Today, more chiropractors are flocking to nonsurgical spinal decompression (NSSD). Many choose NSSD because they feel it is a good way to add additional income to their practice. However, that is not the right way to think as a doctor. As a chiropractor, what would be one of the worst cases you would ever see in your office? I believe that’s a herniated disc. As many people flock to have epidurals that are not FDA approved for back pain or choose back surgery, now is the best time to be a chiropractor treating the most difficult cases. Now is the time to decide if you want to be average. Average is the best of the worst and the worst of the best. I never wanted to be average, I wanted to be the best, and now it’s your time to take control of your future and be the best at your craft.
I have spent years reviewing herniated discs. Now, it’s your turn. One of the first chiropractors to recognize the importance of a herniated disc was Dr. James Cox, who has written numerous papers on his work with disc problems. Early on, we had a Cox table in our office, but how many chiropractic schools teach Cox today? How many teach NSSD? Degenerative disc disease (DDD) is a major cause of back problems, according to Dr. Shaufele’s study — the number one cause of disability in our country. I remember two of my teachers in chiropractic school, Dr. Charles Alchermes and Dr. Donald Gutstein, saying we do not treat symptoms — we treat the cause! My question is, if it is a disc problem, how are you treating the disc? Do you target a specific disc, or do you utilize NSSD.? The Ramos and Martin study done by video fluoroscopy shows how imbibition takes place with negative disc pressure. When done properly, NSSD can create negative disc pressure, whereas inversion therapy can create positive disc pressure, which is contraindicated and not advised by studies from both the Mayo Clinic
Dr. Alan Dyer and Dr. Norman Shealy are two pioneers who revolutionized NSSD. Dr. Shealy, MD, PhD, stated, “The first time I did a back surgery, I knew that was not the answer. I had to find a better way.” NSSD is a better way with failed back surgery syndrome (FBSS) now reaching epidemic proportions, and patients are looking for an alternative to drugs and surgery. and Harvard Medical School.
Spine surgeons are typically trained as orthopedic surgeons or neurosurgeons who do essential things. They play an important role. They repair traumatic injuries, excise spinal tumors, and fix congenital abnormalities. It is estimated that some 60% of patients who walk into a spine surgeon’s clinic have back pain that will be diagnosed as “ordinary,” “axial,” “mechanical,” “degenerative,” “functional,” or “nonspecific.” Those terms describe flattened discs, black discs, bulging discs, herniated discs (described as “prolapsed discs” in the United Kingdom), and the bony outgrowths known as osteophytes. Too often, surgeons point to these artifacts on an MRI and diagnose “degenerative disc disease.”
This is where the dilemma begins. They may first recommend medication, may recommend an epidural, or might recommend surgery, often recommending lumbar spinal fusion surgery as the best option. There’s a problem with that very common procedure, though, because the intervertebral disc is excised, and adjacent vertebrae are connected with cages, screws, plates, rods, and other medical devices. Studies show that lumbar fusion succeeds in barely 40% of patients, and in this context, the word “success” is very subjective.
It is estimated that a minimum of one in five patients who undergo spinal surgery for a degenerative disorder returns for a revision procedure — a second operation. Even when the fusion is deemed to be “radiologically perfect” — meaning that on an X-ray, the vertebrae have grown together and the hardware is positioned correctly — the fusion itself imposes increased stress on other vertebral segments, which often results in “adjacent segment deterioration,” a condition where the vertebral level above or below degrades, causing more pain. A second back surgery has a 30% chance of success. That prognosis drops to 15% for a third back surgery and 5% for a fourth. My son, Dr. Jason Kaplan, estimates that one to five patients come to his office with a failed back procedure.
In an article in a medical trade journal, orthopedic surgeon Terry Amaral noted some of the things that can go wrong — things that are rarely mentioned to surgical candidates. He stated, “The spinal cord is right next to where we are putting the screws in; we are working near where the nerve roots exit.” He also observed, “If you perforate that area, the patient will experience weakness or even paralysis. Then in the front of the spine, there are other things to be concerned about, like the aorta, the vena cava, the lungs.” There are other risks that go unspecified; it has been estimated that spinal screws are misplaced in 5 to 10 % of all fusion procedures. After spinal fusion, infection is common. Nerves may be jostled and inflamed, resulting in dull, diffuse, aching, or sharp stinging pain in the legs that may or may not ever go away. Supportive spinal ligaments and muscles disturbed during the surgery rarely work with the same efficiency, and that incompetence may result in more back pain. Despite risks and mediocre outcomes, the number of spinal fusions performed in the United States grew from 61,000 in 1993 to more than 465,000 in 2011 — more than a 600% increase, accounting for more than 60% of the spinal fusion surgeries performed worldwide. It’s the most expensive form of elective surgery in the United States, costing over $40 billion annually.
So, doctors, this is where we fit in. Study after study show up about the success of spinal decompression. Millions of Americans who have suffered or know someone suffering from back pain know there is a nonsurgical, noninvasive solution. Back pain has reached epidemic proportions. To understand the severity of this epidemic, consider that low back pain is the second most common symptom-related reason for seeing a physician in the United States, or approximately 19 million physician visits annually. It is estimated that 85% of the US population will experience an episode of low back pain in their lifetime.
Spinal decompression has been proven effective in relieving the pain associated with bulging and herniated discs, degenerative disc disease, sciatica, and even relapse or failed back surgery. Since its release, clinical studies have revealed an amazing success rate in treating lumbar disc-related problems with spinal decompression.
How does it work?
Spinal decompression uses state-of-the-art technology to apply a distraction force to relieve nerve compression often associated with low back pain and sciatica. The goal is to get spinal distraction without muscular contraction. There is a difference in tables, and some tables are more effective in my opinion than others. Do your homework, know your table, and review the FDA 510k of your table.
Your ability to communicate consequences to patients really is the difference between a practice that can run, a practice that can fly, and a practice that can soar.
• Consequences with respect to ongoing use of opioids (organ damage and addiction).
• Consequences with respect to epidural injections (risk of spinal fluid leaks and not FDA approved for back pain treatment).
• Consequences with respect to possible surgeries (anesthesia risks, scar tissue, failed back surgery syndromes).
• Consequences with respect to not acting right now (problem becoming progressively worse and the patient no longer being eligible as a candidate for nonsurgical spinal decompression within your office).
Be the best. Do the best consultation. Do the best examination and cut no corners with your patients. With failed back surgery reaching epidemic proportions, this is our time as doctors to shine. Nobody wants to go to an “okay” doctor; everybody wants to go to the best.
Doctors, do you want your practice to soar? It begins by knowing your craft. Being the best. Remember, we’re not Ron Popeil (RONCO); we don’t just “set it and forget it.” Know your machine and know the patient. Stop treating symptoms and start treating the cause. We should not treat all patients the same. A patient with a bulging disc is different from a patient with a subluxation, which is different from a patient with a herniation, which is different from a patient with spinal stenosis. How do you treat a patient with one herniation? How do you treat a patient with two herniations? Do you do decompression of the cervical spine and lumbar spine at the same time? Do you have guidelines and protocols from your manufacturer? These are the type of questions we review with the national certification program sponsored by Life University, but you should ask yourself these questions daily by working with the best of the best and being an expert in the field of decompression. Now is your time, our time, so let’s get to work.
During 34-plus years as business partners, Dr. Eric Kaplan and Dr. Perry Bard have developed Disc Centers of America, Concierge Coaches, and the first national certification program for non-surgical spinal decompression a 12 CEU credit event. Being held for the 10th anniversary on November 5,6. This event has been sold out for two years running.
Dr. Jason Kaplan is a Parker University graduate practicing in Wellington, Florida with his wife, Dr. Stephanie Kaplan. Jason also is an Instructor for Disc Centers of America and teaches techniques for the National Certification Program at Life University. To learn more, call 888-990-9660 visit thechiroevent. com or decompressioncertified.org.
