IDD For Vista Dec 15

Spine Plus 02/12/15 Large Extrusion of L5/S1, hard / dry
protrusion with fresh / wet fragment
IDD Therapy WHAT IS IT WHAT IT FOR EVIDENCE BASE PATIENT EXPERIENCES / OUTCOMES CONTRAINDICATIONS 02/12/15 …T2 Saggital image showing modic
change
Management of DD Disease
Manual Therapy -­‐ Manipulation (HVT), massage, dry needling, traction. -­‐ Postural reducation and realignment -­‐ Core stability Invasive (Guided injections) -­‐ Facet injection (Fluroscopy or CT guided) (intracapusular or extra-­‐capsular?) (Are the facets actively inflammed….SPECT CT scan?) -­‐ Pulsed Radio Frequency Nerve Denervation -­‐ Medial Nerve Branch Block? Surgery -­‐ (micro)discectomy / (Endoscopic) -­‐Fusion (ALIF, PLIF, TLIF, XLIF) Helping to Bridge the Treatment Gap Manual T
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ns 02/12/15 IDD Therapy 1 Spine Plus 02/12/15 The Origins of Back Pain Treatment Typical Tradi?onal Trac?on Hippocrates -­‐ 400 B.C. Hippocrates, the father of medicine, “…have his knees and ankles ?ed to a ladder, to be liFed upside down” Stoddard was a big fan or mechanical traction Latest research – effective for 50% of cases 02/12/15 02/12/15 02/12/15 02/12/15 1 -­‐ Improve Disc Health Understand the origins *  1995 Study by Ramos & Mar?n – measured the effects of vertebral axial decompression (Journal of Neurosurgery ) *  Recorded a reduc?on in intradiscal pressure from +60mm Hg to -­‐100mm to -­‐160mm Hg *  Precisely angled pulling force distracts targeted spinal segments *  Joints distracted in longitudinal plane, not anterior -­‐posterior *  Vertebrae opened to create pressure differentials in the disc space *  Negative pressure to promote retraction of bulging nucleus *  Stimulate fluid exchange by diffusion to help improved disc health *  Improve mobility to free natural nutritional pathways for the 02/12/15 disc. IDD Therapy Pressure differentials promote fluid exchange within the disc space to aid improved disc health and to help retract a bulging nucleus pulposus. Ramos G and Martin 1. Effects of vertebral axial decompression on intradiscal pressure. J Neurosurg. June 1995. 82 (6): 1095 02/12/15 2 Spine Plus 02/12/15 Origins cont/ 1997, Shealy & Bourgmeyer test established scien?fic principles to to develop new thinking for trea?ng targeted spinal segments. They perform a single blind RCT comparing tradi?onal trac?on with new distrac?on decompression techniques, (American Journal of Pain Management). *  Leads to the creation of the IDD Therapy spinal decompression protocols. *  Distraction observed at different spinal levels by altering the angle of application and the amount of distraction force. With fluoroscopy, measure a 7mm distraction at L5 Shealy CN and Borgmeyer V. Decompression, Reduction and Stabilization of the Lumbar Spine: A Cost-­‐ Effective Treatment for Lumbosacral Pain. American Journal of Pain Management 1997. 7:63-­‐65 02/12/15 Nutri?onal Pathways to the Disc NO direct blood supply, nutri?on from: • Diffusion from the vasculature within the vertebral body (V) through the endplate (E) to the nucleus (N) or • From the blood supply outside the annulus (A) Working Together The Effects of Compression Manual Therapy A compressed sponge loses water and is unable to absorb water. 02/12/15 Decompressing (taking pressure off) the sponge allows it to absorb water. 02/12/15 Vector Illustration of Altered Pulling Force Angles IDD Therapy Tripartite solutions to resolve chronic back pain and neck pain Rehabilitation 02/12/15 The Effects of Increasing Pulling Angles on the Spine Fy Pulling forces angled to treat targeted segments Fx Increasing the angle causes the point of applica?on of the pulling force to move along the spine B A As the angle which a pulling force makes with the horizontal increases, the component of force in the horizontal direction (Fx) decreases and the vertical component of force (Fy) increases. This causes the relative direction of the pulling force to change and therefore the focus point of application of the pulling force to move progressively along the X-­‐Axis. 02/12/15 IDD Therapy Further increase enable us to target different spinal segments 02/12/15 Note: Angles shown for illustra?ve purposes, not to scale. 3 Spine Plus 02/12/15 How does IDD Therapy work? Linear vs Sinosoidal Waveform *  Mechanical linear force is unnatural to the body *  May prompt muscle spasm *  Cause actual increase in intradiscal pressure •  Natural to body, non linear pull •  Applying slow stretch to Golgi Tendon Organ causes it to fire, inhibits tension in the muscle •  Allows parallel elas?c component (sarcomere) of the muscle to remain relaxed and lengthened 02/12/15 02/12/15 IDD Therapy – Treatment Summary Intermittent Distraction Joint mobilisation
High
Force
High Force
Low Force
Sinusoidal
Waveform
Distraction maintained
Low Force
Constant Distraction
Twenty-five minute treatment
•  With conventional intermittent traction, the force is typically ON or OFF •  Spinal decompression has a maximum high tension and a low tension •  The low force does not go to zero, so tension is maintained throughout treatment 02/12/15 *  Measured angle of distraction targeted to specific levels *  Sinusoidal waveform pulling force to avoid spasm *  Stronger pulling forces to achieve distraction *  Twenty five minute treatment duration for soft tissue change *  13 minutes of maximum disc decompression to promote fluid exchange *  13 full minutes of Oscillation / joint mobilisation for improved mobility *  Treatment components occur concurrently, not successively 02/12/15 Oscillation & Joint Mobilisation Tracking System Target Tension Vs Actual Tension *  Patented oscillation feature which is achievable by having the sinusoidal waveform *  Top of the high hold when the joint is under distraction, oscillation mobilise targeted joints *  Mobilisation in a longitudinal plane rather than an anterior-­‐posterior plane 02/12/15 IDD Therapy 02/12/15 4 Spine Plus 02/12/15 IDD Therapy Protocols Improved Harnessing Techniques •  The IDD Therapy treatment protocols were developed to help guide clinicians treating targeted spinal segments. •  The standard protocol is based on a series of 20 treatments spread over a 6 week period. The IDD Five Therapy Guidelines xists a ctwo onstantly set of protocols treatments per ew
eek off or weeksexpanding -­‐ No Exercises. for kteeping today’s standards en best -­‐p P
ra?ces: Three reatments per m
wedical eek for two weeks
assive Exercises Only •  Herniated Discs Protocol, 5-­‐S1, L4-­‐L5, L1-­‐L2 Two treatments per wLeek for two Lw3-­‐L4, eeksL2-­‐L3, -­‐ Active Exercises •  Degenera?ve Disc Disease Protocol, L5-­‐S1, L4-­‐L5, L3-­‐L4, L2-­‐L3, L1-­‐L2 •  Posterior Facet Syndrome Protocol, L5-­‐S1, L4-­‐L5, L3-­‐L4, L2-­‐L3, L1-­‐L2 •  Herniated Discs Protocol, L5-­‐S1, L4-­‐L5, L3-­‐L4, L2-­‐L3, L1-­‐L2 Scia?ca Protocol • •  Degenerative Disc Disease Protocol, L5-­‐S1, L4-­‐L5, L3-­‐L4, L2-­‐L3, L1-­‐L2 General FLacet ow BSack Pain Protocol • •  Posterior yndrome Protocol, L5-­‐S1, L4-­‐L5, L3-­‐L4, L2-­‐L3, L1-­‐L2 •  Sciatica Protocol •  General Low Back Pain Protocol •  Old harnesses did not lock the pelvis and thus were prone to slippage •  Uncomfortable nature of old harnesses could constrict the patient uncomfortably as higher application forces are applied. •  Improve the harness design using modern materials and design techniques, including an inbuilt air bladder at the rear. •  Harness is secured comfortably on the pelvis and patient is secured at the top of the bed, with the harness following the lines of the rib cage. North Amdericam Medical and its distributros accept no medical liability for the applica?ons of these protocols, in whole or in psrt. See IDD Therapy Protocol Book for full details 02/12/15 02/12/15 EXERCISE Cervical Treatment *  Treatment forms part of a rehabilitation programme which includes exercise training *  As well as education 02/12/15 Evidence 02/12/15 IDD Therapy Spinal Decompression cont/ McClure & Farris examine 415 pa?ents treated with IDD Therapy programmes. Treatment success measured as 50%+ decrease in average pain scores taken at 2 months and 2 years. (European Musculoskeletal Review, 2006 92% Success rate in 129 pa?ents categorised as surgery candidates 02/12/15 IDD Therapy McClure D and Farris B, Intervertebral Differential Dynamics Therapy – A New Direction for the Initial Treatment of Low Back Pain. European Musculoskeletal Review 2006. 45-­‐48.
02/12/15 5 Spine Plus 02/12/15 Committed to Evidence-­‐Based Medicine All parameters are recorded, making IDD Therapy measurable and duplicable as part of a commitment to evidence-­‐based treatment. Use internationally recognised assessment forms including the Oswestry Disability Index and Visual Analogue Scale. * 
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Expected IDD outcomes From pilot study at another clinic involving detailed analysis of 123 patients who received IDD Therapy Expected IDD outcomes From pilot study involving detailed analysis of 123 patients who received IDD Therapy Lumbar stenosis with leg symptoms (5 people) Pain score (VAS): 60% improved 20% had no change, 20% were worse Function (Oswestry): 80% improved, 20% got worse Lumbar stenosis without leg symptoms (5 people) Pain score (VAS): 80% improved, 20% were worse Function (Oswestry): 60% improved, 20% had no change, 20% got worse Lumbar prolapse (no stenosis) with leg pain (38 people) Pain score (VAS): 93% improved 7% had no change Function (Oswestry): 87% improved, 13% got worse Lumbar prolapse (no stenosis) without leg pain (only 2 people) Pain score (VAS): 50% improved 50% no change Function (Oswestry): 50% improved, 50% got worse 02/12/15 * 
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Lumbar degenerative disc disease with leg pain (46 people) Pain score (VAS): 90% improved, 7% had no change, 3% were worse Function (Oswestry):
90% improved, 10% got worse Lumbar degenerative disc disease without leg pain (18 people) Pain score (VAS): 95% improved, 5% were worse Function (Oswestry):
90% improved, 5% had no change, 5% got worse Cervical degenerative disc disease with arm pain (6 people) Pain score (VAS): 100 % improved Function (Oswestry): 100 & improved Cervical degenerative disc disease without arm pain (4 people) Pain score (VAS): 100% improved Function (Oswestry): 75% improved, 25% got worse 02/12/15 Large Extrusion of L5/S1, hard / dry
protrusion with fresh / wet fragment
*  In summary: based on this study, taking into consideration all conditions, 70% of people will improve with IDD treatment (improving by an average of 72% in their pain level and 40%-­‐50% on their function). 10% get worse but the majority of these people are those who spinal stenosis. In the case of spinal stenosis 20% seem to get worse, (60% improve), it is unclear whether they get worse anyway or whether the IDD causes the deterioration. The best results are seen in people who have herniations and nerve pain in an arm or leg pain and in people with neck / back pain and disc degeneration in that area with or without arm / leg pain, for these people around 90% seems to improve and 10% seem to get worse or were destined to get worse anyway. 02/12/15 02/12/15 IDD Therapy 02/12/15 6 Spine Plus 02/12/15 02/12/15 Here’s what patient think 02/12/15 Ideal Candidates for IDD “For 40 years or more, I have suffered with some degree of back pain, but about ten years ago it became much worse. Physiotherapy did not help -­‐ indeed, it only aggravated it. After a course of sessions with Spine Plus, using the IDD, there was a dramatic improvement. Now, two years later, I have still have virtually no back pain at all.” Patients with… *  Chronic back or neck pain due to spondylotic changes, modic type 1 (non infective) and type 2 change. *  Radicular pain due to foramenal or spinal stenosis, disc protrusion. *  …For whom regular manual therapy of injections have not worked and who want a way of managing their pain without surgery. 02/12/15 IDD THERAPY -­‐ Contraindica?ons •  Pregnancy •  Pa?ent younger than 15 •  Pa?ent weight greater than 425lbs •  Severe osteoporosis (T-­‐score -­‐2.5 to -­‐2.8 or greater) •  Congenital abnormal?es of the spine •  Pacemakers •  Unstable post-­‐surgical condi?ons •  Any kind of surgical hardware (if in the area being treated) •  Spine instability (Doctor’s precau?on) •  Recent vertebral fracture(s) •  Open growth plates •  Severe canal stenosis •  Rotatory or severe scoliosis •  Abdominal aor?c aneurysm •  Some annular tears (Doctor’s precau?on) •  Spondylolysis PATIENT SCAN •  Spondylolithesis (Grade II or higher) •  Vertebral fusions, less than 6 months old •  Inflammatory, infec?ous or neoplas?c condi?ons •  Meningi?s •  HNP (sequestered/ free floa?ng fragment) •  Mul?ple myeloma •  Osteosaracoma •  Osteomyeli?s •  Hemiplegia •  Cauda equine syndrome •  Severe peripheral neuropathy •  Paraplegia •  Pelvic or abdominal cancer •  Pars defect 02/12/15 IDD Therapy 02/12/15 •  A suitable scan is recommended to assist the clinician in ruling out contraindications. •  The scan may also help the supervising clinician to confirm diagnosis of the pathology and to the targeted level. •  It is recommended that IDD Therapy patients undergo a suitable scan, although treatment may be given without a scan at the direction of the supervising clinician. 02/12/15 7 Spine Plus 02/12/15 IDD Therapy Benefits Summary   Degenerative Disc Disease (Spondylosis) To contact us  Radiculopathy (Cervical and lumbar) Modic end plate changes seen on MRI *  Future CPD events, e.g. Understand MRI and disc pathology.   Recent MRI scan usually a necessity  Further treatment option where manual therapy is having limited *  IDD Therapy referrals benefit – but before considering injections and surgery.  Intermittent traction forces (between high and low tension) Tel: 0203 369 8577 Email: London@spineplus.co.uk  Sinusoidal type increases in traction pressure  Patented oscillation at high tension  Objective feedback mechanisms (red line plot during treatment) Thank You  When provided alongside regular manual therapy and core strengthening equals ideal package of non-­‐invasive care. IDD Therapy 02/12/15 02/12/15 8