Question
Dear Dr. Durnin,
I have been suffering from episodes of low back pain caused by a bulging L5 disc for the past 15 years. I have to date managed the pain through conservative treatment (chiropractic, acupuncture,massage, etc.) About 6 weeks ago, I woke up with extreme pain in my right leg which was initially diagnosed as sciatica, and I was given pain medication by a PA who made a house call as I was immoble and unable to leave the house. After about a week, I was able to get to my chiropractor who said I was having a "disc episode" and, over the next week did several adjustments. By this point the pain had spread to both legs and I was having low back muscle spasms and pain along with very apparent weakness along with numbness in my right leg and foot. By that point, I visited and MD and was put on percocet to control the pain. I then consulted with a neurologist who ordered an MRI which showed a large rupture of material from L5 which was pressing on the nerve. I was advised to have emergency surgery to avoid permanent nerve damage which I did two days later. The procedure was a laminectomy, facetectomy and L4, L5 discectomy. I was able to stand and walk (very carefully) the next day and it has been 2 weeks since the surgery and I am now fairly ambulatory. I was surprised however when I asked the surgeon for a physical therapy prescription, and his response was "you don't need it." As I said, it has been approximately 2 weeks since the surgery and I am now starting to have some recurrence of low back pain, stabbing pains in my low back and occasional numbness in the right foot again. I am really unclear how to procede here. I do not want to return to the same surgeon as I was not happy with the quality of services provided by the hospital staff (and I have a sneaking suspicion that he may want to order additional surgery. I live in NYC and have access to the Hospital For Special Surgery which I understand is the best facility in NY. I would like to go there for follow up care as they are in my insurance network. I want to undertake a rehabilitation program as both my back and stomach muscles are very weak and I tire very easily. I'm scheduled to return to work in 3 weeks, but I am in no condition to do so, and to make matters worse, I have a 9-10 hour a day desk job and sitting for more than a half hour at a time aggravates my low back pain. But, I'm not sure how to proceed. Should I request an initial appointment with a neurologist or a physiatrist (the latter being what I had in mind.)Ideally, I would like to avoid further surgery if at all possible and resume conservative care, but I'm not sure how to approach this. Any thoughts that you can offer on my condition and how to proceed would be most appreciated.

Answer

DTS Table Hi Craig,

As you are aware, spine surgery rarely has a positive oucome for the simple fact scar tissue proliferation causes more entrapment. Of all the spine surgeries I have been involved with, most if not all fail. It is my opinion they should be illegal.

Flexion-Distraction Therapy - What is it?


Flexion-Distraction, (F/D) is a gentle, chiropractic treatment procedure utilized for back and neck pain. Flexion-Distraction is a safe alternative to back surgery for those 95% of patients whose conditions do not demand surgical intervention. The doctor is in control of the treatment movements at all times.

Flexion-Distraction is utilized for many conditions such as:

Failed Back surgical Syndromes
Disc Herniation/Ruptured Disc / Bulging Disc / Herniated Disc
Sciatica / Leg pain
"Whiplash" injuries
Stenosis
Arm Pain
Neck Pain
Failed course of Steroid Injections
Chemical Radiculitis
Spondylolisthesis
Headache
Transitional segment
Many more conditions?
How does Flexion-Distraction Work?

For Disc related conditions:

Increases the intervertebral disc height to remove annular tension on the annular fibers and nerve by making more room and improving circulation.
Allows the nucleus pulposus, the center of the disc, to assume its central position within the annular fibers and relieves irritation of the spinal nerve.
Restores vertebral joints to their physiological relationships of motion.
Improves posture and locomotion while relieving pain, improving body functions, and creating a state of well-being.
For Non-Disc related conditions:

Patients with other conditions causing back pain (facet syndrome, spondylolisthesis, sprain/strain, scoliosis, transitional vertebra, sacroiliac restrictions and misalignment, certain types of spinal stenosis), Flexion/Distraction provides all of the above benefits plus the ability to place the spinal joints into normal, painless movements so as to restore spinal motion without pain:

The posterior disc space increases in height.
F/D decreases disc protrusion and reduces stenosis.
Flexion stretches the ligamentum flavum to reduce stenosis.
Flexion opens the vertebral canal by 2 mm (16%) or 3.5 to 6mm more than extension.
Flexion increases metabolite transport into the disc.
Flexion opens the apophyseal joints and reduces posterior disc stress
The nucleus pulposus does not move on flexion. Intradiscal pressure drops under distraction to below 100mm Hg. On extension the nucleus or annulus is seen to protrude posterior into the vertebral canal.
Intervertebral foraminal openings enlarge giving patency to the nerve.

(Please see our page on Spinal Decompression for another treatment option.)
Reference: Cox JM, Feller JA, Cox-Cid JA: Topics in clinical Chiropractic 1996; 3(3):45-59




About Spinal Decompression
Non-surgical spinal decompression therapy as performed in our office is a very high-tech form of traction.  It is a highly successful, non-surgical alternative procedure for relieving low back, neck, and arm and leg pain.  It is an effective treatment for:

 

?        Herniated or bulging discs               ?        Sciatica

?        Degenerative disc disease             ?        Post-surgical patients

?        Facet syndrome                                ?        Spinal Stenosis




   
What is Spinal Decompression Therapy?

  Decompression Therapy is a modern, high tech, non-surgical traction procedure that effectively treats disabling low back, neck, and radiating leg and arm pain. This type of traction is very successful in relieving pain associated with disc herniation, degenerative discs, and posterior facet syndromes, due to decompression of spinal discs and facet joints by utilizing traction, distraction and positioning.

  This therapy effectively enhances the healing process and renders quick, effective and amazing pain relief that enables most patients to return to a more active lifestyle.

  Research to develop this procedure was conducted by prominent physicians, engineers and technicians at major teaching hospitals.


  Do you have a herniated disc, multiple herniated discs, degenerative disc disease, facet syndrome?  Is your doctor suggesting surgery, pain management, or physical therapy?  Call Mitchell Chiropractic Back and Neck Pain Clinic in Claremore, Oklahoma for a free consultation about our spinal treatment programs.

 

  Our DTS Triton traction system is FDA approved and has been clinically proven with a very high success rate for the pain and symptoms associated with herniated and/or bulging discs卐ven after failed back surgery.



  Research indicates that the disc is responsible for a significant number of lumbar/leg pain and neck/arm pain syndromes. Compression increases internal disc pressure leading to possible protrusion, herniation and bulging of disc material.



  DTS Triton spinal traction therapy in conjunction with the additional treatment modalities provided in our clinic can, in most cases, effectively relieve the pain and disability resulting from disc injury and degeneration, aiding in the healing of damaged discs and reversing dystrophic changes in nerves.  DTS Triton spinal traction treats the functional and mechanical aspects of disc pain through non-surgical traction (decompression) of spinal discs.



  Clinical studies verify the significant reduction of internal disc pressures which result in the non-surgical traction of the disc and nerve root. Older, conventional traction has never demonstrated a reduction of this internal disc pressure; on the contrary ?many older traction devices actually increased internal disc pressure, most likely due to reflex muscle spasm.



  Our new computer controlled DTS Triton spinal traction equipment is designed to apply distraction and decompression to the patient抯 spine without producing reflex paravertebral muscle contractions.

                                                                                          This is a picture of the computer screen.



  By significantly reducing internal disc pressure, DTS Triton spinal traction promotes retraction of the herniation back into the disc and promotes intake of fluids, oxygen and other substances necessary for healing the disc.  This activity stimulates repair and inhibits leakage of materials from the nucleus of the disc.  



  The most recent research trial sought to correlate clinical success with MRI evidence of disc repair as a result of such treatment and found that reduction of disc herniation ranged between 10% and 90% depending on the number of sessions performed, while disc annulus healing was evident in all cases.

 
 The most recent clinical study of 219 patients has shown that this type of non-surgical therapy, provided nearly immediate resolution of symptoms for 86% of the participants, and 84% remained pain-free 90 days after the treatment was finished.  (See our section on clinical studies.)






   MRI picture of disc herniation before and after treatment.


What Are The Treatments Like?


  After lying on the comfortable DTS Triton spinal treatment table, you will be fitted with a support system. The support system helps to stabilize your body. The advanced computer controlled system automatically adjusts to the proper angle of pull (distraction), allowing us to target the specific discs that are causing your pain and symptoms. The distractive forces utilize a computer controlled logarithmic curve to avoid reflex responses which would create muscle spasm. The split table design decreases friction and allows separation of the vertebra.





 Basically, you lay down on the table and the DTS Triton spinal traction computer system simulates an anti-gravity effect on your spine that helps herniated material return toward its normal position thus reducing pressure and pain. Patients describe the treatment as a gentle, painless, intermittent pulling sensation.  Many patients actually fall asleep during treatment!

                                                    
How Long Are Treatments And How Many Do You Need?


  Patients typically undergo 15 to 20 treatment sessions. Each treatment lasts between 45 and 60 minutes. This, of course, depends on your individual case and is determined by thorough pre-treatment evaluation.  Following each session, a cold pack and electric muscle stimulation/sedation is usually applied to speed the healing process.  It is important to note that many patients get substantial, immediate relief after just a few treatments. Some have significant reduction of pain after just one session.  The really good news is that this is not something you have to continue to do for the rest of your life! So it is not a big commitment.



Can DTS Triton Spinal Therapy Help My Pain?



  Though each patient is different and no doctor can guarantee success, the clinical results of this type of therapy have been shown to be effective in 86% of patients treated.  The common problems of many back conditions are damaged discs and poor spinal muscle control.  Our treatment program addresses both of these core problems.  The specially designed DTS Triton spinal traction system  creates a controlled unloading of the spine which appears to decrease disc pressure thus increasing blood and nutrient exchange.  This exchange of fluids is something the damaged disc desperately needs to help it heal from the inside out.  Muscle strength, control and endurance can all be improved with our spinal therapy program that includes specific controlled spinal exercises.



Will DTS Triton Spinal Treatments Hurt?  Is it Safe?



  DTS Triton Spinal Traction Therapy treatments are one of the most gentle and comfortable therapies available.  The treatments utilize FDA cleared equipment with proven safety and efficacy.  Most patients report a mild sense of stretch on their back or hips, and often fall asleep during treatment sessions.  The DTS Triton system is produced by one of the world抯 largest manufacturers of hospital based therapy and rehabilitation equipment.



Is Spinal Decompression a New Type of Treatment?



  Although traction therapy has been around for thousands of years, DTS Triton computerized spinal traction therapy is new.  Advances in equipment and procedures have dramatically improved effectiveness.  This system is the most comprehensive program available, allowing the safe delivery of this previously hospital based therapy in our office.  Continual improvements in the delivery system and regular updates in protocol keep this system in the forefront of non-invasive disc therapy.  Each year over 50,000 patients are treated with this type of therapy and that number is growing.  For a complete comparison of spinal decompression traction and other surgical options, check out the article below



How Long Will My Treatment Program Be?



  This depends on the complexity and extent of the treatment and rehabilitation needed, however we typically treat 4 times a week for 1 month, transitioning from passive to active treatments as you respond.  The treatment is administered over a reasonable timeframe and your response is continually evaluated.  Further treatments may be necessary or a reduced frequency may be recommended at that time.  



  The rehabilitative phase may include additional DTS Triton spinal traction  treatments coupled with special exercises, spinal manipulation and adjustments to enhance the results.  Most patents are released from treatments after 6 to 12 weeks.



Why is this type of therapy more successful than other treatment options?



  DTS Triton traction therapy as practiced in our clinic is a comprehensive program of the newest traction techniques and targeted 揷ore?stabilization exercises combined with biofeedback and gentle chiropractic care.  In addition, we use other adjunctive treatments that have proven effectiveness in back care.  It is this multi-faceted approach that makes our combination of treatments so effective and is what sets our procedure apart from others in this area.  



  Additionally, discs have been shown to be a predominate site of pain, so treating the disc as directly as possible makes sense.  The blending of focused traction of the site, rehabilitation to the supporting structures, and overall strengthening of musculature makes the treatment unique.   This therapy affects the disc as directly as possible without surgery.  For a complete comparison of this therapy with surgical options, check out the article below




DTS Triton Spinal Traction vs. Surgery:



Surgery Facts:

In some cases surgery is necessary, more often it is not necessary.
Increased danger from anesthetic.
Increased danger from possible infections.
Prolonged recovery time after back surgery is generally 6-8 weeks.
Another 6-8 weeks of rehabilitation and physical therapy at 3 to 5 times per week.
Lower rate of successful results.
Without insurance patient抯 cost for surgery is often over $25,000.
Even with insurance, patient抯 share of surgical cost is often over $4,000 to $5,000.
DTS Facts:

Relief of acute or chronic (long term) low back pain and /or associated leg pain or numbness, generally within 4 weeks.
Successful in over 75% to 85% of patients.
Early return to work.
Non-invasive and extremely safe.
No injections.
No knifes.
No drugs.
No patient hospitalization.
Cost effective treatment.  Usually about $65 per treatment and less than $1,500 total and it is usually covered by insurance.
Why the Need for Exercises and Other Therapies?



  Along with the damage in the disc, we also need to treat the supporting spinal muscles.  A complete program targeting the function of the stabilization muscles of the spine is a vital part of spinal decompression therapy.  Heat, muscle stimulation, and ultrasonic therapy can offer additional benefits for inflammation and spasm reduction.  Our goal is to not only to help heal the disc but enhance muscle control and support of the low back.  A gradual breakdown of the foundational support of your back is what puts undue stresses on the discs and leads to disc degeneration, pain and loss of function.  Our program of spinal exercise and adjunctive therapies will assist in rehabilitating these structures.



Will My Pain Go Away For Good?



  Although it is difficult to predict the future, experience has shown that most patients do find long-term relief or effective management of their pain when they complete the entire recommended program of treatments.  Regular home exercise and periodic visits to our clinic will help in maintaining your spinal health and reduce the probability of reoccurrence.  As with any comprehensive rehabilitation program, your continued home care exercises and discretion in some daily activities is the key to long-term relief.



How Much Will it Cost?



  The cost varies depending on your condition and the extent of care needed.  (See above for comparison with cost of surgery.)   We promise to only do those procedures necessary for your fullest recovery.  You always have the choice as to the extent of care.  Our staff will review all costs, payment options and insurance coverage before treatment begins.  We want to help and we believe finances shouldn抰 stand in the way of your good health.



How Does Triton DTS Differ from Other Spinal Treatment Tables?



  Our office uses Trition DTS spinal decompression equipment from The Chattanooga Group, which has become the gold standard for spinal decompression.  For a detailed comparison as well as our reasoning for choosing this table, refer to the section below



How is Spinal Decompression different from older type traction?



  Older type traction is a simple steady force that is put on the patient抯 body with the intent of unloading the body's joints, muscles and other structures.  For example, hanging upside-down is a common method to put the spine into traction.  Rather than one's body weight putting stress on the spine, which is what happens when standing erect; the body weight is working to unload the spine.  



  Various forms of traction have been around for over 1000 years; however, pain relief has been inconsistent and short-lived until now.  In fact, several clinical studies have shown ordinary (old type, steady pull) traction to be an ineffective form of back and neck pain relief.  The reason is unexpected, but pretty simple.  Our bodies react to the steady pull of the traction on the spine by contracting, or squeezing, the muscles surrounding the spine.  Rather than achieving the desired effect of unloading the spine, the pressure on the spine is actually increased, thus increasing intradiscal pressure.  Thus this old type of traction does NOT allow the discs to re-hydrate and heal, which is what ultimately yields pain relief.



  DTS Triton Spinal Traction, on the other hand, is a modern, computerized, updated form of traction.  Computer technology is used to control variations in the unloading (traction pull) of the spine, effectively avoiding the body's muscle contraction response.  Notice in the figure below that the traction tension is varied over time according to the graph.  The doctor can control how many progressive tension steps are experienced by the patient before reaching the maximum tension.  The doctor also has complete control over how long the tensions are held steady and how often they are repeated through the computerized system.




                                                         Computer screen showing how
                                                                             tension is varied over time.