Preliminary Report for Outcome Study
Of DRS Treatment
Ira Silverstein, Peter A. Moskovitz,
Vincent Desiderio and William Laurman
It is difficult to identify precisely the origins of lower back pain,
because even if the characteristics sometimes point to a given
structure, the pain often remains nonspecific. The most common cause of
intermittent, episodic injury is thought to be from internal derangement
of the intervertebral disc. Several prior studies have documented
changes in intradiscal pressures with both position and
activity.increased intradiscal pressures are present with and generally
thought to be responsible for disc injury. Exercise programs and
ergonomic techniques emphasize the maintenance of a lordosis to maintain
lowered intradiscal pressures, even though we are still uncertain that
reducing intradiscal pressures prevents injury. Recently a new treatment
program has been reported in the literature to successfully treat low
back pain by lowering intradiscal pressures using the DRS System.
Dr. C Norman Shealy, world renowned neurosurgeon and pioneer of non
surgical pain techniques has developed a medical device that lowers
intradiscal pressures, is non invasive, and has high patient compliance.
Dr. Nachemson has stated that 85% of the back conditions go undiagnosed
and therefore they are difficult to treat. Although a plan of
mobilization and treatment may be correct poor outcomes can be
attributed to inadequate force, frequency, or degree of motion applied.
Even Mckenzie notes that refractory cases may benefit with more frequent
cycles to end range movement. Effective mobilization of the disc space
leads to a lowering of intradiscal pressures and has been shown to
reduce the size and extent of herniations by MRI. Neuroradiographic
imaging has also been reported to show early evidence of healing and
rehydration of the disc nucleus. Reducing intradiscal pressures should
enhance a diffusion of blood and nutrients and promotes faster healing.
The action of the device is to mobilize the joint space and through
intermittent kinetic action of the lower spinal segments work to direct
treatment at individual spinal segments without irritating overlying
paraspinal muscles. Reversing the effects of high intradiscal pressure
quickly should promote healing, a quicker return to homeostasis, and
better long term outcomes than traditional treatments.
Patients complaining of lower back pain from herniated lumbar disc wi
thout an extruded segment were the object of our study. We identified 7
men and 6 women with lumbosacral radiculopathy and herniated lumbar
discs. Four patients carried additional diagnosis of degenerated lumbar
discs. The radiation of pain varied to six different extremity sites.
The range of ages was 23 to 67 and all have been through treatment for
their back pain. Symptoms were present from four months to four years.
Three patients decline to participate. The remaining ten began treatment
with the angle and power of distraction according to the DRS protocol.
The DRS protocol allows for changes in the angle of distraction and
power according to decrease in symptoms. The program includes a physical
therapy evaluation consisting of a history, postural analysis, range of
motion, neural tissue tension testing, and Mckenzie test movements. Each
session is initiated with a review of symptoms, affects of the home
exercises program and biomechanics. This is followed with a postural
review and movement analysis. Based on these findings, soft tissue and
joint mobilization techniques along with the DRS system with adjustments
in the procedure based on the evaluation findings. Post-treatment
includes ice, electric stimulation, and a review of home exercise
program and biomechanics. Treatment times lasted initially (1-3
treatments) for 20 minutes and progressed to 30 minutes of lumbar
distraction controlled by positioning and intermittent cycling, which
produces the lowering of intradiscal pressures. Patients were initially
evaluated by an orthopedic surgeon for a diagnosis.
Radiculopathy symptoms subsided in the first few treatments. Lumbar
range of motion was restored in all patients with a complete relief of
pain. The average number of sessions was 4.76. The subsiding of symptoms
seemed to directly correlate with the progression of treatment. All
patients had final evaluations at which time functional range of motion
was restored and resumption of activities of daily living. The patients
were re-instructed in biomechanics and modifications we made according
to postural changes as outlined in the DRS system protocol.
The investigators of this study are: Peter A.
Moskovitz , Private Practitioner, Clinical Professor of Orthopedic
Surgery and Neurological Surgery at George Washington University;
Vincent Desiderio, Private Practitioner, Clinical Associate Professor of
Orthopedic Surgery with Georgetown University; William Laurman,
Department of Orthopedics at Georgetown University, Associate Professor
of Orthopedic Surgery, and Chief of Spine Surgery. The chief clinical
investigator is Ira Silverstein, Physical Therapist in Private Practice
in the Washington, D.C. area. His practice primarily deals with spinal
dysfunction, work site ergonomics, and sports medicine. He is a regular
presenter on these topics in the D.C. area, has a master's in exercise
physiology and is a certified athletic trainer.
Non invasive methods of treatment by machine have been limited to
treating the symptoms of lower back pain related to surrounding spinal
soft tissue. Individual practitioners have delivered inconsistent
results leading to prolonged treatments and escalating medical costs.
The DRS system seems to bridge the gap for the patients. It delivers
treatment to the underlying cause of lower back pain, the spinal disc
segment. The focus of treatment can be adjusted by the doctor
specifically for each patient condition. The effect is consistent,
reproducible and easily tolerated by the patient. Also noted should be
the positive effect on the patient in having progressive improvement
through the sessions. This has a positive effect on the patient in their
mental attitude and psychological outlook. The patient is placed in both
a custom upper and lower harness, steps up on a platform tabletop and is
slowly lowered into a horizontal position. They are then positioned with
harnesses, shoulder supports, and knee rests all designed to position
the patient as well as the lumbar spine for treatment. Several
relaxation features are designed into the system. These parameters are
recommended by the patients from previous radiological evaluation during
research that revealed the amount of distraction and mobilization at
each spinal level with the DRS system.