Non-invasive Spinal Options Set New Standard in Treatment and Rehabilitation

'As complications arise resulting from surgical treatment of spinal disorders, health care professionals look for a non-surgical, patient-friendly solution.' By Dan Pastorius

January 2005

The debate about the necessity of invasive surgery to treat spinal disorders has reached a critical moment, as noninvasive treatment options have been rapidly gaining recognition among physicians. Whereas many therapists cite open spinal surgery as causing greater complications and some morbidity for patients, alternative treatments — such as orthoses, hands-on techniques and new technologies — have proven more effective, less precarious options in rehabilitation and elimination of spine-related pain.

Before therapy can occur, the first step in actively treating patients with spinal disorders is to accurately assess the precise root of the problem. According to Malcom R. Hooper, director of the Melbourne Hyperbaric and the Spinal Rehabilitation Group, Australia’s largest non-hospital-based Hyperbaric Medicine service provider, the key to a successful outcome for any patient is to establish the exact cause and nature of the condition at the outset of treatment.

“Numerous patients have received many forms of physical treatments and medications for years, without proper and often with inadequate clinical investigation,” he said. “Inappropriate diagnosis and treatment is often more detrimental than just leaving the patient alone. What starts out as a single level problem may eventually emerge as a disease and/or degenerative process because of inappropriate treatment recommendations, which may in fact further compromise a poor and inadequate immune response.

“Every patient is different and every patient’s condition is different,” Hooper continued. “Gone are the days of simply operating, giving another drug or cracking your back and hoping for a good outcome.”

Short-Term Solution

The spine is defined as being the central pathway of the body — not only does it operate as the mechanical connection between the arms and legs, but it serves as an internal nerve highway running from the brain to the rest of the body. For that reason, surgery to the spine can only be viewed as a precarious procedure, full of potential complications and long-term risks. What is naively perceived as a non-life-threatening condition can quickly become a life-altering disaster, which is why it is important for both surgeons and patients to investigate and look into all available treatment options.

Dr Mal Hooper attending the recent 3rd Joint Congress of the Swiss, Austrian and German Society of Neurorehabilitation and World Federation for Neurological Rehabilitation; Zurich 2004

A doctor who has spent the better part of his career researching these treatments is Bogdan M. Luklinski, MSc, of the Luklinski Clinic in London. He believes that surgical procedures such as fusion and discectomy involve a crude and costly approach to treating back pain, and considers spinal surgery completely unnecessary for the vast majority of back conditions no matter how severe they are initially claimed to be.

“When I started my studies of the spine more than 30 years ago, I came to the conclusion that spinal surgery was definitely the wrong approach to the treatment of chronic and acute pain, because no matter how serious a spinal condition, it can always be cured or at least made asymptomatic,” noted Luklinski. “The spine is a biomechanical wonder, but it cannot function properly if disks are cut away or vertebrae are fused together, and many patients are persuaded to undergo more than one spinal operation when preceding operations fail.”

Sharing a similar outlook as Luklinski, Hooper is also quick to criticize spinal surgery, noting that many times surgeons perform spinal operations as a temporary solution rather than a long-term cure.

“Patients are too frequently offered surgical strategies and procedures which are designed to provide a ‘quick fix’ — an attempt to alleviate pain — however the quick fix in most instances contributes to the long-term suffering and the continued deterioration of the patients’ condition,” said Hooper. “Who has benefited? Certainly not the patient. You have to get to the root of the problem clinically and not just provide short-term strategies with the outward symptoms”

Oxygen Therapy

To facilitate noninvasive treatment measures that equate to nominal results, Hooper adopted a revolutionary treatment dubbed Hyperbaric Oxygen Therapy (HBOT) into his practice. HBOT safely delivers 100% oxygen to a patient through a mask or hood while inside a pressurized air chamber. The pressure inside the chamber causes the oxygen breathed to be dissolved at greater levels in the blood. This provides an approximate 2,000% increase in tissue oxygenation, which significantly accelerates the rate of healing, stabilization and repair of the spine.

Hooper noted that his original objective in incorporating HBOT into his practice was to raise awareness of the treatment, promote early usage and intervention in major hospitals, and continued rehabilitation in day facilities for the long-term injured. His results, he admitted, speak for themselves, as he has found that both the frequency and intensity of his spinal patients’ episodes have greatly diminished and the need for ongoing treatment has been significantly reduced.

“The impact of HBOT, coupled with assertive physical therapy, has clearly demonstrated that complex illness including spinal and related neurovascular disorders can be significantly influenced with greater success outcomes,” Hooper said. “Conditions previously thought to be beyond the limitations of conventional treatments have been afforded dramatic, and in many patients, astonishing results by the mechanisms of HBOT coupled with assertive physical therapy. Our work demonstrates that even small gains can dynamically affect the quality of life for these patients.”

Although he admitted that HBOT is not offered as a guaranteed cure, Hooper noted that the treatment continues to demonstrate dramatic immune responses, assisting patients with problems ranging from simple delayed wound healing to complex disabilities and impairment. In a controlled environment, including defined entry and exit policy with pre- and post-diagnostic assessment, he said that HBOT is a safe and effective treatment option with minimal side effects to the patient.

“My initial thoughts were that perhaps the mechanisms associated with the clinical effects of HBOT might have a role in the clinical management of patients with acute and chronic pain due to disk prolapse, failed back surgery and spinal cord dysfunction,” he said. “Little did we realize that, in fact, the inclusion of HBOT would completely revolutionize the way in which spinal and related disorders could be clinically assessed and treated.”

Hands-On Alternatives

Despite the fact that HBOT provides a competent treatment of spinal disorder, a more common method might appeal to therapists looking for a more hands-on alternative. Suggesting that the traditional tried and tested method generally works best, Luklinski said that mobilization — a procedure involving a small oscillatory movement of varying amplitudes combined with a manual rotation and traction movement — is a painless and essential procedure in spinal treatment.

Although most chiropractors and osteopaths rely on manipulation over mobilization, Luklinski noted that mobilization is generally the most effective and all around safest procedure for treating chronic spinal conditions such as correcting slippage or a herniated disk.

“Mobilization is by far the most effective procedure for treating serious spinal disorders,” he noted. “This achieves the aim of freeing a trapped nerve or restoring a slipped disk by gently restoring the passive mobility of the affected spinal joints through carefully applied pressure and/or oscillatory movement. It cannot cause the patient any harm and always produces good results, whereas the clunk-click approach of manipulation can often be contraindicated by many conditions and generally should not be performed.”

Nonetheless, when combating spinal disorders that leave patients with partial paralysis, Marmaduke D.R. Loke, a product and solution developer for Dynamic Bracing Solutions, has codeveloped a lower extremity orthotic system that builds upon the fundamental principles of prosthetics. Citing triplanar control as the underlying key for alignment and realignment of the body, the orthosis incorporates a series of levers involving all three planes for the patient to walk over and balance on. As variations in the levers affect balances and stresses within each plane, walking efficiency is enhanced and body compensations are reduced or eliminated to maintain balance and a more normal gait appearance.

“What we are trying to do is reestablish what normal walking parameters are, and bring the weight back to the extremities that are weakened and supported by the brace,” Loke said. “My focus is to get them standing and walking more efficiently with a better lower limb orthosis. Through this new technology, we are now able to do and emulate what we’ve all been doing in prosthetics for quite some time, which is to get people to walk with a normal gait appearance and even run by just using bracing systems.”

Continuous Rehabilitation

Once a patient completes treatment and begins the rehabilitation process, the patient must remain motivated and continue forward with postsurgical exercises to speed healing. To reach their maximum potential, patients need to realize that healing requires commitment, work and determination, with the payoff resulting in a fit physique and a much higher quality of life.

In an effort to keep rehabilitation as diverse and energetic as possible, Loke recommends programs that blend flexibility, balance and mental focus into a patient’s rehab regimen. One program he suggested is Pilates, a series of exercise movements designed to improve strength, flexibility, and range of motion, and also to encourage musculoskeletal alignment. Regardless of a person’s level of body fitness, Pilates body conditioning programs can be integrated into rehabilitative exercise and diverse physical therapy programs designed to speed recovery of spinal injuries.

“Maintaining range of motion allows better mobility, balance and efficiency that is integral for patients with spinal injury to obtain the most potential from new developments in bracing,” Loke said. “Aside from Pilates, we have also found that tai chi works wonders — a recent study showed that one group of geriatrics did tai chi and the other did nothing, and the group that did tai chi was able to reduce their falls by 48%. So basically, any type of conditioning with stretching and maintaining normal range of motion are important issues when it comes to the rehabilitation of patients, not just for people suffering from spinal disorders, but everybody.”

As an alternate to exercise programs, clinical devices can also be used to combat chronic spinal pain and aid in a patient’s rehabilitation. Luklinski recommends his own invention, the Back-Rack, as a quintessential aid in successfully treating most forms of back pain. Constructed from high-quality wood and consisting of a number of lateral spindles, the device is designed to treat stiffness, muscular pain, sciatica and back pain, among other symptoms.

“The wooden nodules push up on either side of the spine, and this lifts the individual vertebrae, causing them to pivot about the joints in the back,” Luklinski said. “As a result of this, the joints are decompressed and the spine lengthens, joint mobility and soft tissue elasticity increases, and stiffness and back pain are therefore reduced. In addition to this, the pressure on the joints and the intervertebral disks is lowered, thus lowering the risk of spinal osteoarthritis and bulging, or herniated disks.”

On the other hand, for patients suffering from paralysis or partial spinal cord injuries, Hopper recommends a different yet equally unique technology. Dubbed the Lokomat by creators, the device consists of a powered exoskeleton robot that retrains patients to walk by distributing power to their hip and knee joints. The device operates by strapping the patient’s legs to the machine, while a suspended harness supports their upper body weight over a treadmill. Once the patient is perched, the walking begins to take place, with an emphasis on the fact that the repetitive movement may eventually help them redevelop and regain functional walking patterns.

“Much of the brain’s control of walking is linked to neural circuits located within the spinal cord,” Hooper said. “Research strongly suggests that this spinal circuitry, even when limited as with partial spinal cord injuries, can be functional and retrained to generate walking movements. Therapy to generate those movements advances into dramatically new territory with Lokomat, due largely to the machinery’s precision.”

Dedication Important

As time passes, some patients may ultimately feel less pain and be well on their way to a healthy recovery. From a psychological standpoint, this could be attributed to the fact that better tools and better solutions give patients the determination and potential to do more to fight against their disability. An important lesson for patients to learn early is that despite how they feel after treatment, it is important for therapy to continue and for them to give their all, despite the pain or odds stacked against them.

“Following treatment, mobility and strengthening exercises are given to a patient to prevent a recurrence of the problem,” Luklinski noted. “Positive patients always recover quicker than those with bad outlooks. Recovery is not psychological, although chronic spinal pain can make patients insecure and dependent because they are in constant pain. It could ultimately create a psychosomatic circle.”

Luklinski makes it clear that recovery should represent to the patient a demanding yet rewarding process. Loke maintains a more casual outlook while echoing the same sentiments. Once the orthotist or therapist does his or her job in helping the patient get back up to speed, it is the patient’s responsibility to continue forward and not let all of their combined hard work and progress go to waste. Even great athletes must practice to stay on top of their game.

“I’ve seen people really flip in terms of motivation, once new hope is provided,” said Loke. “We must keep them aware of the fact that we can only enable someone with better solutions, and that it is their job to be committed to see the rewards — it is up to the patient to continue working on it. But it does take time to retrain, and patients have to realize that it is a life-long commitment that in most cases will reap rewards, and for some of them, rewards once thought unobtainable.”