Proven Slipped Disc Treatment: Therapy Fixed Extruded Lumbar Disc (Severe “Slip-Disc” or “Slipped Disc”).
“A case study (proven slipped disc treatment) of two patients treated nonsurgically for extruded L5 discs: With pre and post-therapy MRIs of the lumbar spine”.
Proven Slipped Disc Treatment By: Yama Zafer, D.C.
This case study was performed to evaluate the effects of NSD Therapy® (Non-surgical Spinal Decompression Therapy) on two patients—one with a moderately extruded lumbar disc and the other with a severely extruded lumbar disc—rendered in a multidisciplinary center on an outpatient basis. The results have clearly proven slipped disc treatment provided to these two patients improved symptomatology and retracted severe spinal disc disorders.
The cases presented here demonstrate that protruded and extruded spinal discs can be successfully treated using the NSD Therapy® protocols without the need for surgical and invasive procedures. Also, these results reveal a promising future for non-surgical biotechnological advancements of the physiotherapeutic modalities as utilized in the NSD Therapy® protocols. Larger clinical studies are needed to show the effectiveness of this method of treatment on patients with varying characteristics.
Introduction to Back Pain, Neck Pain, Spinal Disc Disorders: Degenerated, Bulging, Herniated and Extruded discs (Slip Disc or Slipped Disc)
Back pain is fast becoming an epidemic in which there is no immunity. Besides the common cold in the United States, back pain results in more lost workdays than any other affliction in persons under the age of 45 [1,2]. According to the American Academy of Orthopaedic Surgeons, the estimated annual direct cost for all spine-related conditions for the years 2002-2004 were $193.9 billion US dollars .
Research from US , Europe , Japan , and India  cites and recommends the use of decompression therapy for conditions such as Degenerative Disc Disease (DDD), Facet Syndrome (facet hypertrophy or spinal bone spurs or arthritis), Failed Back Surgery/Post Surgical Pain Syndrome, Herniated Disc (Neck & Low Back), Sciatica and Spinal Stenosis; some reporting 86%  to 92%  improvement.
The research available on advanced non-surgical spinal decompression therapy has undoubtedly proven slipped disc treatment through decompression therapy in reducing symptoms on 86-92% of those with pain. However, we wanted to explore the effects of decompression therapy (rendered through NSD Therapy®) on spinal discs utilizing pre and post MRI studies, objective physical findings, and patient symptomatology.
The Importance of Our Proven Slipped Disc Treatment
The traditional methods of non-surgical slipped disc treatments have failed. Chiropractic care and physiotherapy treatments have not managed to fix or repair a bulging, herniated, protruded, prolapse, extruded disc, and fragmented discs collectively known as slipped disc or slip-disc. Even if you were to obtain care from physiotherapists and chiropractors your chances of getting favorable results have been minimal. That is until now! Our centers went further than what most chiropractors or physiotherapists offer patients that suffer from a slipped disc. In 2009, we were the first in Asia to incorporate therapeutic benefits through advanced spine technology: the RxDecom®.
Our centers initiated an integrative treatment approach for herniated and protruded discs (slipped disc) through NSD Therapy®. NSD Therapy® is made possible through the clinical efforts of research-based chiropractic, physiotherapy, targeted rehabilitation, nutrition and advanced spinal decompression therapy devices. NSD Therapy®, also known as Non-surgical Spinal Decompression Therapy, is a multi-prong therapeutic procedure that utilizes spinal decompression therapy. In addition to spinal decompression, NSD Therapy® involves therapeutic modalities such as ultrasound therapy, interferential current therapy, trigger point therapy, ESWT Shockwave Therapy, manual mobilizations and most importantly, a progressive exercise system designed to strengthen the para-vertebral musculature and targeted non-forceful chiropractic adjustments.
Proven Slipped Disc Treatment was made Possible by NSD Therapy®
NSD Therapy®, also known as Non-surgical Spinal Decompression Therapy, is a multi-prong therapeutic procedure that utilizes spinal decompression therapy. In addition to spinal decompression, NSD Therapy® involves therapeutic modalities such as ultrasound therapy, interferential current therapy, trigger point therapy, manual mobilizations and most importantly, a progressive exercise system designed to strengthen the para-vertebral musculature and targeted non-forceful chiropractic adjustments.
The treatment setting for the spinal decompression therapy segment of the NSD Therapy® is calculated by our clinical teams of Chiropractors and Physiotherapists. Once the therapy settings are calculated and entered into the software, the program (Treatment Management Software) will record and direct the RxDecom® through specialized sensors to render the inputted treatment setting for the patient. The combined efforts of our clinical team and the technologies present in the Rxdecom® are the primary reason for our clinical successes that others have failed to achieve through other forms of spinal decompression therapy or traction devices. No other center in Asia has proven slipped disc treatment that we have provided you here.
Patient Case Presentation of Severe Herniated Disc (Extruded Disc) better known by its layperson’s term: “Slip-Disc” or “Slipped Disc.”
First Case Presentation of a Severe Extruded Disc (“Slipped Disc” or “Slip-Disc”):
A 42-year-old white, German male employed as a fire suppression system engineer, who was suffering from constant, severe lower back pain that radiated to the posterior and postero-lateral aspects of the right thigh and leg. On a visual analog pain scale of 1-10, with 1 being the lowest level of pain and 10 being the most severe pain ever experienced, the patient rated his pain at a 9.
A mild right foot drop and absent (0) Achilles reflex on the right foot were noted during patient evaluation. Due to the severity of his condition, provocative testing procedures such as SLR, Milgram’s and Valsalva’s Maneuver were not performed. The following paragraph reports the impressions observed on Magnetic Resonance Imaging (MRI) of his lumbar spine, as shown in figure-1.
At the L4-L5 segment of the lumbar spine, disc degeneration and moderate reduction in disc heights were observed. Also, moderate Modiac Type-II changes were noted at the inferior endplate of L4 and superior endplate of L5 vertebral bodies. At the L4-L5 disc, a diffuse disc bulge existed that slightly indented the thecal sac. And, at the L5-S1 segment, disc degeneration and a reduction in disc height were observed. Furthermore, there was a rather large right paracentral disc extrusion obliterating the right neural foramina and significantly compressing the right lateral aspect of the thecal sac.
Treatment Management Plan and Frequency of Treatment
Following a thorough discussion with the patient, we decided to proceed with NSD Therapy®. Patient characteristics, symptoms, exam findings along with MRI impressions were entered into the Treatment Management Software of the RxDecom® (a spinal decompression modality). Initially, NSD Therapy® was rendered daily (Monday-Friday) for three weeks, which was then followed by a course of treatments that were given three times a week for a five-week period. A total of 30 therapeutic sessions were rendered.
Patient’s Response to the NSD Therapy® (Proven Slipped Disc Treatment)
Patient’s response to therapy was excellent. On his last recorded evaluation on April 27, 2010, the patient reported significant improvements in condition. Pain level had decreased from a constant 9/10 (VAS) that was accompanied with significant radiculopathy to an occasional 1/10 without radiculopathy. Provocative tests such as Valsalva’s Maneuver, Mailgram’s test, and SLR were all negative. Also, the Achilles reflexes were +2 bilaterally. For a more thorough evaluation, the patient was scheduled for a lumbar MRI. The subsequent MRI taken on April 29, 2010, (shown in figure-2) was reported by a board-certified radiologist who provided a comparison study with the previous MRI dated November 11, 2008.
The comparison study revealed a significant reduction of the extruded discal materials resulting in significantly less compression of the thecal sac. In addition, the neural foramina were intact bi-laterally at L5-S1. The L4-L5 comparison study revealed no significant change.
Second Case Presentation of a Moderate to Severe Extruded Disc (“Slipped Disc” or “Slip-Disc”):
A 44 year old white, male engineer of Persian descent complained of severe lower back pain that radiated to the left buttocks, left posterior thigh and left posterior and postero-lateral leg. The patient further reported numbness, tingling, and a burning sensation along the plantar aspect of his left foot and the entire big toe. The patient also complained of weakness that affected the entire lower left limb. On a visual analog pain scale of 1-10, with 1 being the lowest level of pain and 10 being the most severe pain ever experienced, the patient rated his pain at a 10.
Patient examinations revealed a mild left foot drop with an Achilles reflex of zero (0) on the left and a +2 on the right. However, due to the severity of this patient’s symptoms provocative orthopedic testing procedures were not performed. Before his exam, the patient had undergone two MRI studies, the first on December 29, 2009, and the second, less than a month later on January 23, 2010, (shown chronologically in Figures-3 and 4).
A comparison study of the initial MRIs revealed that the disc bulge initially observed on December 29, 2009, had significantly worsened (in less than a month), leading to a moderate discal extrusion with significant compression of the thecal sac and the S1 nerve root.
Ultimately, the patient was placed on NSD Therapy® to assist with symptomatology and aid in repairing of the spinal disc tissues. Due to the severity of this patient’s condition, a series of 25 session of NSD Therapy® given at a rate of five (5) times per week for five (5) weeks was recommended and performed.
What Were the Clinical Outcomes of our proven slipped disc treatment?
Patient symptomatology and condition continuously improved. On his last therapy session, the patient rated his lower back pain 0/10 (zero) and the radicular component of his condition at an occasional 1/10 (one) on the visual analog pain scale. Evaluation performed on April 16, 2010, revealed a normal (+2) bilateral Achilles reflexes and no foot drop. Also, provocative orthopedic tests such as SLR, Milgram’s and Valsalva’s were all negative. A subsequent MRI of the lumbar spine dated April 19, 2010, (Figure-5) revealed significant improvements in a comparison study with the latest pre-therapy MRI (dated Jan. 23, 2010) of the lumbar spine.
Discussion on Spinal Discs and How Non-Operative Measures Utilized through NSD Therapy® Provided these Favorable Outcomes:
Discs are considered to be the largest avascular structure in the human body [10, 11 and 12]. They obtain the life-sustaining nutrients such as water, oxygen, glucose and amino acids through the process of diffusion; taking place across the endplates . Diffusion of nutrients is passive, resulting from the vessels in the subchondral bone adjacent to the hyaline cartilage of the endplate .
The diffused nutrients are utilized by the chondrocyte-like cells of the nucleus and inner annulus to synthesize the proteoglycan molecule  — a protein-like molecule needed for disc maintenance and repair. A disruption in the flow of these nutrients will have a dramatic impact on a spinal disc, leading to a decrease in production of the proteoglycans and an eventual degeneration of the disc .
FACT: Increased Intradiscal Pressure is the Leading cause of Spinal Disc Disorders
With degeneration, discs lose their osmotic pressure [15, 16], making the disc less able to maintain its hydrostatic behavior . When a disc loses its hydrostatic behavior, axial load bearing activities will significantly increase the intradiscal pressure , leading to loss of height [18, 19] and fluids rapidly .
The average intradiscal pressure (non-load bearing) is 70mm Hg . Any time the intradiscal pressure exceeds diastolic blood pressure, infusion of nutrients and oxygen (imbibition) into the disc stops . Also, increased intradiscal pressure, especially in a degenerated disc, leads to the degradation of the Aggrecan molecule (clusters of proteoglycans), which are then readily leached out, adding to the proteoglycan deficiency already present in a degenerated disc[19, 21]. With the loss of fluids and proteoglycans, a degenerated disc is susceptible to bulging or perhaps worse, tearing of fibers leading to herniations and extrusions.
What is the Root-Cause of Spinal Disc Damage?
According to medical research, the underlying cause of disc degeneration, disc bulge, disc herniation, and disc extrusion is a lack of nutrients that result from an increased intradiscal pressure. Research conducted by neurosurgeons Gustavo and Martin  showed a significant reduction in the intradiscal pressure as a result of distractive tensions applied. In fact, they stated that the intradiscal pressure dropped to negative levels in the range of -100 to -160mm Hg. .
The treatments rendered for the two patients above were through specific protocols that are incorporated in the NSD Therapy®. This system of therapy is centered on spinal decompression (RxDecom®) with the aim of inducing imbibition of nutrients through the endplate and decreasing the intradiscal pressure. Also, Specialized methods of targeted chiropractic adjustments and focused physiotherapeutic procedures such as therapeutic ultrasound, interferential current therapy and manual, rehabilitative and strengthening procedures are employed to stabilize and strengthen the entire joint compound.
In an era where neck pain, back pain, slip-disc, and scoliosis are fast becoming an epidemic coupled with its skyrocketing socioeconomic burden, the need for an effective form on non-invasive, non-surgical procedure has never been greater. It is time for a change; the practitioners need it, and the patients are demanding it! This case report, supported by research, provides an insight into the effectiveness and significance of NSD Therapy®–a non-surgical, non-invasive procedure performed on an outpatient basis.
In both case reports, pre and post comparison MRI studies correlated clinically, via subjective and objective clinical findings which attest to the significance of NSD Therapy®. It is apparent that NSD Therapy® is an effective form of therapy, which has significantly improved both patients symptomatically, objectively and pathophysiologically. Even with a limited number of subject participants, the clinical benefits of NSD Therapy® shines through. However, we suggest larger and more diverse cases, monitored over a longer period to further establish the clinical importance of this method of therapy.
Research Reference for our Proven Slipped Disc Treatment Options:
For those keen on research, we have provided the list of articles used in preparing for this case study. Also, we have provided links to two of these references. You may cut and paste into Google Scholar to search the rest of these research articles. Should you need additional clarifications or information about our proven slipped disc treatment options, please call our main center at 03 2093 1000.
- Labar G.: A battle plan for back injury prevention. Occup Hazards. 1992; 11:29-33
- Gou H., Tanaka S., Halperin E. W., Cameron L.L.: Back Pain Prevalence in US Industry and Estimates of Lost Workdays: American Journal of Public Health. July 1999 Vol.89, No. 7, pp 129-135.
- United States bone and joint Decade: the burden of Musculoskeletal Diseases in the United States. Rosemont, Il.: American Academy of Orthopaedic Surgeons, 2008, Chapter 2.
- Alan E. Ottenstein, MD : Distraction Techniques for Lumbar Spine. Practical Pain Management, Mar/Apr 2003.
- Pergolizz J, Richmond C, Auster M, Florio ; Non-Surgical Spinal Decompression. European Musculoskeletal Review, Vol 3, Issue 2, 2008.
- Naoyuki Oi, Akira Itabashi, Shusuke Kasano, Mitsura Yamamoto, Mustsuo Yamada, Yasuyuki Takakura, keigo Kumamoto, Tetsuo Suyama: Effects of Spinal Decompression For Lumbar Disc Herniations. The Journal of Saitama kenou Rehabilitation. Vol 6, Nov. 2006, Kawagoe, Japan.
- Malti Hiranandani, Non-Surgical Spinal Decompression Treatment of Low Back Pain by Spinal Decompression and Spinal Exercises. Award-winning presentation at the 45th Annual Indian Association Physiotherapy Conference in Kolkata, India, Feb. 2007.
- Shealy NC, Borgmeyer V: Decompression, Reduction, and Stabilization of the Lumbar Spine: A Cost-Effective Treatment for the Lumbosacral Pain. American Journal of Pain Management Vol. 7, No. 2, April 1997.
- Gionis AT, Groteke E: Spinal Decompression: Orthopedic Technology Review, 2003.
- Urban, J.P.G., Holms, S., Maroudas, A. and Nachemson, A. (1977) Nutrition of the intervertebral disc: An in vivo study … Clin Orthop 129, 101-114.
- Roberts S., Menage J. and Urban J P G: Biochemical and Structural Properties of the Cartilage End- Plate and its Relations to the Intervertebral Disc: Spine, 1989 14, 166-177.
- Oegema, T.R.: The role of disc cell heterogeneity in determining disc biochemistry: speculation: Biochemical Society Transaction, 2002 Vol. 30, part 6 pp839-844
- Holm, S., Maroudas, A., Urban, J.P.G., et al.: Nutrition of the Intervertebral Disc- Solute Transport and Metabolism: 1981, Connect Tiss Res 8:101-119.
- Choi, Y.: Pathophysiology of Degenerative Disc Disease: Asian Spine Journal, 2009, Vol. 3, No., 1, pp 39-44.
- Adams MA, Dolan P, Hutton WC, Porter RW: Diurnal Changes in Spinal Mechanics and Their Clinical Significance. The Journal of Bone & Joint Surgery March 1990; 72-B(2) 266-270.
- Urban JPG, McMullin JF: Swelling Pressure of the Lumbar Intervertebral Disc: Influence of Age, Spinal Level, Composition, and Degeneration. Spine Feb 1988; 13(2): 139-225.
- Adams Ma, McNally DS, Dolan P: Stress Distributions inside Intervertebral Discs. Bone & Joint Surg [Br} 1996; 78-B: 965-972.
- Forbin W, Brinkmann P, Kramer M & Hartwig E: Height of the Lumbar Disc Measured From Radiographs Compared With Degeneration and height Classified From MRI Images. European Radiology 2001 11(2) 263-269.
- Adams MA, Hutton WC: The Mechanical Function of the Lumbar Apophyseal Joints. Spine 1983 8(3) 225-345.
- Urban J. PG, Roberts S: Review Degeneration of the Intervertebral Disc: Arthritis Res Ther 2003, 5:120-130.
- Alan Abram, MD: Non-linear Spinal Disc Traction. California Journal of Alternative medicine, December 1999.
- Gustavo, R., Martin, W.: Effects of Vertebral Axial Decompression (VAX-D) on Iinterdiscal Pressure:, Journal of Neurosurgery, 1994 81:350-353.