .There have been similar complaints from other NSAID’s such as: Bextra and Celebrex.

Epidural injections (“injection within the epidural space of the spinal cord”) can be mildly effective but are most often temporary and require repeat injections, several per year, not to mention the chances of contracting a spinal infection which can lead to meningitis.

Surgery is an option when other therapies have failed. This type of invasive intervention is aimed at removing many of the support elements of the spine and “fusing” multiple levels of the spine together. A study to determine 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 .This can lead to a loss of range of motion, further pain, further degeneration and a condition known as failed back surgery/post-operative pain syndrome which is a very disabling and troubling reality of surgical intervention.

Non-surgical Spinal Decompression: Spinal Stenosis

The following is the rationale, based on anatomical and physiological principles of non-surgical Spinal Decompression Therapy. Spinal Decompression therapy offers to treat the root cause of the disease –narrowing of the intervertebral foramin and narrowing of the diameter of the spinal cord. When the pressure is relieved from the disc, it is called Spinal Decompression. When pressure is relieved from the joints, it is called Spinal Distraction. You cannot have one without the other. Spinal Decompression, or “distraction”, of the degenerated facet joints can alleviate the pain in several ways. In lateral canal stenosis when the facet joints are degenerated, the intervertebral foramin (the opening from which the spinal nerves exit the spinal cord) are narrow (like a small circle) due to bone spurs or calcification of ligaments. As a result, the spinal nerves become “pinched” in this bony “circular” opening causing back pain and extremity (arm/leg) pain and/or numbness/tingling. Spinal Decompression therapy causes distraction of the vertebral joints thus converting the small, narrowed, circular intervertebral foramin into a larger, oval shaped intervertebral foramin in which the spinal nerves have ample room to exit the spinal cord without being “pinched”. In central canal stenosis, the spinal cord is being pinched from bone spurs or calcified ligaments. This decreases the space in which the spinal cord and nerves travel through. Research has shown that a flexed posture (“bent forward at the waist”) increases the diameter of the space in which the spinal cord and nerves travel through. Spinal Decompression therapy is aimed at increasing flexion in the lumbar spine (increasing the sagital diameter of the vertebral foramin) thus relieving pressure from the spinal cord. This is why people with this condition find relief of back and leg pain when they bend forward.

Thus, Spinal Decompression therapy for spinal stenosis is based on the following principles:

For lateral canal stenosis

(1) Distraction of the degenerated facet joints causes a widening of the
intervertebral foramin (the opening where the spinal nerves
exit the spinal cord).
(2) Pressure is relieved from the spinal nerves exiting the from
the spinal cord as the small, circular, “bony” opening is widened
to form a larger, oval shaped “bony opening”.
(3) Since the spinal nerves innervate (attach to) the skin and
muscles of the extremities (arms/legs), the pain and/or numbness
in these areas is decreased or eliminated.

For central canal stenosis

(4) Distraction and flexion (bending forward) of the spine causes
an increase in the space housing the spinal cord or nerves.
(5) This increase in space is called “increase in sagital diameter of the
vertebral foramin.”
(6) This increase in space causes a relief of pressure of bony structures,
such as bone spurs or calcified ligaments, on the spinal cord or nerves.
(7) A relief of pressure from the spinal cord or nerves causes pain to
decrease.

Wolfe, Michael MD et al. Gastrointestinal Toxicity of Non-Steroidal Ant-iinflammatory 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.
Knox BD, Chapman TM. Anterior Lumbar Interbody Fusion for Discogram Concordant Pain. J Spinal Disord 1993;6:242-244.

CAUSES OF CHRONIC BACK PAIN: Arthritis

Anatomy
Condition: Arthritis
Diagnosis: Arthritis
Treatment: Arthritis
Non-surgical Spinal Decompression: Arthritis

Anatomy

The vertebrae are the “bony elements” the surround the spinal cord. In an adult human, there are approximately 25 bones that make up the spine. 7 cervical (neck), 12 thoracic (mid-back), 5 lumbar (low back) and 1 sacral (“tailbone”). The vertebrae are composed of several elements: vertebral body, pedicles, lamina, transverse process, spinous process & superior/inferior articular processes (which make up the facet joint). The vertebral body is a “hourglass” shaped bone which we commonly associate with the spine. The pedicles and lamina make up the posterior “ring” of the vertebrae which is responsible for housing the spinal cord. The transverse processes are sites for muscle/ligament attachment and rib attachment (in the thoracic spine). The spinous process is the bony “bump” you can feel on your back, this is also a site for muscle/ligament attachment. The superior & inferior articular processes form the posterior joints called the facet joints. The facet joints help guide motions in our spine such as bending forward/backward, bending sideways and turning from side to side. Like any other joint in your body, the facet joints are covered with a layer of cartilage, surrounded by a joint capsule (made of ligaments) and bathed in a lubricating fluid called synovial fluid. In addition to all the “bony” elements commonly associated with the spine, there are many “soft tissue” elements that support the spine by both restricting motion (i.e. ligaments) and enabling motion (i.e. muscles). Some of these soft tissue elements (ligaments) can calcify (“turn to bone”) secondary to arthritis or degenerative disc disease.

Condition: Arthritis

Arthritis of the spine is also called Osteoarthritis (OA), Degenerative Disc Disease (DDD) or Degenerative Joint Disease (DJD). Causes of spinal arthritis include (1) trauma (2) repetitive stress due to occupation, poor posture or other external factors and the (3) natural processes of aging. Osteoarthritis is the most common type of arthritis and is a non inflammatory degeneration of joint cartilage with secondary effects (such as “bone spurs”) on adjacent bone. Usually, the patient will present with local back pain, stiffness, crepitus (joint “popping”), joint deformity and swelling. Osteoarthritis due to trauma usually presents equally in males and females during their 20’s – 60’s. Osteoarthritis due to “old age” is more common in females and presents in their 50’s - 60’s and is most prevalent in weight-bearing joints (such as knees and the spine). Arthritis causes a change in the biomechanical structure of the spine such as: a decrease in intervertebral disc space (due to degenerative disc disease), stress osteophytes (“bone spurs”), and joint “loosening” which causes “slippage” of the vertebrae and alteration of the spinal curves. Pain is usually due to biomechanical changes in the spine (decrease range of motion) and pressure on the diseased disc.

Diagnosis: Arthritis

Arthritis is a very common condition and can usually be diagnosed with a thorough physical examination including X-rays. X-rays will typically show: a decrease in disc space(s), bone spurs (osteophytes), joint laxity (loosening), subchondral cysts, loose bodies, subluxation and an alteration of the spinal curves. Usually, pain will be locally in the back but there may be non-specific pain referral in the extremities (arms/legs). In most cases, advanced imaging is not warranted unless severe symptoms are present.

Treatment: Arthritis

Traditional treatment includes pain killers such as: Non-Steroid Anti-Inflammatories (NSAID’s), Physical/Chiropractic Therapy or Surgery (in extremely severe cases). NSAID’s have an inherent risk of Gastrointestinal (“stomach” and “intestines”) disorders such as: ulcers, GI hemorrhage or perforation. In fact, an article in the New England Journal of Medicine reported that it has been conservatively estimated that 16,500 NSAID-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, Stroke and Heart Failure . There have been similar complaints from other NSAID’s such as: Bextra and Celebrex.

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 to determine 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 . This can lead to a loss of range of motion, further pain, further degeneration and a condition known as failed back surgery/post-operative pain syndrome which is a very disabling and troubling reality of surgical intervention.

Non-Surgical Spinal Decompression: Arthritis

The following is the rationale, based on anatomical and physiological principles of non-surgical Spinal Decompression Therapy. Spinal Decompression therapy offers to treat the root cause of the disease – compression of the disc. Spinal Decompression Therapy relieves pressure from the disc and can facilitate a healthy exchange of nutrients (“Imbibition”) through its “pumping action” which can rehydrate the disc, allow proper spinal motion and may prevent further deterioration of the spinal column by restoring proper biomechanics. Once the “compressing” force is relieved from the diseased disc, pain decreases and function increases.

Wolfe, Michael MD et al. Gastrointestinal Toxicity of Non-Steroidal Ant-iinflammatory 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.
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.

CAUSES OF CHRONIC BACK PAIN: Facet Syndrome

Anatomy
Condition: Facet Syndrome
Diagnosis: Facet Syndrome
Treatment: Facet Syndrome
Non-surgical Spinal Decompression: Facet Syndrome

Anatomy

The vertebrae are the “bony elements” the surround the spinal cord. In an adult human, there are approximately 25 bones that make up the spine. 7 cervical (neck), 12 thoracic (mid-back), 5 lumbar (low back) and 1 sacral (“tailbone”). The vertebrae are composed of several elements: vertebral body, pedicles, lamina, transverse process, spinous process & superior/inferior articular processes (which make up the facet joint). The vertebral body is a “hourglass” shaped bone which we commonly associate with the spine. The pedicles and lamina make up the posterior “ring” of the vertebrae which is responsible for housing the spinal cord. The transverse processes are sites for muscle/ligament attachment and rib attachment (in the thoracic spine). The spinous process is the bony “bump” you can feel on your back, this is also a site for muscle/ligament attachment. The superior & inferior articular processes form the posterior joints called the facet joints. The facet joints help guide motions in our spine such as bending forward/backward, bending sideways and turning from side to side. Like any other joint in your body, the facet joints are covered with a layer of cartilage, surrounded by a joint capsule (made of ligaments) and bathed in a lubricating fluid called synovial fluid.

Condition: Facet Syndrome

Facet syndrome, as it is typically called, is type of arthritis that is specific to the facet joints (comprised of superior & inferior articular processes of vertebrae) in the posterior aspect of the spine. As the name implies, it is a “syndrome” which consists of several symptoms with multiple interlinked causes. The cause of facet syndrome is largely unknown but it is thought to occur due to (1) Hyperlordosis (hyper-extended lumbar spine) which pinches on a pain sensitive meniscoid tab (which is like a little piece of cartilage) or (2) Degeneration of the joints causing laxity (loosening) of the joint capsule which can lead to a type of spinal stenosis called lateral canal stenosis. Lateral canal stenosis can cause “pinching” of the nerve at the intervetebral foramin where the spinal nerves exit your spinal cord to “innervate” or attach to the extremities (legs/arms) causing arm/leg pain and/or numbness/tingling. Further degeneration of the facet joints can cause bony outgrowths in the spine called osteophytes or “bonespurs”. This can lead to another type of spinal stenosis called central canal stenosis. When this occurs, it is not the spinal nerves that are “pinched” (as in lateral canal stenosis), it is the actual spinal cord. Central canal stenosis can cause a variety of symptoms depending on its location. In essence, facet “syndrome” is due to several aspects:

(1) “Jamming” of the facet joints causing “pinching” of the small pain sensitive mensicoid tabs within the facet joints or
(2) Degeneration of the facet joints which can lead to lateral canal stenosis
causing:
i.) “Pinching” of the spinal nerves as they exit the intervertebral foramin of
the vertebrae. These nerves innervate (“connect to”) the skin and
muscles in your extremities (arms/legs) which can cause pain/
numbness/tingling in the extremities.
(3) Further degeneration of the facet joints can lead to central canal
stenosis causing:
i.) “Pinching” of the actual spinal cord.

Diagnosis: Facet Syndrome

Facet syndrome can be accurately diagnosed with a proper physical examination. X-rays can be helpful to view the facet joints to determine if there is any significant “pressure” on them. Facet joints can also be injected with a pain relieving substance to help determine if this is the primary cause of back pain, For more advanced cases, usually other co-morbidities (“conditions”) are contributing to the pain such as spinal stenosis, arthritis of the spine and degenerative joint disease. In these cases, more advanced imaging such as a MRI/CT scan may be required.

Treatment: Facet Syndrome

Traditional treatment includes pain killers such as: Non-Steroid Anti-Inflammatories (NSAID’s), Physical/Chiropractic Therapy , Injections or Surgery. NSAID’s have an inherent risk of Gastrointestinal (“stomach” and “intestines”) disorders such as: ulcers, GI hemorrhage or perforation. In fact, an article in 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, Stroke and Heart Failure .There have been similar complaints from other NSAID’s such as: Bextra and Celebrex.

Facet joint injections can relieve pain caused by inflammation in the facet joints but this relief is temporary. Minor surgical procedures have recently been developed to “destroy” the nociceptive (pain sensing) nerves that attach to the facet joint however research indicates that these particular nerves can regenerate within months thus necessitating the need for further treatments.

In extreme cases, with co-morbidities present, surgical intervention is aimed at removing the facet joints at each level of pain and “fusing” the spine together. A study to determine 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 . This can lead to a loss of range of motion, further pain, further degeneration and a condition known as failed back surgery/post-operative pain syndrome which is a very disabling and troubling reality of surgical intervention.

Non-surgical Spinal Decompression: Facet Syndrome

The following is the rationale, based on anatomical and physiological principles of non-surgical Spinal Decompression Therapy. Spinal Decompression therapy offers to treat the root cause of the disease – compression of the facet joints and a narrowing of the intervertebral foramin. When the pressure is relieved from the disc, it is called Spinal Decompression. When pressure is relieved from the joints, it is called Spinal Distraction. You cannot have one without the other. Spinal Decompression, or “distraction”, of the facet joints can alleviate the pain in several ways. Distraction, or “widening”, of the facet joints can relieve the pressure from the pain sensitive meniscoid tab which can be “pinched” causing localized pain. Once the pressure is removed from the mensicoid tab within the facet joint, pain is often eliminated. In some instances when the facet joints are “jammed together”, the intervertebral foramin (the opening from which the spinal nerves exit the spinal cord) is narrow (like a small circle). As a result, the spinal nerves become “pinched” in this bony “circlular” opening causing extremity (arm/leg) pain and/or numbness/tingling. Spinal Decompression therapy causes distraction of the vertebral joint thus converting the small, narrowed, circular intervertebral foramin into a larger, oval shaped intervertebral foramin in which the spinal nerves have ample room to exit the spinal cord without being “pinched”.

Thus, Spinal Decompression therapy for facet syndrome is based on the following principles:

(1) When decompression occurs at the level of the disc, distraction
occurs at the level of the facet joint.
(2) Distraction (widening) of the facet joints can relieve pressure
from the pain sensitive meniscoid tab that may be “pinched”
(3) This causes a relief of local symptoms

While at the same time

(4) Distraction of the facet joints causes a widening of the
intervertebral foramin (the opening where the spinal nerves
exit the spinal cord)…
(5) Pressure is relieved from the spinal nerves exiting the from
the spinal cord as the small, circular, “bony” opening is widened
to form a larger, oval shaped “bony” opening.
(6) Since the spinal nerves innervate (attach to) the skin and
muscles of the extremities (arms/legs), the pain and/or numbness
in these areas can be decreased or eliminated.

Wolfe, Michael MD et al. Gastrointestinal Toxicity of Non-Steroidal Ant-iinflammatory 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.
Knox BD, Chapman TM. Anterior Lumbar Interbody Fusion for Discogram Concordant Pain. J Spinal Disord 1993;6:242-244.

CAUSES OF CHRONIC BACK PAIN: Failed Back Surgery/Post-Operative Pain Syndrome

Anatomy: Failed Back Surgery/Post-operative Pain Syndrome
Condition: Failed Back Surgery/Post-operative Pain Syndrome
Diagnosis: Failed Back Surgery/Post-operative Pain Syndrome
Treatment: Failed Back Surgery/Post-operative Pain Syndrome
Non-surgical Spinal Decompression: Failed Back Surgery/Post-operative Pain Syndrome

Anatomy:

The intervertebral discs are found between each vertebrae in the human spine. Like 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. Their function is to: (1) “absorb shock” from everyday wear and tear
(2) allow movement of our spinal column and (3) separate the vertebrae. The spinal disc is actually considered a type of cartilaginous joint. Discs consist of an outer annulus fibrosis layer and an inner nucleus pulposis, which is a soft, jelly-like, substance. The disc is made up of proteins called collagen and proteoglycans which attract water. Normally, discs compress when pressure is put on them and decompress when the pressure is relieved. Discs do not have a blood supply and exchange nutrients by a process called “imbibition”. Imagine a sponge with water, when you compress the sponge you release water. When you remove the compressive force, water is “sucked” back in the sponge. This is exactly how discs work and the importance of healthy discs.

Condition: Failed Back Surgery/Post-operative Pain Syndrome

Failed back syndrome (FBS) is a condition which is described as a chronic condition and is the end result or complication of a failed back surgery. Many reasons are thought to contribute to this disturbing and troubling reality of surgical intervention :

(1) The original (pre-operative) condition was not treated completely or a possible recurrence of the original condition (such as a recurrent disc herniation).
(2) A joint may be irritated because surgery had altered the patient’s posture.
(3) Scarring from the surgery may be irritating the spinal nerves and contributing to Biomechanical dysfunction.
(4) Other conditions such as depression or anxiety may be interfering with the patient’s ability to heal. These are called Psychosocial issues.
(5) Non-union of the vertebrae (vertebrae did not “fuse” together)
(6) Patient general health has deteriorated. Muscle atrophy (“shrink”) leads to a general loss of strength and physical activity is restricted due to pain and dysfunction. This is known as Deconditioning Syndrome.

Diagnosis: Failed Back Surgery/Post-operative Pain Syndrome

Diagnosis of a failed back surgery is quite simple. Once the patient undergoes a spinal procedure and fails to achieve the desired surgical outcome (i.e. reduction or elimination of the pain), the patient is usually diagnosed with this condition. Symptoms usually include: the original symptoms that the patient initially presented with pre-operatively and/or diffuse, dull and achy pain in the back and/or legs and a sharp, prickling, and stabbing pain that radiates (“moves”) from the legs. In some cases, the post-operative (“after surgery”) results can be worse than the pre-operative (“before” surgery) condition.

Treatment: Failed Back Surgery/Post-operative Pain Syndrome

Treatment for failed back surgery is often palliative (“pain relieving”) and usually not curative. Traditional treatment includes pain killers such as: Non-Steroid Anti-Inflammatories (NSAID’s), Exercise Therapy, Repeat Surgery or Implantable Devices. NSAID’s have an inherent risk of Gastrointestinal (“stomach” and “muscles”) disorders such as: ulcers, GI hemorrhage or perforation. In fact, an article in 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 Gastroinestinal disorders, drugs such as VIOXX have been known to cause serious Cardiovascular (CV) events such as: Heart Attacks, Stroke and Heart Failure .There have been similar complaints from other NSAID’s such as: Bextra and Celebrex.

Exercise therapy which can be hard to perform due to pain and deconditioning. Repeat surgeries are considered if the original condition was not treated completely or if there is a recurrent herniation. Implantable devices such as interspinal opiod delivery systems can cause habit forming behavior and have a limited reservoir which necessitates repeat removal and implantation procedures.

Pain management is usually the mainstay of failed back syndrome and includes drug therapy (as described above), periodic psychiatric evaluations, exercise therapy and neurodestructive/neurostimulatory interventions which require periodic minor surgical and/or injection therapy.

Non-surgical Spinal Decompression: Failed Back Surgery/Post-operative Pain Syndrome

The following is the rationale, based on anatomical and physiological principles, of non-surgical Spinal Decompression Therapy.

Spinal Decompression therapy is often aimed at arriving at the correct diagnosis. In some instances, multiple disc herniations are found as the source of pain. Recurrent (re-occuring) disc herniations may also be responsible. In other cases, the pain may be caused by other factors such as degenerative disc disease, spinal stenosis, arthritis or facet syndrome which were not diagnosed correctly. In addition to Spinal Decompression therapy, active therapies such as functional restoration should be used in conjunction to interdict Deconditioning Syndrome.

Long DM. Failed Back SurgerySyndrome. Neurosurg Clin N Am. 1991 Oct; 2(4):899-919.
Wong et al. Unremitting Low Back Pain. North American Spine Society: Phase III Clinical Guidelines for Multidisciplinary Spine Care Specialists. 2000.
Wolfe, Michael MD et al. Gastrointestinal Toxicity of Non-Steroidal Ant-iinflammatory 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.

About Us | Back Pain | Patient Education | Research | Clinic Locations | Maps and Directions | Testimonials | Contact Us | Q&A LCD Spinal Care System Serving Northern California, Peninsula 650-349-1516, East Bay 510-232-4333

About Us | Back Pain | Patient Education | Research | Clinic Locations | Maps and Directions | Testimonials | Contact Us | Q&A
LCD Spinal Care System Serving Northern California, Peninsula 650-349-1516, East Bay 510-232-4333