Question
QUESTION: Hi Dr. Grassi,
My Mom (a young age 74) has been in pain for nearly 6 months-mainly showing up as sciatic left leg pain. She has very little loss of strength and no numbness. She is hunched over when walking and cannot stay upright for more than a few minutes at a time. She hates taking medications but is forced to by the pain. Her MRI indicates a bulge at L5 S1 with only slight stenosis and sciatic nerve impingement.  In the last few weeks her bladder %26 bowels are also irritated. She was offered steroid injections and was tempted to try them but she is allergic to the contrast material needed to perform the procedure. She wants to avoid surgery(including the laser types-like foraminotomy)if possible.  
We are now exploring the possibility of spinal decompression therapy but will have to drive approximately 1 hr.each way to get the treatments.  I would appreciate your opinion regarding this treatment. I'm aware of the DRX 9000 computerized table and the cox table- do you have any thoughts about either or both of these, or other treatments that may work?
Thanks in advance for your help.
Julie




A view from paradise.   ANSWER: Hi Julie: Has your Mom had an EMG Nerve Test by a Neurologist,MD.? If not, she needs to get one. The MRI shows anatomy. The EMG shows physiology. I'm concerned about Bladder/Bowel (Cauda Equina Syndrome) involvement. That does not add up because of minimal findings of Spinal Stenosis. That is probably a coincidence. I would go with the IDDD. But, only AFTER clearance from Neurologist. You DO NOT want to make anything worse. Cox method is great. Much less expensive but time consuming. You will know if IDDD is working in 3 to 6 sessions. If no significant improvement. At least 20-30%. It's NOT for her. Combine IDDD with Acupuncture, Biofeedback & Physical Rehab. YOU MUST strengthen the Multifidi and Psoas Muscles. Long term goal. Get her into Yoga/Palates. Groups of Seniors at the Y water aerobics. Consider getting her a home Inversion Traction Device. You can pick one up cheap at a Sports Consignment Store. Only OK too after clearance from Neuro. Get a Neuro. that's open minded. Most of them are not. Once she proceeds past the IDDD she should start Chiro. Adjustments to maintain her at MMI or Maximum Medical Improvement. Yes, there is much hope for her. Julie, please read this a few times and follow through. She will improve. You need to keep in touch with me to let me know if she is making any progress so I can determine if she is on the right path. Later....Dr Ron Grassi,Jupiter,Florida.DC.,MS. www.DrGrassi.com

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QUESTION: Hi Dr. Grassi,
Thanks so much for your reply.  No, she hasn't had an EMG nor was it ever suggested. It sounds like this is a pretty important diagnostic piece to our puzzle.  We only have 2 neurologists in our town so I will find out whatever I can about them and look in a neighboring town as well.  Could you help me understand how the results of the EMG will guide us in the next steps of this process? What should we be listening for?

Could you please clarify your statement: " I would go with the IDDD." I'm guessing that you are referring to decompression therapy- is that correct?

Mom wasn't very comfortable with the Doctor who had the Cox machine and is now considering another Doc who uses the DRX9000(assuming decompression is the right direction to go).  Do you think it is as effective as the Cox table?
Your advice is more valued than you know. Thank you.
Julie




My favorite Guitar   ANSWER: Hi Julie: IDDD=Intra Discal Disc Decompression. Remember my suggestion about hanging upside down at home IF Mom's into it. Mine was not. I AM. The EMG ( Electromyography ) Is like checking a wire, Only in this case the wire is the Nerve. The combination of the MRI findings & EMG. will unequivocally tell you the nerve root level involved. The bladder bowel issue is a red flag to get this test anyway. The Cox has it's applications. The IDDD is Cox on steroids. None of this though till EMG results. Do you know any Attorneys.? They can usually suggest good Doc's. They have good knowledge of mostly everyone. Julie, you are a good Daughter!. Dr Ron....

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QUESTION: Hi Dr. Ron,
Thank you for the explanation of the EMG- it makes good sense. One question regarding IDDD. Are you referring to surgical or non-surgical decompression?
Mom is fine about hanging upside down on her inversion table- are you saying she should do this now?
Thanks, Julie

Answer

Surealistic John   Hi Julie: GOOD POINT.! What a difference. We are referring to NON-SURGICAL with the 9000.Just make sure they "tune in" to the right level on the machine.    If Mom blood pressure OK. Go from 90 degrees (horizontal) advancing at 10 degree increments for 5 minutes at each station. Until she finds the angle she likes. Does NOT have to be full 180 degrees inversion. Then 10 min. 2X/day there. Take her blood pressure initially in inversion then every once in a while in inversion. Dr Ron.