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Nuclear tracking spine model – helping explain research findings.

3D discogenic pain model

Nuclear tracking as a result of vibration for spine has been revealed in an ISSLS price winning study in Spine. In a microanatomical investigation titled : ” Vibration Really Does Disrupt the Disc ” 1 researchers looked at motion segments and the influence of vibration as it relates to intervertebral disc damage.

There has been background knowledge stating that whole body vibration can lead to back pain but no-one had studied the micro structure of the disc. Looking carefully how nuclear tracking disrupts the annulus and endplate, this study looked at sheep discs, with controls, and vibrated motion segments under 7 degrees of flexion. The forces used were 1300 plus or minus 500N and the frequency applied was 5hz. This equates to 5 vibration movements per second. They conducted the movement for 20,00 to 120,000 cycles to mimic lose does and high dose variation.

Nuclear Tracking in a Spine Model

nuclear tracking, flexion, motion segment, model, modeling

Flexion load causes posterior nuclear tracking.

They found there was no sharp significant drop in displacement revealing there was not one moment of catastophic failure. What they found was nuclear tracking and internal disruption of the inner and mid layers of the annulus fibrosus. They also saw delamination of the annular fibres where they attach to the endplate (aka, Sharpey’s Fibres)

In conclusion, these researchers revealed that vibration in a flexed spinal motion segment leads to inner and mid layer annular disruption rather than outer annular disruption that is seen with disc herniation. They believe this mechanism could lead to a better understanding of the initiation of the degenerative cascade of spine.

Dynamic Disc Designs tries to highlight important research and model the respective findings for spine professionals working with patients of back problems. Educating patients about the mechanisms  of back pain can be an empowering tool for both doctors and patients.

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Spine Patient Education to Improve Compliance

spine patient education, patient education, spine, models, lumbar, cervical

Improving compliance through spine patient education.

Communication is very important. We all know that. In any relationship, communication seems to be the key element in making sure a common goal is delivered. This is especially important when doctors connect with patients about spinal problems. Spine patient education is imperative in a patient centered model. It also seems helpful in reducing fear avoidance behaviours. 1

Spine Patient Education, Patient Centered, Education

Patient Centered

Doctor-patient communication is critical when relaying information about what the spinal diagnosis is.  Effective communication is also important when relaying the best options for treatment. Doctors and therapists will use their skills to connect with patients. Making reference to the experience they have had with the condition with some offering of favourable outcomes.

What is important is that the patient feels ‘listened to’ and that the doctor can relate their symptoms with the spinal movements that seem to aggravate or miminize the problem.

For example, if a patient exhibits pain bending forward, it can be very helpful to have a dynamic spine model that bulges under flexion load. If a patient can physically see and understand that bending forward can compress the discs (or squeeze on the nerves), this can be very effective in communicating the disc is the likely culprit in the case of sciatica.

spine, education, patient, doctor

Bending forward can cause pain.

Conversely, if a patient demonstrates pain while bending backwards, a dynamic model can show how the facets rub together into extension.

A doctor unequipped for spine patient education is like a mechanic without its tools. Patients are usually very curious about the internal workings of their own bodies. When a doctor or therapist can clearly demonstrate where and why it hurts, often they will be a patient for life.

Spinal pain frequently relates to the spacing of the vertebrae, or lack thereof. Dynamic disc height loss, for example, can now be shown with a model both a doctor and patient can hold and manipulate.

 

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sciatica – coughing, sneezing and straining

Sciatica, disc, model

Sciatica is often worsened by coughing, sneezing and straining. It is a sign that patients complain about in the case of back pain. In some, the act of coughing or sneezing can actually cause a disc herniation.

In a recent study in The European Spine Journal, researchers wanted to find out if the act of coughing, sneezing or straining is important in the assessment of nerve root compression or disc herniation on MRI.

In “A diagnostic study in patients with sciatica establishing the importance of localization of worsening of pain during coughing, sneezing and straining to assess nerve root compression on MRI” 1 they found that the worsening of leg pain with these actions which includes increasing intradiscal pressure 2 has good diagnostic value for nerve root compression and disc herniation with MRI.

The research revealed the importance of asking whether the patient has these symptoms in the history taking.

At Dynamic Disc Designs, our models showcase how compression will extrude the nucleus….helping patient’s understand their pain.

Quote by the famous Karel Lewit:

“The first task for the physician is to show the patient the cause of their pain”.

  1.  Eur Spine J. 2016 May;25(5):1389-92. doi: 10.1007/s00586-016-4393-8. Epub 2016 Feb 2.
  2.  Spine (Phila Pa 1976). 1999 Apr 15;24(8):755-62. New in vivo measurements of pressures in the intervertebral disc in daily life. Wilke HJ1, Neef P, Caimi M, Hoogland T, Claes LE.
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Back pain and radiculopathy – upright mri research

Radiculopathy, upright mri

Back pain and radiculopathy is common….very common. Furthermore, it is very common for patients to explain that it ‘hurts’ more when they are vertical. Then why are we mainly looking at supine MRI for findings? Supine MRI is helpful in ruling out pathology and does offer higher resolution with the 1.5 and 3.0 Tesla…but this magnet power is not necessary to investigate biomechanical problems.

In a recent research paper published in The Journal of Craniovertebral Junction and Spine [full text], these group of researchers looked at seventeen adults (10 asymptomatic and 7 symptomatic) and used the .6 Tesla MRI to evaluate the lumbar spine and pelvis in the seated position.

They looked at the “foramen area, height, mid-disc width, width, thickness of ligamentum flavum, disc (bulge, height, width), vertebral body (height and width), and alignment (lordosis angle, wedge angle, lumbosacral angle).” 1

Some of the important results showed significant foramen narrowing and disc bulge was 48% greater in symptomatic volunteers compared to asymptomatic volunteers. Thickness of ligamentum flavum increased as well.

Overall, the researchers were cautious in their conclusive remarks…like all great researchers. But the bottom line is that we all know that symptoms related to spine are often worse being vertical. It is a bit of a no-brainer to continue to investigate the tissue in its load bearing state.

Yet another reason why Dynamic Disc Designs knew it was inevitable that a dynamic model would be to market. They were the first to pioneer this patient education movement. Be sure you are equipped.

flexible spine model nerves

 

  1.  Nguyen HS, Doan N, Shabani S, Baisden J, Wolfl a C, Paskoff G, et al. Upright magnetic resonance imaging of the lumbar spine: Back pain and radiculopathy. J Craniovert Jun Spine 2016;7:31-7.
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Dynamic Degenerative Disc Model

Degenerated Disc Model - Dynamic Disc Designs

Coming this fall, a Dynamic Degenerative Disc Model with the ability to show innervation of the nucleus pulposus dynamically.

Dynamic Disc Designs strives to showcase important research in a dynamic platform so spine doctors can effectively educate their patients. This new design includes many new features including:

  1. dynamic two-part disc that is easier to squeeze
  2. neoinnervation into the dynamically mobile and fully visible nucleus pulposus
  3. facetogenic arthropathy narrowing the lateral recess
  4. dynamic disc bulge vs. herniation
  5. degenerative specimen chosen to copy
  6. much much more…

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With these features, spine professionals can quickly demonstrate pain generators and the solutions related to mechanical back pain. Help patients understand how to centralize the nucleus during movements in the teaching of lumbar lordosis with load, for example.

Centralization of pain is an important goal in the treatment/management of back and leg pain as well as neck and arm pain. Patients often think in terms of muscles but the core of the issue is often more central. With this new model, a greater understanding of how the nucleus moves can be a huge benefit as patients can work to minimize annular stress and disruption. If patients understand the mechanical forces responsible for their pain, they are better equipped to work as a team player in the management of back pain. Teaching containment of the nucleus will now be an asset with this new model design.

Degenerated Centralizer

This new Degenerative Centralizer Lumbar Model will change the way doctors and physiotherapists talk to their patients. We expect those that use this model for education will have better outcomes. Pre-orders being accepted now with discount offered to those early on the list.

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Facet Tropism

Facet Tropism - Disc Bulge

Facet Tropism is an asymmetry of the zygapophyseal joints and has been long thought to be related to intervertebral disc degeneration and back pain.

In a research article in The European Spine Journal, Wang et al. looked at how the degree of angle difference between the facets relates to disc bulge and back pain.

(Tropism comes from the Greek root (trope) which means to turn. In the embryological development of the vertebrae, some facets turn more than others and then in turn can have an affect on the overall biomechanics of the spine.)

In the research article (FULL TEXT) titled: “The relationship between degree of facet tropism and amount of dynamic disc bulge in lumbar spine of patients symptomatic for low back pain” , these researchers used Dynamic MRI to evaluate disc bulge and tropism by categorizing tropism into three distinct categories.

  1.  less than 6 degree difference = no tropism
  2.  6-11 degree difference = mild tropism
  3.  greater than 11 degree difference = severe tropism
What they found was that severe facet tropism was associated with disc bulge in only a subset of older patients.

Dynamic Disc Designs is a spine modeling company that highlights important research topics like facet tropism, and develops models that showcase natural anatomical details. Many of our models demonstrate facet tropism because they include real human variations.