Chronic Pain Patients

How about a little history on the conception of the company : ddd ?

First off, ddd’s name was chosen because of three main reasons:

1. Degenerative Disc Disease (DDD) is a common spinal finding and the models are hoped to inspire mechanical based regenerative medicine.

2. ddd represents 3d — inspired by Frank Netter and his drawings.

3. Dynamic Disc Designs speaks accurately about the company’s focus. Designs around a dynamic disc is at the core of this company.

Jerome Fryer, chiropractor, founder and chief innovations officer of Dynamic Disc Designs Corp. (ddd) knew there was something missing in the marketplace. In 2006 he decided to purchase the best lumbar spine model on the market. At the same time, he was doing research using upright MRI that lead to “Magnetic resonance imaging and stadiometric assessment of the lumbar discs after sitting and chair-care decompression exercise: a pilot study“.

Immediately Jerome knew there was something not quite right with the model he ordered. It was static and did not move. Even though it was the best on the market at the time, it was a static model. Pain (and structures related to pain) are often load sensitive. We all know this.

And so, Dr. Fryer embarked on designing something different to help him explain what he knew about spine to his own patients — a dynamic disc model that would match up to what the literature currently knows about back pain. He had recently moved to Nanaimo, BC, Canada for better opportunities and was in the process of building a new practice from the bottom up. With his time, he dedicated himself to building a model that would be durable and representative of the real tissue. The models he had used in the past would consistently break and would need repair frequently because he would bend them so frequently–he was fed up with this. He also knew the intervertebral disc was often the culprit in back pain. It, itself, is often the pain generator (and related to pain generators like the facet). He also wanted to show the innervation of the disc to inform patients of their pain and how to avoid certain postures to help improve outcomes.

Empowering patients with hands-on dynamic spine models ensures they understand.
-Jerome Fryer

After several years of development, the Professional LxH Model was launched. The model’s features are numerous. Dr. Jerome packed as much anatomical detail into a reasonably priced product always keeping perspective of what spine doctors need to be equipped with when patients need to know their pain generators. The Professional LxH Model continues to remain the best seller and will likely remain for decades to come. This dynamic disc model is the first of its kind and Dynamic Disc Designs is proud to be the leader in spine modeling.

Connecting with patients quickly and effectively is at the hallmark of any good physician. Common conditions of the spine include disc herniation, intradiscal disc herniation with annular fissures, facet pain and stenosis. If doctors can effectively show these conditions in a convincing (and timely) way to the patient, they can move on to therapeutic solutions. Saving precious clinical time is key for all doctors.

Educate to motivate patients. Anything to facilitate the #patientdoctorteam to improve outcomes.

Published by: Dynamic Disc Designs

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Bulging-Disc-Model - Dynamic Disc Designs

Using a bulging disc model that can show these lesions can be very helpful in getting patients to understand the differences with the different types of disc problems.

Interverterbal discs can bulge and can cause pain. Many people think a bulge and a herniation is the same but that is not true.

According to a recent paper published in The Spine Journal, a disc bulge is defined by the presence of disc tissue extending beyond the edges of the endplates of the vertebrae throughout the full circumference. See Figure 3

On the other hand, a disc herniation is a general term to explain both a focal or localized displacement of disc material which can include the nucleus pulposus, annulus fibrosus and/or the endplate. See Figure 4

Herniation can be further classified into:

  • protrusion
  • extrusion
  • sequestration

This is the amount the material is sticking out. Migration is a term to explain the traveling of extruded material.

Intravertebral disc herniations, or Schmorl nodes, are perforations of the endplate into the vertebral body. This can be a superior or inferior lesion. See Figure 7

Educating patients about the differences is important. Using a bulging disc model that can show these lesions can be very helpful in getting patients to understand the differences with the different types of disc problems.

bulging disc model - Dynamic Disc Designs

Accurate modeling engagement reassures the patient about the painful anatomy and helps in the plan of management moving forward.

We invite you to explore our roster of anatomical spine models to help speed up and facilitate doctor-patient communication of spine pathologies.

One of the biggest challenges I have had with my patients is helping them understand what is happening to their spine…..I recommend these models to all the docs I know!  Keep up the good work!
-Dr. Raymond Uhlmansiek, D.C.

Discogenic pain is controversial–or is it?

Low back pain is common, really common, and responsible for the second most common reason why people visit their doctors. And yet, it still continues to elude scientists of its specific origin.

One convincing theme in low back pain are findings associated with the intervertebral discs. Often it is first recognized with reduced disc height on x-ray and then if persistent, followed up with MRI demonstrating the same but with evidence of hypointesity in a T2 weighted MRI. Most researchers agree that this finding indicates a reduction in water and proteoglycan content.

Discogenic Pain Model - Dynamic Disc Designs

Professional LxH Model demonstrating discogenic pain

Since the development of upright MRI, we are now able to see the spine under load and motion. This has provided us a window into the dynamic movement of the vertebrae and the discs in between them–showing spondylolisthesis in flexion and retrolisthesis in extension.

Some believe the only way to discern whether the disc itself is the painful anatomical structure, is to do a discogram. This is a procedure that punctures the disc with a needle and over pressurizes it to see if it is painful to the patient. This is kind of like over inflating a bicycle tire. The problem with this procedure is we know when a disc is punctured, it facilitates the degeneration process.

Discogenic pain is often a deep kind of pain because it is an anterior structure and heavily innervated. It is often relieved by lying down and worse with sitting.  It is also known to get sore after a long period of recumbency–like after a nights rest.

Engaging and educating patients about these symptoms can curtail their worries and helps when 3d models are used to explain the avoidance of activities that increase intradiscal pressures.

Dynamic Disc Designs enables the practiotioner to explain the inner workings of the disc. When patients understand flexion load stresses the posterior annulus, they quickly get motivated to maintain their lordosis with bending and lifting. This modification behaviour improves outcomes with spine.

Discogenic pain is for real. We are learning more and more about how the discs are at the core of low back pain.

Spinal Nerves - Sensory and Motor Divisions

Spinal nerves exit (and enter) through the intervertebral foramen. The spinal nerve consist of two main divisions (anterior/motor and posterior/sensory).

A patient’s symptoms are often related to whether the anterior division or posterior division is compromised.  This can occur as a soft compromise (like a disc bulge, or herniation) or by an inflammatory process (like chemical radiculitis) or by a hard compromise like bony stenosis due to osteophytic compression.

Tingling or numbness is a symptom when the sensory division (or posterior division of the spinal nerve) is affected.

Spinal Nerve - Dynamic Disc Designs

Clinically, if the spinal nerve is compressed from a posterior lesion, and the nerve is compromised, the patient will present with a sensory type symptom like tingling or numbness.

On the other hand, if the anterior division is compressed from an anterior lesion, the patient can present with motor symptoms like weakness.

Dynamic Disc Designs has developed spinal nerves to include both divisions to enable the doctor to explain and correlate the patient’s symptoms associated with spinal nerve compromise. All other spine models on the market do not represent the spinal nerves accurately.

In behind the scenes at Dynamic Disc Designs Corp. the research and development in the accurate representation of the spinal nerve anatomy came, in part, directly from one of Dr. Fryer (Chief Innovation Officer) mentors.  Prior to the final product manufacturing, Dr. David Panzer provided guidance in the proper placement the spinal nerves in both the Professional LxH Model and the Academic LxH Model . On the right aspect of the cauda equina in these lumbar models, the dural sheath has been removed to show the two separate divisions of the exiting (and entering) spinal nerves.

Spinal Nerves - Lumbar Disc Herniation

The most common L5 spinal nerve root compression is a result of a posterior-lateral herniation at the L4-5 level. The developed cauda equina extends superiorly to demonstrate the descending nature of the spinal nerves and to show which nerve would be affected both at the L4-5 and L3-4 levels.

 

Patient Education - Cervical Models

Dynamic cervical spine models have been static in the past.

Research demonstrates MRI can show problems like disc bulge and disc herniation even though patients do not have symptoms. Interestingly, there has been a shift in clinical thinking that many MRIs are ordered unnecessarily and can lead to unnecessary surgery.

What we are beginning to learn is that specific MRI imaging may be better at looking at pain generators in the cervical spine. In a recent publication in the Journal of Orthopedic Science, these researchers looked at T2 mapping as a way to indicate whether the discs are symptomatic or not.

This has always been the problem with MRI imaging. Most pain generators are dynamic in nature. That is, most of a patient’s pain comes with moving in certain direction or moving in a certain direction for an extended period of time. To date, the only way we were to determine whether the interevertebral disc is painful, is use of the gold standard discogram.

This is an invasive procedure that pokes the disc, with a needle, and over inflates it, like a tire, to see how much pain can be generated in the patient. The problem with this procedure is that if you poke a disc it begins to degenerate. Researchers use this model to study degeneration.

T2 mapping MRI is non-invasive–at least we have no evidence, yet, to suggest it is. And T2 mapping is also suggestive that it is looking at the water content of the intervertebral discs.

The future of understanding pain generators of the spine will be a the careful analysis of disc height loss, water content of the nucleus pulposus, and dynamic MRI imaging.

An accurate and dynamic cervical spine model can help explain load related pain generators like disc bulging and disc herniation. Treatments targeting the restoration of disc heights and the lordotic curve will lead the way in decades to come. Dynamic Disc Designs produces models to encourage research and education.

Spinal Cord - Cauda Equina Dynamic Disc

Spinal Cord and Endings

The spinal cord is a delicate structure. It is protected by the neural arch of the vertebrae and also by the intervertebral discs anteriorly and the ligamentum flava posteriorly.

Below the thoracic region, the spinal cord comes to an end, namely called the conus medullaris, and continues as a cauda equina coming from the name of a horse’s tail.

Dynamic Disc Designs create models that demonstrate this anatomy including the exiting lumbar nerve roots which include the re-current menningeal nerve, the gray rami communicantes as well as the posterior primary division that exhibit the medial branches from the facet joints. Each exiting nerve root contains both an anterior motor division and a posterior sensory division that includes the dorsal root ganglion. Encroachment syndromes can present patients with tingling downstream which likely indicates sensory compression while weakness usually indicates a motor compression. Having a model with more anatomical detail helps in the determination of the spinal anatomy in question–targeting treatment.

Spinal Cord - Intervertebal foramen

The lumbar vertebra model includes the cauda equina which includes the dura mater, arachnoid, and pia layers. These are the important coverings of the spinal cord because just inside these coverings is the cerebral spinal fluid.

Spinal Cord - Dura Mater

Dura Mater

Dynamic Disc Designs offers models to help in the management of spinal cord encroachment syndromes. Disc herniation can compress the cord in the cervical and thoracic spine region while it can compress elements of the cauda equina in the lumbar region. Other space occupying lesions can affect the cord and create a variety of sensory or motor disturbances.

Doctors of chiropractic and other spine specialties like minimally invasive surgeons /spine surgeons use patient education as part of the work-up towards initiating treatment. An accurate spinal model can aid the risk management of outcomes that may include spinal canal compression. Having patients better informed can lead to better outcomes.

Disc Herniation Model - Dynamic Disc Model

Disc herniation is a common term used to describe the disruption of the intervertebral disc.

A disc herniation model is helpful is the explanation of how the nucleus pushes out radially through the outer walls of the disc.

Recently, lumbar disc terminology has been updated as there has been some confusion in the nomenclature in discussing this common condition. To read the latest in terminology, visit here as the publication is open access and in full text.

Herniation is a general term and not specific enough when describing the type of herniation. It is currently described as a local or focal displacement of disc material beyond the limits of the intervertebral disc space.

The material can be any material of the disc including:
  • nucleus
  • cartilage
  • fragmented apophyseal bone
  • annular material
  • any combination

If a disc’s material extends beyond the boundaries of the apophyseal ring endplates in a circumferential fashion, then the term used to describe this is a ‘bulging’ disc and not a herniation.

Disc herniation can be classified into the shape of displacement of material and they are classified into:
  • protrusion (if the base of the material is larger than the material protruding)
  • extrusion ( when the material is smaller at the base)
  • sequestrated (material has moved independently away from the disc)
  • intravertebral herniation (where the material has moved into the endplate)

There is also another category indicating whether the disc is contained or non-contained. Contained indicates the the material has not ‘broken through’ the posterior logitudinal ligament, whereas, a non-contained has.

Disc Herniation Model-Dynamic Disc Designs

Disc Herniation Model by Dynamic Disc Designs Corp.

Annular tears, which was a term used to describe the damaged annular wall, is now described as a annular fissure. Fissures are a better descriptor because tears indicates a traumatic event which in most cases it is difficult to tell if the damage is traumatic or as a result of ongoing poor posture, for example.

Dynamic Disc Models strive to remain current with terminology so patients can understand the mechanisms of their back pain and manage accordingly. An accurate disc herniation model can assist in the patient-doctor team to improve outcomes.