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Transcript of Vaxd brought to you by the Back Pain Institute of Dallas
TheNon-Surgical Treatment For
Low Back & Neck Pain
Consider These Facts OnBack Pain & Back Surgery…
FACTS:
• More money is spent on the treatment of chronic pain than is spent on heart disease, AIDS and cancer combined.
• Back pain is the number one cause of work absence after colds/flu.
• 5.4 million Americans are disabled annually due to back pain.
• 70% of patients who had lumbar back surgeries still complained of back pain. 23% complained of constant pain, and 35% were still under treatment.
• The average cost for back surgery is about $40,000.00
• Only 37% of patients undergoing their first back surgery returned to work. Only 27% of patients with more than one back surgery return to work.
The Birth of A Phenomenon:The Discovery of Spinal Decompression
In March of 1994 Dr. Allan Dyer along with neurosurgeon Dr. Gustavo Ramos and radiologist Dr. William Martin at the Departments of Neurosurgery and Radiology, Rio Grande Regional Hospital, McAllen, and Division of Neurosurgery, Health Sciences Center, University of Texas, undertook to measure the pressures inside the intervertebral disc as patients received VAX-D treatment.
With a fluoroscopically guided cannula/catheter and pressure monitoring equipment, they watched and measured the patients’ disc pressures drop to negative levels. Thus the birth of spinal decompression with VAX-D.
This discovery led to a landmark clinical study that showed for the first time it was possible to lower a intradiscal pressure in Vivo with a non-surgical treatment.
10075
0
-100
-150
VAX-D actuallylowers disc pressure to
negative levels
0 10 20 30 40 50 60 70 80 90 VAX-D TENSION (LBS)
DISC
PRESSURE
Effects of Vertebral Axial Decompression On Intradiscal Pressure
HCA HOSPITAL STUDYMcAllen Texas
Gustavo Ramos MD, William Martin MD Departments of Neurosurgery and Radiology
Journal of Neurosurgery 81: 350-353, 1994
INTRADISCAL PRESSURE MONITORING
CATHETER INSERTED VIA A CANNULA INTO THE NUCLEUS PULPOSUS
RECORDING INTRADISCAL PRESSURE CHANGES DURING VAX-D
Dr. RAMOS MONITORING PROCEDURE
DUAL RECORDING VAX-D TENSION AND INTRADISCAL PRESSURE
0
-150
+100
25 50 75
INTR
AD
ISC
AL
PR
ESSU
RE
- mm
Hg.
-
VAX-D - TENSION
Intradiscal Pressure Reduced to Negative LevelsDuring VAX-D Treatment
HOW DOES VAX-D WORK?
1. VAX-D Decompresses the intervertebral discs and neurological elements. This reduces the hydrostatic effects of the nucleus (protrusion, herniation, extrusion etc.) and the resulting compressive injury.
2. By reducing the disc pressure to negative levels, this increases the diffusion gradient from the vertebral endplate (into the disc), which brings oxygen, fluids, nutrients into the disc. The exchange of fluids reduces the concentration of catabolites and lactic acid.
3. Along with the increased flow of fluids into the disc, the flow of prescribed pharmaceutical agents will also be increased. All of this will serve to reduce the INFLAMMATORY CASCADE.
4. Reduction of inflammation in the disc and surrounding structures – means less pain for your patients, and will allow the disc to heal naturally.
Science & Medicine :VAX-D Decompression Treatment
-160 mm Hg
-40 mm Hg
-100 mm Hg
The Commissioner ofPatents and Trademarks
Has received an application for a patent for a new and useful invention. The title anddescription of the invention are enclosed. The requirements of law have been compliedwith, and it has been determined that a patent on the invention shall be granted underthe law.
Therefore, this
United States Patent
No. 6,039,737OPERATION OF A VERTEBRAL
AXIAL DECOMPRESSIONTABLE
Grants to the person(s) having title to this patent the right to exclude others frommaking, using, offering for sale, or selling the invention throughout the United States ofAmerica or importing the invention into the United States Of America for the term setforth below, subject to the payment of maintenance fees as provided by law.
If this application was filed prior to June 8, 1995, the term of this patent is the longer ofseventeen Years from the date of grant of this patent or twenty years from the earliesteffective U.S. filing date of the application, subject to any statutory extension.
If this application was filed on or after June 8, 1995, the term of this patent is twentyyears from the U.S. filing date, subject to any statutory extension. If the applicationcontains a specific reference to an earlier filed application or applications under 35 U.S. C120, 121 or 365(c), the term of the patent is twenty years from the date on which theearliest application was filed, subject to any statutory extension.
Commissioner of Patents and Trademarks
[11] Patent Number …... 6,039,737[45] Date of Patent ..Mar. 21, 2000Primary Examiner - Michael BuizAssistant Examiner - Jonathan D. GoldbergAttorney, Agent - Blackwell Sanders Peper Martin
[57] ABSTRACTA vertebral axial decompression table is operated byapplying a baseline tension to the two table parts, increasing tension to about 50% of the maximum above baseline, then logarithmically increasing tension to maximum tension. This cycle is repeated a programmed number of times to effect therapy 23 Claims, 8 Drawing Sheets
United States Patent [19]Dyer
[54] OPERATION OF A VERTEBRAL AXIAL DECOMPRESSION TABLE[76] Inventor: Allan E. Dyer[21] Filed: Oct. 29, 1998[30] Foreign Application Priority date Aug. 12, 1998 [AU] Australia .. 79929/98[51] Int. Cl 7 ……………………..A61b 17/56[52[ U.S. Cl………………………606/58; 606/54[58] Field of Search ……………..606/54; 53, 57[56] References cited U.S. Patent Documents 4,995,378 2/1991 Dyer ……128/75 5,115,802 5/1992 Dyer ……602/23
Fechners Law of Biological Response
VAX-D employs the inverse of this principle and applies the force (Tension) in a reverse Logarithmic curve. Applying the tension in this manner avoids stimulating the proprioceptors in the back and spine.
TIME - (Linear Scale)
LOGARITHM OF STIMULUS
THE MAGNITUDE OF THE SENSATION IS PROPORTIONAL TO THE LOGARITHM OF THE STIMULUS
Logarithmic Formula Exp [ C x Ln (Bti) ] = BTn + [ N x In ]
N
DECOMPRESSION
LOGARITHMIC PHASE
RETRACTIONLOGARITHMIC PHASE
VAX-D DOUBLE LOG THERAPY CURVE
30 60
100
80
60
40
20PERCENT MAXIMUM TENSION
90
PRETENSION
Seconds
Column traction devices fail to decompress the discs because:
1. The force is applied in a linear fashion, and proprioceptors recruit back and trunk muscles to contract and guard in a protective mode.
2. The use of chest harnesses and axillary restraints INCREASES intradiscal pressure by significant amounts.
TractionColumn Traction Devices
FORC
E
100
TRACTIONLinear Phase
RETRACTION Linear Phase
HOLD0
50
VAX-DPROPRIOCEPTOR THRESHOLD
150
100
50
0
-50
-100
-150
INTRADISCAL
PRESSURE-200
200
250
20 40 60 80 100TENSION - lbs.
VAX-D vs TRACTION
TRACTION
VAX-D® vs. TractionVAX-D® Traction
1. Effect of Vertebral Axial Decompression On Intradiscal Pressure. J Neurosurg 81: 1984.
2. Intervertebral Disc Pressures During Traction. Scand. J. Rehabil. Med. 9: 1983
3. An Overview of Vertebral Axial Decompression., Can. J. Clin. Med. , 5; 1998.
4. The Effect of Lactate and ph on Proteoglycan and Protein Synthesis rates in the Intervertebral Disc. Spine, 17: 1992.
5. Nutrition of the Intervertebral Disc: Solute Transport and Metab., Connective Tissue Research,8: 1981
•Intradiscal Pressure reduced to negative levels (1)
•Intradiscal Pressure unchanged or increased (2)•Negative IDP enhances
Oxygen and Nutrientdiffusion into the disc (3)
•Positive IDP inhibits diffusion with lactic acid accumulation (4)•Aerobic metabolism
fostersbio-physiological functionsand cellular repair activity (3,5)
•Anaerobic metabolism inhibits cellular activity and repair functions (5)
VAX-D Genesis G2 System
In 2007 VAX-D released the Genesis G2 System with true ‘Biofeedback Motion Control’ for absolute accuracy in decompression of the lumbar and cervical spine.
The equipment has a unique ability, in that the tensioning source can be programmed to move simultaneously in the horizontal plane and the vertical plane to follow the curves of the spine.
This system also accurately tracks the horizontal and vertical movement curves and adjusts position and tension (instantly) at the same time.
These advances are significant because variability in flexion or extension curves greatly increases patient comfort and muscle relaxation.
G2 Cervical: A System Like No Other
• Patients receiving VAX-D cervical treatment are treated wearing a harness with an integrated supportive cervical collar.
•The collar is designed to allow some mobility of the patient’s head and neck during decompression, while providing a circumferential lift system.
• The collar provides the necessary immobilization and protection for patients in the post treatment period when the muscle guarding reflexes have been reduced.
• Without the protection of the collar, head and neck movements will trigger muscle spasm, increased intradiscal pressure and neck pain.
• Patients wear the collar during the treatment and for 1-2 hours after to provide stability and to help the proprioceptors accommodate to movements of the head and neck.
Genesis Dynamic Mode for Cervical Decompression
The Genesis Dynamic Mode allows the operator to program the tensionometer to move synchronously in the horizontal and vertical plane in order to apply tension in a logarithmic time/force progression that can be designed to follow a curvature comfortable for the spine.
The tensionometer head moves in an ‘arc’ from the starting point to the end point. It can be programmed to move in an upward (flexion) or downward (extension) arc. Communication with the patient will determine the most comfortable settings for the Dynamic Mode.
Genesis ‘Dynamic’ Treatment for Cervical Herniated Disc
A lower angle of tension tends to place more force on the mandible and TMJ. A higher angle of pull tends to transfer more of the tensile forces to the occiput, because of the circumferential (collar) harness system.
Once the most comfortable treatment parameters have been established, they will be recorded and remembered by the system for future treatments.
- HERNIATED LUMBAR DISCSExtruded and/or SubligamentousOne or more levels
- DEGENERATED DISC DISEASE
- LUMBAR AND SCIATIC NERVE COMPRESSION
- FAILED BACK SURGERIES
- POSTERIOR FACET SYNDROMES
VAX-D Therapeutic Indications
MULTI-CENTER EFFICACY STUDY778 CASES
HERNIATEDAND
DEGENERATEDLUMBAR DISCS
NEUROLOGICAL RESEARCH JOURNALVOLUME 20, 1998
Drs. E. Gose, R. K. Naguszewski, W. K. Naguszewski
EXTRUDED
53%
MULTIPLE
72%
SINGLE
73%
FAILED BACK SURGERY
68%
DEGEN. DISC
72%
FACETSYNDROME
68%
Vertebral axial decompression therapy for pain associatedwith herniated or degenerated discs or facet syndrome:
An outcome study
Pain Remission 778 cases
100
75
50
25
PERCENT OF CASES
HERNIATED LUMBAR DISC
Vertebral Axial Decompression Therapy for pain Associated
with Herniated or Degenerated Discs or Facet Syndrome:
An Outcome Study._________________________________________________________
______Earl E. Gose, William K. Naguszewski and Robert
Naguszewski[ Journal of Neurological Research, April 1998 ]
Relief of pain and Disability
PERCENTAGE IMPROVEMENT
50 %
75 %
25 %
65 %
MOBILITY
71 %
PAIN
78 %
ACTIVITY
PROSPECTIVE RANDOMIZED CONTROLLED TRIAL
VAX-D vs TENS
CHRONIC BACK & LEG PAIN
NEUROLOGICAL RESEARCH JOURNAL Volume 23, No. 7, 2001
Department of OrthopaedicsSidney University - Australia__________________________________
Eugene Sherry MD, FRCS
Peter Kitchener M.B., B.S., FRANZCR
Russel Smart M.B., Ch.B.
RANDOMIZED CONTROL TRIAL CHRONIC DISCOGENIC BACK & LEG PAIN
Statistical significance p < 0.001
6
5
4
3
2
1
0
VAS - PAIN SCALE
VAX-D vs TENS
PREVAX-D
5.59
POSTVAX-D
PRETENS
5.44
POSTTENS
5.97
1.69
Randomized Control Trial
VAX-D TENS
ADLDECLINED
-2%-17%
PAININCREASED
PAINDECREASED
69%
ADLIMPROVED
34%
60
80
0
20
40
-20
% CHANGE IN
INDICES
STATISTICAL SIGNIFICANCE - P < 0.001
BLUE CROSS SPONSORED296 CASES
Prospective Outcome Study________________
Activity-LimitingLow Back Pain
Arch. Phys. Med. Rehabil. : Vol 89, 2008
P.F. Beattie, R.M. Nelson, L.A. Michener, J. Cammarata, J. Donley
VAX-D Research Studies:Outcomes After a Prone Lumbar Decompression Protocol for Patients With Activity-Limiting Low Back Pain: A Prospective Case Series Study (2008) Paul F. Beattie, PhD, PT, OCS, Roger M. Nelson, PhD, PT, Lori A. Michener, PhD, PT, ATC, SCS, Joseph Cammarata, DC, Jonathan Donley, DPTSArchives of Physical Medicine And Rehabilitation, Volume 89, February 2008© 2008 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation
• A two and one-half year study on the treatment of chronic back pain sponsored by Independence Blue Cross, a leader in the insurance industry, confirmed the effectiveness of VAX-D.
• The purpose of the study was to determine short- and long-term outcomes after VAX-D treatment in a large sample of patients with activity-limiting low back pain that had failed at least two previous, non-surgical treatments.
• A total of 296 subjects with low back pain and evidence of a degenerative and/or herniated intervertebral disk at 1 or more levels were enrolled in the study.
• In this study all subjects had pre-intervention imaging evidence of lumbar intervertebral disk degeneration and/or herniation.
• The study showed that patients had significantly improved pain and disability scores at end of treatment, at 30 days and at 180 days post-discharge.
6 MONTH FOLLOW-UP STUDY Blue Cross Sponsored Study
Arch. Phys. Med. Rehabil. , Vol 89, 20088
6
4
2VAS - PAIN SCALE
BEFORE VAX-D
STATISTICAL SIGNIFICANCE P < 0.01
5.8
EXIT 30 DAYS 180 DAYS AFTER VAX-D
3.53.73.4
PAIN
SIGNIFICANTLY REDUCED
6 MONTH FOLLOW-UP STUDY Blue Cross Sponsored Study Arch. Phys. Med. Rehabil. , Vol 89, 2008
12
8
6
4DISABILITY SCALE
BEFORE VAX-D
STATISTICAL SIGNIFICANCE P < 0.01
12.6
EXIT 30 DAYS 180 DAYS AFTER VAX-D
6.0
7.0
5.9
DISABILITY
SIGNIFICANTLY REDUCED
VAX-D Research Studies: VAX-D Reduces Chronic Discogenic Low Back Pain
FOUR YEAR FOLLOW UP STUDY
Anesthesiology News - Vol 29, March 2003
Odell R. H., MD, PhD. , Boudreau D. A., DO
FOUR YEAR FOLLOW-UP STUDY
8
6
4
2VAS - PAIN SCALE
BEFORE VAX-D
4 YRS AFTER VAX-D
STATISTICAL SIGNIFICANCE P < 0.001
7.41
1.57
FOUR YEAR FOLLOW-UP EMPLOYMENT STATUS
100 %
70 %
30 %
BEFORE VAX-D
4 YEARS LATER
UNABLE TO WORK
FULLY EMPLOYED
COMPARATIVE OUTCOME STUDY
Journal of Neurological Research Volume 26, April 2004
_______________________________
Valley Neurosurgical Center Center for Neurosurgical Sciences University of Texas
REGULAR PROTOCOL VS
REDUCED COURSE OF THERAPY
COMPARATIVE OUTCOME STUDYJournal of Neurological Research - Vol. 26,
April 2004
75
60
45
30
15PERCENTAGE OF CASES
10 DAILY SESSIONS 20 DAILY SESSIONS
COURSE OF THERAPY
43
REMISSION
24
PARTIALREMISSION 33
NEGATIVE
76
REMISSION
20
PARTIALREMISSION
5
NEGATIVE
20 vs 10 SessionsStatistical Significance P < 0.001
STANDING
100
FLEXED
150
LIFTING
220
FIRM
CHAIR
140
SOFT
CHAIR
185
BED
REST
75
LEGS
FLEXED
150
EXTENDED
180
CRUNCH
210
KNEES
FLEXED
140
TRACTION
130
EVERY DAY POSITIONS PHYSICAL THERAPY INDRADISCAL PRESSURES
INTERVERTEBRAL DISC PRESSURES
STANDING+100
BED
REST
+75
KNEES
FLEXED
+140
TRACTION+130
VAX-D
THERAPY
REAL SCIENCE
REAL STUDIES
REAL RESULTS
-150
QuickTime™ and aTIFF (LZW) decompressorare needed to see this picture.
DECOMPRESSION REPAIRS DISCS
Herniated Nucleus
Pulposus
Nucleus Retracted by
Vacuum Effect
Annular Fissure
Closed & Healing
BEFORE VAX-D
L4 -L5 left posterior large extruded disc
compressing thecal sac
AFTER VAX-D
“ This the most dramaticreduction of an extruded segment I have seen “
Curvel A. Ferrari MD
Left posterior - L4-L5 Extruded disc compressing & retro-displacing left nerve root
BEFORE VAX-D
Extruded disc retracted Left nerve root decompressed
Curvel A. Ferrari MD
AFTER VAX-D
ANATOMY OF ANNULUS FIBROSUS
DISTRACTION CLOSES OBLIQUE LAYERS AND RADIAL DIFFURES
Canadian Journal of Clinical Medicine
Vol. 5, No. 1, Jan. 1998
Frank Tilaro, M.D.
DISC DECOMPRESSION
PLUS
NEURO- DECOMPRESSION
RESEARCH PROOF
SCIATICPAIN
NEUROLOGICALDEFICIT
74
REMISSION
26
NEGATIVE
76
REMISSION
24
NEGATIVE
75
60
45
30
15PERCENTAGE OF CASES
CLINICAL OUTCOME
RADICULOPATHY RESPONSE TO VAX-D
An Overview of Vertebral Axial DecompressionF. Tilaro MD - Can. Jour. Clin. Med. Vol. 6, 1999
The Effects Of
Canadian Journal of Clinical Medicine Volume 6, Number 1, January 1999
Dr. Frank Tilaro & Dr. Dennis Miscovich
Vertebral Axial
Decompressionon
Sensory Nerve Dysfunction
BEFORE VAX-D
6.36
AFTERVAX-D
2.09
IMPROVEMENT SIGNIFICANT
P < 0.05
7.0
5.0
4.0
3.0
2.0
1.0
6.0
NEUROMETER GRADE
CURRENT PERCEPTION THRESHOLDEVALUATION OF SENSORY DEFICIT
THE EFFECTS OF VAX-D IN SENSORY NERVE DYSFUNCTION IN PATIENTS WITH LOW BACK PAIN AND RADICULOPATHY
J. CLINICAL MEDICINE - JANUARY 1999
JOURNAL OF NEUROLOGICAL RESEARCH
VOL 23, No. 3, November 2001
DERMATOMAL SOMATOSENSORY EVOKED POTENTIAL (DSSEP)
DEMONSTRATION OF NERVE ROOT DECOMPRESSIOINAFTER
VAX-D THERAPY
Naguszewski W. K., M.D.Naguszewski R. K., M.D.
Gose E., Ph.D.
DERMATOMAL SOMATOSENSORY EVOKED POTENTIAL ELECTRODE PLACEMENT
L5
S1
STIMULATING ELECTRODES -- ON FOOT
RECORDING ELECTRODES ----- ON SCALP
NERVE ROOT DECOMPRESSION (DSSEP) WITH VAX-D THERAPY
PERCENT - DSSEP READINGS
60
30
STATISTICAL SIGNIFICANCE - P < 0.0013
IMPROVED
61
SAME
29
NEGATIVE
10
ADJUSTMENT TO PRETENSION BASE LINE
RELAXATION PHASE
CONTROL CONSOLE
COMPUTER
Bio- feedback Loop
CONTROL CONSOLE
COMPUTER
LOWER BODY, PALLET, TENSIONOMETERCONTROLLED AS A
UNIFIED MOTION SEGMENT
DECOMPRESSION PHASE
BIO- FEEDBACKLOGARITHMIC MOTION CONTROL
BED REST
DIFFUSION GRADIENT
INTRADISCAL PRESSURES
100
75
50
25
0
-25
-50
-75
-100
-125
-150
-175
DIASTOLIC BP - 80 mm Hg.
VAX-D DIFFUSION GRADIENT > 200 mm Hg.
ACROSS THEVERTEBRAL END PLATE
VAX-D THERAPY
VAX-D DECOMPRESSION
“Vertebral distraction producing decompression creates a favorable
diffusion gradient across the endplate enhancing disc nutrient transfer promoting the natural healing process”
Kirkaldy-Willis - Managing Low Back pain
Non-steroidal Anti-inflammatory Drugs Naproxen Sodium (Aleve) 220mg bid Diclofenac (Voltaren) 50 mg bid Indomethacin (Indocin) 25mg tid or SR 75mg
VAX-D PROTOCOL • PHARMACOLOGICAL AGENTS
Analgesics - When necessary
Muscle relaxants - When necessary
Mucosal protective agents Misoprostol - Cytotec 100-200mg H2 Antagonist - Zantac 75 -150 mg
Steroid Methylprednisolone 4 - 8 mg 2-3 hrs before Tx (10 days) Prednisone 20 mg tid (10 days) Medrol Dosepak
INTERNAL DISC DISRUPTION VAX-D PROTOCOL
METHYLPREDNISOLONE - 4 TO 8 MG.
Taken orally 2 to 3 hours before each VAX-D sessionFirst week - One dose each daySecond week - One dose Monday,Wednesday & Friday
DOXYCYCLINE - 200 MG. (Matrix Metalloproteinase Inhibitor)
Taken orally 2 to 3 hours before each VAX-D sessionOne dose each day
NB: Doxycycline should not be used for patients allergic to Tetracyclines
For optimum absorption: Medications should be ingested on an empty stomachNo Antacids with Doxycycline
INTERNAL DISC DISRUPTION
HIZHIGH INTENSITY ZONE
Pathognomonic of IDD
DISCOGRAM DYE PENETRATES ANNULUS FIBROSUS INDICATES DISRUPTION OF INTERNAL STRUCTURES
INTERNAL DISC DISRUPTION
CONTRAINDICATIONS and PRECAUTIONS
1. Fracture
2. Neoplasm
3. Unstable Spondylolisthesis
4. Cauda Equina Syndrome
5. Ankylosing Spondylitis
6. Severe Osteoporosis
7. Rotator Cuff Tear
8. Arthrodesis with Instrumentation
NORMAL DISC HEIGHT &LATERAL FORAMEN
DEGENERATED DISC FACET SUBLUXATION NARROWSLATERAL FORAMEN
DEGENERATED DISC FACET HYPERTROPHY IMPINGES LATERAL FORAMEN
DEGENERATED DISC FACET HYPERTROPHYOSTEOPHYTIC SPURS IMPINGESLATERAL FORAMEN
-STENOSIS-LATERAL FORAMENAL ---------------------------------- disc hydration opens foramen
IATROGENIC FORAMINAL STENOSIS
Normal Lateral foramen
Post fusionStenotic foramen----------------------Refractory toDecompression
SPONDYLOLISTHESIS
SPONDYLOLYSIS
SPONDYLOLYSIS
0
20 K
40 K
60 K
80 K
100 K
120 K
140 K
160 K
Surgical Care
VAX-D after 4 wksStandard care
Medical
Disability
Total
A Graphic Comparison of CostsA Graphic Comparison of Costs
StandardConservative Care
$ Costs
$ Costs
Don’t Be Fooled By The Imposters:Real Decompression: Where Science & Technology Meet
How does VAX-D compare to its competitors?
VAX-D developed and patented the process of non-surgical spinal decompression (not NASA). VAX-D is the only equipment shown in studies to lower intradiscal pressure. VAX-D has demonstrated the retraction of herniations on post treatment MRI’s. VAX-D has established 75-85% success rates in 10 clinical studies, hospitals and private clinics. VAX-D is the only equipment shown to decompress nerve roots using DSSEP and CPT studies.
Why buy old technology?
Copycat equipment is based upon TRACTION technology that was introduced in 1986, and dressed up with fancy columns and tilt tables.
No other devices have published studies proving they decompress the spine.