1	The VAX-D Network www.vaxd.net END BACK PAIN WITHOUT SURGERY
2	Today’s Topics Costs and Causes of Low Back Pain Normal Lumbar Spine Conditions of the Discs Types of Treatments for Low Back Pain Benefits of Massage Therapy Trigger Point Therapy Types of Patients We Refer
3	Costs of Low Back Pain $100 billion in losses per year including disability and litigation 150 million lost work days ($14 billion in wage costs alone) $33 billion in direct medical costs
4	Causes of Low Back Pain Degenerated Disc Disease #1 cause Facet Internal Disc Derangement Disc herniation Sacroiliac Joint disorders Myofascial syndromes Post Laminectomy and Spine Fusion Syndromes
5	Normal Lumbar Spine Vertebra Discs Muscles Ligaments Balance Correct Posture
6	Normal Healthy Discs Healthy discs are so strong the bone will break before the disc will tear. A healthy disc requires motion between the vertebrae to draw the vital fluids into the disc to keep it nourished.
7	Disc Degenerate and Tear When discs dry out or degenerate, they become brittle and can easily tear. Here is an example of a torn bulging disc. Also called a slipped disc.
8	Discs Produce Pain and Numbness The damaged disc can protrude or herniate placing pressure on the spinal nerves producing back pain & pain & numbness down the legs.
9	Herniated / Ruptured Discs The “jelly-like” nucleus extrudes through the torn dried out annulus pressing on the spinal nerves.
10	Advanced Degeneration Produces Spinal Stenosis As the disc dries up, the bone also thickens and roughens. The bone growth surrounds the nerve openings and squeezes the nerves.
11	The Discs Progressively Worsen As the degeneration process continues, the discs get drier, thinner, brittle and the more likely to tear. A typical patient’s story. I used to get the pain once or twice a year, then, every couple of months. At first chiropractic and physical therapy would relieve the pain but then, the pain became constant. Now I have the pain at some level all the time, sometimes it is very severe and sometimes it eases. I’m also having pain or weakness in my legs especially after standing or sitting for prolonged periods. I wake up with pain and stiffness every morning.
12	Typical Course of Treatment Medication Chiropractic Physical Therapy Injections Surgery
13	Medication Medication is usually the first thing done for mild to moderate pain conditions whether over the counter or prescription. Acute pain from a soft tissue strain will usually resolve within a few days to a few weeks. The big concern is the prolonged use of medication, only covering up the underlying problem.
14	Chiropractic / Physical Therapy Chiropractic and Physical Therapy are usually very effective for the treatment of acute and chronic LBP--up to a point. The effectiveness seems to diminish the greater the degree of disc damage and degeneration.
15	Injections Epidural Steroid Injections are usually given in a series of three. They are invasive and in most cases are usually temporary, lasting a few days to a few months. The only purpose is to reduce the pain by reducing the inflammation around the nerves.
16	Spinal Surgery Surgery should only be used as a last resort, when all else fails and if it appears that there is a strong likelihood that it will improve the condition.
17	Discectomy Herniated-Ruptured-Protruded Disc, the nucleus is cut away removing pressure off the nerve.
18	Fusion with bone graft
19	Fusion with Cages and Rods VAX-D cannot be used with metal implants
20	LBP (Waddell) Evidence for surgeries lumbar disc prolapse --> conflicting percutaneous discex - limited & contradictory fusion - no acceptable evidence spinal stenosis - no acceptable evidence DDD - no acceptable evidence DDD - no acceptable evidence in effectiveness in returning patients to work
21	Post Surgical Syndrome Less than 1 out of 4 of disc surgeries are successful after 5 years Re-operation rate of 17-20% Causes: Inadequate (multilevel involvement) Incorrect Diagnosis (wrong level, pain is not relieved by surgery) Scar Tissue formation Altered biomechanics of the spine
22	Side Effects: Surgery Risks of anesthesia, infection, bleeding, nerve disruption, instability Most serious side effect --> increased risk of additional surgery Risks of additional surgeries not additive, but a multiple of the initial risk. Interference with dynamic functional compensation of the low back (ref. Naguscewski & Naguscewski, J. Neuro. Res. October 2001)
23	Spinal Decompression Therapy VAX-D is a safe and highly effective alternative to lumbar disc surgery. VAX-D is also highly effective in the treatment of degenerated and bulging discs especially when chiropractic, physical therapy and injections have failed to significantly reduce the pain.
24	Benefits of VAX-D The Average Total Cost of VAX-D is $3,500 - $4,500 The Typical VAX-D patient does not lose time from work Studies Have Shown That, On Average More Than 70% of VAX-D Patients Report a Pain Scale Reduced to Less Than 2 , in 4 Weeks Studies Have Shown That, On Average More Than 70% of VAX-D Patients Returned To Work
25	Effects of VAX-D on the Spine VAX-D creates a negative intradiscal pressure or vacuum effect within the disc and draws the nucleus of disc back into place. Vital fluids containing the nutrients and oxygen are also drawn back into the disc so the disc can heal. With none of the risks or side effects associated with surgery.
26	Repair of Disc with VAX-D
27	MRI of the Lumbar Spine
28	Before and After VAX-D
29	VAX-D Vs. Traction Traction has a minimal effect on the treatment of low back pain since it doesn’t get to the source of the problem, the disc. When traction is applied, the muscles of the spine contract preventing the disc from being decompressed. The reason VAX-D works is that it “fools” the muscles so they don’t contract and a negative pressure or vacuum effect is produced within the disc.
30	Patients Under VAX-D Treatment
31	Long Term Efficacy – VAX-D 4 Year Follow-up Study Improvement of VAS from 3.41 just after VAX-D therapy completed --> 1.57 four years later 70% working at 4 years 86% working or retired w/o LBP at 4 years Therefore, rarely a need to retreat the VAX-D patient Evidence that the treatment lasts for many years.
32	Conclusions: VAX-D is a more effective treatment than surgery. VAX-D is a safer treatment than surgery. VAX-D has no dangerous side effects. Surgery has a number of dangerous side effects. VAX-D has beneficial side effects such as improved mobility and rehydration.