Spinal Conditions

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Spinal Conditions Outcomes

• Dr. Gregg Mantonya
• The Mantonya Chiropractic Centers
• Newark Hebron

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My background

• Undergraduate study - Ohio U. Marycrest Intl.
  U.
• 4 year Doctor Chiropractic Degree from Cleveland
  Chiropractic College-KC
• Completed year-long study from Spine Research
  Inst. of San Diego for spine injury during
  vehicle crashes
• Past Team Doctor for High Schools
• Additional post-graduate study in Pediatric
  Chiropractic, Rehab, Nutrition

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www.mantonyachiropractic.com

• Go to...
• Recent Talk Handouts

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Chiropractic

• Required 2-4 yrs undergrad, 4 year Chiropractic
  School
• Extensive training in Musculo-skeletal and
  nervous systems - More hours than Medical school
• Detect correct joint mis-alignments
• These can affect nerve function
• Do not prescribe medication
• Physicians through Medicare, Ohio BWC, Court
• PCP for many of our patients

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Chiropractic
Therapy Modalities
Rehab
Adjusting Table
Low-force Instruments
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Conditions, Causes, Prognosis

• Sprain/Strains
• Repetitive Stress
• Arthritis
• Discs
• Scoliosis
• Chronic Pain Patients

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Sprain/Strain
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Sprain/Strain

• Will heal within 6-12 week, right?...
• ...Remodeling phase of healing, up to 12 months
  or more (Kellet Acute Soft Tissue Injuries - a
  review of lit. Med Sci Sport Exerc,
  18(5)489-500, 1986)

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Sprain/Strain

• Whiplash Its estimated that 50 of those
  exposed to trauma will be injured
• 50 will recover within weeks or months
• Leaving 20 of the initial 100 exposed to late
  whiplash symptoms
• Approximately 5 will be disabled

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Sprain/Strain

• Whiplash At Risk For Acute Injury
• Female
• History of neck injury
• Poor head restraint/tall patient
• Use of seatbelt - 1.5 - 3 x more likely
• Out of Position/Head turned
• Non-aware of impending impact
• Increasing age (middle age beyond)
• Impact by vehicle of greater mass

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Sprain/Strain

• Whiplash At Risk for Late Whiplash
• Female, especially if small body mass
• Immediate/early onset of symptoms
• Ligament/Joint instability
• Greater of symptoms
• Use of seatbelt - 34 vs 20
• Initial limited range of motion
• Initial neurological symptoms
• Loss or reversal of cervical curve

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Sprain/Strain

• Mercy Guidelines -
• Factors that Complicate Recovery
• Used by Ohio BWC
• Pain longer than 8 days - 1.5 x longer
• Severe pain - 2 x longer
• 4-7 previous episodes - 2 x longer
• Injury on underlying condition - 2 x longer
• Poor compliance
• Biomechanical Stress
• Psychosocial Stress

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Repetitive Stress Injury

• Carpal Tunnel Syndrome
• Common in those performing assembly line work
• Women 31
• Surgery up to 90 successful?
• Tendonitis

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DJD Osteoarthritis
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DJD Osteoarthritis

• Wear Tear Arthritis
• Large percent are remarkably asymptomatic
• More common in males until age 45, Females 101
• Hip degeneration reduced risk of osteoporosis
• Recent problems with pain medication
• Vioxx, Bextra, Celebrex etc

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Disc Conditions

• Discs are the spongy thing between the spinal
  bones
• Shock absorbers
• Spacers for nerve to exit
• Up to 50 of people asymptomatic have lumbar disc
  degeneration on MRI
• Up to 60 in cervical spine
• MRI of 98 people without back pain
• only 36 had a normal disc at all levels.
• 52 bulge at least one level
• 27 protrusion
• 1 extrusion
• 38 had abnormality at more than one level

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Discs

• Cant slip
• Swollen
• Bulge - No outer fibers are torn, center has
  moved toward the outer rings
• Protrusion - Sometimes used in place of bulge
• Herniation - Some tearing of outer ring fibers,
  center moves toward outer rings
• Rupture - Piece of Center has gone outside of disc

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Discs - normal, top view
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Discs - bulge, front view
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Discs - herniation, front view
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Discs - rupture, front view
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Discs
Pain Meds/Chiropractic, Rehab Shots, Nerve Block,
Surgery

• Rupture most likely to need surgery.
• One study showed 83 of patients with herniations
  and radiating pain improved up to 2.5 years
  after73 had actual herniation improved or
  resolved not just the symptoms (non-operative
  treatment).
• Surgery - Studies vary on its success, as little
  as 50 or worse

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Back Surgery - What studies say

• 50-70 have complete relief of back and leg pain
  when followed-up at 5 years
• 10-15 will have worse pain
• 18-29 will undergo further surgery

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Scoliosis

• Idiopathic (unknown cause) most common type
• Most rapid progression during growth spurt
• 10-15 degrees progression during adult years
• Complications cardiopulmonary dz., DJD, pain,
  curve progression
• Tx stretches, braces, Chiropractic, massage,
  surgical bracing

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Scoliosis

• In my practice experience, pain and disability
  depend upon patients...
• Physical Fitness
• Activity Level
• Severity of Scoliosis
• Occupation

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Spondylolisthesis

• 50 never have pain
• Most of the others that do have another cause
• Rarely progresses during adulthood
• Studies showed no worsening with strenuous sports

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High Risk
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Chronic Pain Patients
The longer a patient is disabled from work, the
less likely they are to return.

• BWC Data
• Pharmaceutical Reimbursement
• 1998 57,026,132
• 2003 130,000,000
• Chiropractic Costs
• 2002 64,467,227.00
• Actual cost of Chiropractic vs. Medical Claims
  new injury, 1998- 2002
• Allopathic care drugs 709,709,700.95
• DC care 167,396,045.11
• Long-term care costs 2002
• DC - 34 million
• MD Drugs - 189.6 million

1 in 6 Americans live with chronic pain. 120
billion a year in medical costs and lost
productivity.
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Chronic Pain Patients

• 30,000 hospitalizations/yr from NSAIDS use
• One study showed only 25 resolved from original
  pain complaint one year later
• Recent Increase in Pain Management Centers
• Chiropractic 1-2 visits/month shown to be
  beneficial
• Fibromyalgia - 3-6 million Americans
• Tenderness particularly in the neck, spine,
  shoulders, and hips - usually after trauma.
• Most able to be fully active, may need job
  modification.

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Chiropractic Terms

• Adjustment vs. Manipulation
• Subluxation, Subluxation Complex
• Intersegmental Dysfunction

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Info Outlets

• www.mantonyachiropractic.com
• Chiropractic info
• Kids Chiropractic
• ACA - www.amerchiro.org
• insurance managed care
• Spine Research Inst. - www.srisd.com
• sprain/strain info/research
• My email - mantonyachiro_at_yahoo.com