Treatment for herniated discs is done with a technique known as Cox® Flexion -Distraction. In our office we combine Cox® Technic with other conservative, non-surgical treatment.

The Cox® Technic is spinal manipulation, a non-surgical, established, evidence-based treatment for spine pain performed by a trained physician and supported by years of clinical experience, many publications of clinical and laboratory outcomes, and clearly defined protocols for application to attain the highest positive clinical outcomes for acute and chronic back pain as well as failed back surgical syndromes. All this to help restore a patient's quality of life.

Since the Cox® Technic is spinal manipulation, most insurances cover this treatment unlike Spinal Decompression.

Here are some facts to consider when deciding treatment for a herniated disc:

• There are approximately 1.2 million spinal surgeries in the U.S. each year, double the rate in those other countries. (1)
• Epidural steroid injection is moderately effective for short-term (but not long-term) symptom relief. (2)
• Prolotherapy, facet joint injection, intradiscal steroid injection and percutaneous intradiscal radiofrequency thermocoagulation are not effective. (2)
• Surgery for leg pain and herniated disc gives short-term benefits that decline long-term compared with non-surgical therapy. (3)
• Guidelines sponsored by the American Pain Society and the American College of Physicians recommends spinal manipulation as an effective treatment option for low back pain. (4)
• Surgical outcomes for disc herniations' leg pain (sciatica) are nearly equal those of conservative care (69% vs 61% respectively)(6), yet no surgical intervention opened the spine.
• Four to 6 weeks of non-operative, conservative treatment is recommended prior to imaging studies and surgery. (7, 8, 9, 10) The American Academy of Orthopaedic Surgeons states that "acupuncture or chiropractic manipulation can also be attempted" prior to surgery for stenosis. (11)

References

1. Dance A: For back pain sufferers, surgery isn't always the answer. LA Times January 12, 2009, http://articles.latimes.com/2009/jan/12/health/he-backpain12 accessed on 6/8/09

2. Chou, R; Atlas, SJ; Stanos, SP; Rosenquist, RW. Nonsurgical Interventional Therapies for Low Back Pain A Review of the Evidence for an American Pain Society Clinical Practice Guideline. SPINE 2009; 34 (10):1078-1093

3. Chou, R; Baisden, J; Carragee, EJ; Resnick, DK; Shaffer, WO; Loeser, JD Surgery for Low Back Pain A Review of the Evidence for an American Pain Society Clinical Practice Guideline. SPINE 34 (10). MAY 1 2009. p.1094-1109

4. Chou, R; Loeser, JD; Owens, DK; Rosenquist, RW; Atlas, SJ; Baisden, J; Carragee, EJ; Grabois, M; Murphy, DR; Resnick, DK; Stanos, SP; Shaffer, WO; Wall, EM: Interventional Therapies, Surgery, and Interdisciplinary Rehabilitation for Low Back Pain An Evidence-Based Clinical Practice Guideline From the American Pain Society. SPINE 2009; 34 (10):1066-1077

5. Atlas SJ, Keller RB, Su YA et al: Long term outcomes of surgical and nonsurgical management of lumbar spine stenosis: 8 to 10 year results from the Maine Lumbar Spine Study. Spine 2005;30(8):936-43

6. Atlas S, Keller RB, Wu YA, Deyo RA, Singer DE: Long term outcomes of surgical and non-surgical management of sciatica secondary to lumbar disc herniation: 10 year results from the Maine Lumbar Spine Study. Spine 2005; 30(8):927-35

7. Deyo R: Annals of Internal Medicine 112(8) 8. Frymoyer: Backletter 10(7)

9. RAND Study: Journal of Chiropractic 29(11)

10. ACHPR (Agency for Health Care Policy and Research) - a federal government research organization - Clinical Practice Guideline No.14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, December, 1994.

11. http://orthoinfo.aaos.org/topic.cfm?topic=A00329 accessed on 6/8/09, American Academy of Orthopaedic Surgeons website, "Lumbar Spinal Stensosis"