Southern California Spine Center

Spine Surgery, S.P.O.R.T. research, Spinal Decompression

The recent information coming out of the Dartmouth Medical School and "SPORT" or Spine Patient Outcomes Research trial has certainly shed some light on the efficacy of spinal surgery.

Here are some facts from the trial and summations that were made by the head researcher Dr. James Weinstein on his MPR interview.....

• Spinal surgery for disc herniation or disc bulges has short term relief for a small number of patients.
• On the other hand looking at this same group at the two year mark following surgery.  The group that underwent surgery is no better off then the non-surgical treatment group.  (commonly at the two year mark a high percentage of patients who have had surgery will need another)
• It would appear in certain cases of spinal stenosis that surgery was effective at the two year mark. (we have found that on certain cases that spinal stenosis responds very well to non-surgical spinal decompression)

It is important to understand what is effective and what is not effective when considering invasive low back surgery.  I am commonly asked what is the longevity associated with spinal decompression?  I have been performing this treatment along with spinal re-strengthening for 4 years now, we were the first clinic to offer treatment with the DRX 9000 in San Diego.  I still talk to many of my first patients who continue to live pain free lives!   The Southern California Spine Center has a very high success rate treating low back disc bulges and herniation.  It has been our experience that the results are long standing.  I do qualify patients carefully for care,  which appears to be a big difference with my clinic as compared to others.  The follow-up re-strengthening is mandatory for long term effects.

Can pain and numbness due to Spinal Stenosis be relieved by Spinal Decompression Therapy

Spinal Stenosis by definition is a narrowing of the spinal canal, similar to stepping on a garden hose and making the hole within the hose smaller.  This can cause the nerves that are within the canal to be pinched.  The pinching is usually worse for most patients when they are standing or walking, it is commonly relieved by bending over or sitting.  I am commonly asked if our non-surgical spinal decompression and low back/core strengthening program can relieve the pain associated with this condition.  Maybe!   Why maybe?  Great question, let"s look at the anatomy of this condition to understand my answer.   The spinal canal is made up of the big part of the vertebra called the body of the vertebra, which have the low back discs in between them on one side(stacked like a hamburger, sorry I am kinda hungry) and the facet joints on the other side.   The inside of this canal is lined with ligaments that stabilize the spinal segments.  Spinal Stenosis is brought on by a problem usually on both sides of the canal.  It can include disc bulges, spondylolisthesis (slippage of one vertebra upon another), ligaments that get bigger due to stress and arthritis( what will commonly be referred to  as bone spurs or facet hypertophy).  As you can see that spinal stenosis is a little more complicated then a basic disc problem.  All considerations for treatment of spinal stenosis will be directed around how much is the disc contributing to the problem.  If the stenosis is mostly boney or ligamentous change then I would not recommend spinal decompression therapy.  If on the other hand the lumbar disc is the major contributor to the condition it is possible that this type of treatment could result in substantial relief and a good result.  The decision on these patients are on a case by case basis.  I have had hundreds of successful cases treating spinal stenosis, but I have chosen these cases very carefully.  The doctor who is assessing these cases should have an excellent ability to read your MRI's.  I am thankfull that I became a board certified Chiropractic Neurologist because the training not only taught me how to read an MRI well but it gave me the knowledge on how best to serve patients with complicated conditions.   

Low back Epidurals, Do They Really Work?

It depends on how you describe work.  Some patients will get short term relief (one day), others long term relief (years) based upon their condition but commonly there will be no relief felt by the patient at all.  Why the huge discrepancy and is the epidural really fixing the problem.  Lets start by stating what an epidural shot is. An epidural is a strong anti-inflammatory that is delivered via a very large needle to a specific area of the low back. Because its effect is to remove inflammation from a low back injury such as a disc bulge or disc herniation they can help people short term.  Removing the inflammatory fluids from one of these conditions does not change the morphology (the position of the disc bulge or herniation) of the disc.  The disc injury will still be sticking out where you don't want it to, in close relationship to the irritated low back spinal nerves.  If the herniated disc material makes direct contact, pinches one of these nerves causing sciatica, then the chances are slim to none that it will have an effect.  On the other hand if the disc is close to the nerve but does not pinch it,  then the inflammation itself can be the triggering factor that causes the low back or leg pain, numbness and tingling.  In this case, if you remove the inflammation the patient might experience temporary relief until the time comes when the disc is irritated again and inflammation starts all over.  As you see epidurals are a band-aid, they do not fix the problem. I think that to illustrate this best, I will describe two of my past patients.

Patient #1.  Had a 4 mm L4 disc bulge and annular tear. She suffered with leg pain and tingling that came and went.  She had no leg weakness.  She was sent to an orthopedist by her primary doctor,  where she was given an epidural after the disc problem was identified.  She had relief for 3 months.  She had another epidural, this time the relief lasted 3 weeks.  She went back for a 3rd epidural. The relief only lasted 2 days.   She explained that she finally realized that this was only masking the problem and to quote her words...she needed to "stop the insanity".  She went through our non-surgical spinal decompression and re-conditioning program.  That was 15 months ago and she continues to be pain free.

Patient #2  This patient had a large 21mm (almost an inch) L5 disc herniation that was giving him continual lancinating pain, numbness and tingling down the left leg as well as weakness and atrophy  (wasting) of his calf muscles.  He tried an epidural and experienced no change.  He was scheduled for low back surgery one week later.  I am happy to say that he decided that surgery was not an option for him if a no risk and non-invasive way to address the actual disc problem was available.  He under went spinal decompression on one of our DRX 9000 machines and strengthened his core/spinal muscles afterwards.  He is pain free and has the strength and muscle back in his left calf.  We did a post MRI on him and the 21 mm herniation was shrunk to 2 mm, a change of 19 mm.

I think the question for each person who suffers with low back pain with, or without, leg pain and numbness is do you want to treat the problem or just put a band-aid on it? 

"Low Back Surgery is for everybody else not for family"

As San Diego's leading provider of non-surgical spinal decompression and advanced low back pain solutions, I get exposed to alot of interesting feed back from patients and consults.  Some of which just cracks me up or knocks my socks off. 

Here is what a patient recently told me that really surprised me.  The ethical and moral problem with it, I thinks will be obvious to many.  This patient, when she initially herniated her disc causing low back pain and sciatica, called her relative who is a prominent neurosurgeon.  She told him about her L5 disc herniation and asked if she should have him operate.  His reply was "I may do spinal surgery for a living on others but I would not recommend it for any family member, try everything else!"  Its amazing and morally scary, but it's happening all over....The nice thing is the Southern California Spine Center in San Diego is helping so many sufferers that up until the last couple of years would have undergone unnecessary, risky and commonly ineffective low back surgery.