Lumbar Spine and Sciatica

1. Healthy Lumbar
For Life

2. Healthy Discs =
Movement, Alignment and Canal

3. Disc Injuries :
Slipped
Bulging
Herniated

4. Nervous system

5. Front view
Back View

6. Piriformis
Muscle and
Sciatic Nerve

7. Cauda Equina

8. Postural Muscles = Proprioception
1. Dorsal columns
2. Cerebellum
3. Vestibular ocular
syst.

9. Psoas muscle
99% of the time
Muscles are
NOT the
Problem

10. Rounding of the Shoulders
Hyper-kyphosis
Toxic vs Disease

11. Start 1st
Year 2nd
Year
Discs can Regenerate

12. Upright positional MRI of the lumbar spine
London Upright MRI Centre, London, UK, and
Department of Radiology, The Royal National Orthopaedic
Supine magnetic resonance imaging (MRI) is routinely used
in the assessment of low back pain and radiculopathy.
However, imaging findings often correlate poorly with
clinical findings.
Clinical Radiology (2008)63, 1035e1048

13. MRI Supine
MRI weight bearing

14. Weight Bearing stress X-rays after Surgery

15. Failed Back Surgery Syndrome
98%,80%,40%,29%,15%
incidence of FBSS depends on how you measure
•spine surgeons often quote a 98% success rate for fusion
surgery.
(This percentage however refers to the success of the fusion
process, not the reduction of pain.)
•pain reduction for single level fusions 40-80%
•Pain reduction with three levels15%
Microdiscectomy quoted by neurosurgeons a 95-98% success rate
•however when success is defined is returning to their previous
occupations without pain medications, the overall success rate
drops to 74%
•For workmans compensation patients, the success rate is 29%
(Surg Neurol 1998 Mar;49(3):263-7; discussion 267-8).

16. •Post-operative plain radiographs showed a correct position of the
implants in all patients.
•The post-operative percentage of spondylolisthesis, measured on
plain radiographs post-operatively and at final follow-up, remained
unchanged in all patients.
•8 out of 12 patient reported a significant improvement of
pain, neurogenic claudication, and radiculopathy.
• However, four patients did not experience any relief of symptoms
following surgery and no improvement at follow-up.
•12 weeks, two patients, that initially had experienced a relief
of symptoms suffered from a recurrence of pain, neurogenic
claudication, and radiculopathy.
•a third patient experienced a recurrence of symptoms at
24 months follow-up.
Eur Spine J. Feb 2008; 17(2): 188–192.
High failure rate of the interspinous distraction device
(X-Stop) for the treatment of lumbar spinal stenosis
caused by degenerative spondylolisthesis

17. In conclusion, the X-
Stop interspinous
distraction device
showed an extremely
high failure rate, …
We do not recommend
the X-Stop for the
treatment of lumbar
spinal stenosis with
degenerative
spondylolisthesis…

18. Infections contracted in
hospitals are the fourth
largest killer in the United
States
causing as many deaths
as AIDS, breast cancer
and auto accidents
combined.
— One out of every 20
hospital patients gets an
infection.
103,000 of die each year
Epidural Injections

19. Knee Pain from the Lumbar
Marge 47 yo woman

20. Lumbar
Surgeries
Increasing

21. Spinal Decompression

22. 7 Surgeries Still in Pain
6 degree reduced to less than 1 degree

23. Never lay on your Back with
Both Knees Bent

24. Turn Sitting into Therapy
•Bottom of the elbow is the bottom of the towel
•Base of the rib cage
•20 min on
•10 min off
Ball Chair stabilizes pelvis
Only time for No Towel

25. Move Twist Bounce
•Moves Lymph
•Stimulates Bone Growth
•Charges up the Brain
•Decreases Fatigue

26. Stabilizing the Pelvis
• Approximate hips
•Unstable pelvis from long term LBP, scoliosis, sedentary lifestyle
•“the adjustment feels good but the pain comes back in a hour”
•Takes about 3 weeks to stabilize
•Trochanter support Vital to check for knee rehab
Approximate hips
Sit Like a cowgirl/cowboy
Stable sitting position
Or Ball Chair

27. Pain Medications Cause
Hyper-sensitization

28.  Decrease cartilage production
 Inhibits proteoglycan production
(the building blocks of cartilage)
 Causes accelerated bone
destruction
American Journal of Medicine,
1999, Dec.
Tylenol and NSAID’s Cause Arthritis

29. Sweet Potato
Broccoli
Cruciferous Veggies
Blueberry
Berries
Papaya
Pineapple
Green Veggie Juice
Anti-inflammitories
Turmeric

30. Suzy 44yo woman
Bowel dysfunction
Back Pain
Fibromyalgia
depression
Nerve pressure from
abnormal Biomechanics

31. Proper nerve supply –
Get Checked for Subluxation
Regular Exercise
Proper Nutrition
Sufficient Rest
Prayer and Meditation

32. Take Action Today
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Sciatica Low back pain
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RLS Restless leg Syndrome
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34. TheThe
ChiropractiChiropracti
cc
AdjustmentAdjustment