Our patient education dynamic spine models helps a low back pain sufferer a better understanding of their sources of pain. Very often, an  accurate diagnosis can be found and the mechanics around the pain triggers can be learned and avoided for a period of time to wind down pain generators.

A dynamic spine model can empower a patient to help him or her get to know the motions postures and loads related to pain. Once the specific movements are identified, a patient can learn what exercises and movement strategies that will reduce their symptoms. A disc bulge is often an MRI finding but it also tells a story about hypermobility very often. For lumbar spinal stenosis, it is also very common for a person to have symptoms while their spine is in relative extension. The Lumbar Spinal Stenosis Model helps a practitioner deliver this important message to engage with accurate patient education.

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Bending or twisting – Which predisposes low back pain?

bending or twisting

Bending or twisting?

In a recent bending study in Clinical Biomechanics, researchers looked at how the nucleus pulposus deformed as the vertebrae rotated at two lumbar levels: L1-2 and L4-5. They were curious about how the nucleus pulposus behaved as this hydraulic tissue has an important role in resisting compression with bending and twisting of the spine.

Rotation is often described as a body position to predispose low back injury but there is not much research on the topic to demonstrate this is actually the case.

There has also been mounting evidence that flexion bending is thought to be a mechanism for disc injury and this Flexion load is thought to be more important.

Coupling movements of both flexion AND rotation has historically been thought to be the worst.

These researchers led by Fazey, P. used MRI to look at 10 asymptomatic subjects of an average age of 29 yrs.

What these researchers determined was that side-ways bending demonstrated greater nuclear deformation compared to rotation. They also showed that the nucleus moves backwards when one bends forwards and moves forwards when one bends backwards. Opposite.

One of the take home messages from this study is that lateral flexion (or side-ways movement) of the spine causes the nucleus structure to deform more than twisting. Therefore, patients should be instructed to minimize sideways bending to help reduce the deformation of the nucleus pulposus.

This study is one example of why Dynamic Disc Designs has worked to showcase the anatomy and inner workings of human discs. Our latest is the Centralizer. Degeneration is as a result of annular fissures and understanding how to minimize annular stress will likely lead to better outcomes for pain practitioners.

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Lumbar Disc Height – A Logical Approach

Disc Height - Patient Education

Disc degeneration is thought by many to be at the root of back and neck pain.

However, measuring degeneration has always been a challenge because of its elusive nature. One characteristic of degeneration that all agree on is disc height, or in other words, the spacing between vertebra. It is one of the most looked for finding on MRI, x-ray and CT when evaluating for a patient’s pain.

In a recent research paper by Andrew J. Teichtahl et al. in Arthritis Research & Therapy (2015) 17:297 DOI 10.1186/s13075-015-0820-1, these researchers found a dose-response relationship between the severity of disc degeneration and lumbar disc height.

The authors believe that their study provides the first evidence that lumbar disc height is a reliable and easily accessible measure in the determinant of lumbar disc degeneration.

Lumbosacral disc degeneration is very common with as many as one third of individuals showing disc degeneration in this region when investigated with MRI. Furthermore, with degeneration, it increases the risk by two-fold in the development of chronic low back pain. With these facts at hand, it is imperative to measure disc degeneration but this is not as easy as thought because of the varying definitions. Disc degeneration can be a complex condition with characteristics of cell proliferation, nucleus pulposus dehydration, annular fissures and clefts, endplate disruption and granulation changes.

Radiographic evidence of disc degeneration can also demonstrate endplate sclerosis, osteophytosis and joint space narrowing (aka, disc height). The most recognized technique to evaluate the degree of disc degeneration is the Pfirrmann’s method which is endorsed as a valid and reliable method of assessing intervertebral disc degeneration using MRI.

These researchers looked at MRIs from 72 community based individuals and found that disc height was the best quantitative measure as an outcome measure in epidemiological studies.

Dynamic Disc Models enables spine doctors to share important clinical findings ,like disc height, to patients in a dynamic and interactive way, demonstrating facet shingling, intradiscal findings and disc herniation on a dynamic platform to improve education of pain generators. An educated patient often is more compliant as they understand more clearly the movements and activities that can exacerbate their symptoms like excessive spinal flexion and incorrect lifting.

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Spondylolisthesis Models

Spondylolysis Spondylolisthesis - Dynamic Disc Designs

Spondylolisthesis is simply the slippage of one vertebra on another.

The medical Latin root comes from the Greek root spondylos” and “listhesis” which means vertebra slippage. They are defined by either a slippage forward, backward or sideways. These are labeled as an anterior, posterior or lateral listhesis, respectively. There are several degrees of slippage defined by grades (1-5).

There are several reasons as to why vertebrae slip out of alignment with the leading reason being arthritis and disc height loss in adults. Recently, in the Journal Medicine, researchers looked at the importance of dynamic loading in detecting degenerative spondylolisthesis. In children, it is the lowest of the lumbar vertebrae most commonly affected. Sudden bending backward activities can cause significant stress on the spinal structures related to spondylolisthesis.

To read more about spondylolisthesis, you can click here.


Products and Patient Education

Spondylolysis Spondylolisthesis

Below is a video to show the second most common spondylolisthesis, called a lytic listhesis. Lytic comes from the word, loosening. You can see the bone has actually fractured. This is sometimes found in active children.


Degenerative Spondylolisthesis

In order to see the most common spondylolisthesis models, you can see the video below of a degenerative spondylolisthesis model.


Multilevel L5 Spondylolysis Spondylolisthesis

In order to see a spondylolytic multilevel spondylolisthesis model you can watch the video below


Double Spondy Model

Our most recent and multilevel spondylolisthesis is shows both a lytic and non-lytic pars in the Double Spondy Model.


Professional LxH Disc Model

Another popular model is The Professional LxH  Model with the optional feature of a spondylolisthesis.

Spondy Option

Interestingly, spondylolisthesis sometimes doesn’t show up with regular recumbent x-ray, CT or MRI. There is growing knowledge that some spines are required to be loaded in order to see the slippage effectively. Often symptoms come with load. Dynamic Disc Models can help relay that message to patients. If a spondylolisthesis option is ordered with the Professional LxH Lumbar Model, ‘unroofing‘ will be able to be demonstrated.

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Patient Education for Spine

Patient Education Spine Model

Patient education for spine can come in many forms. Whether a doctor, physiotherapist, osteopath or a chiropractor does the talking and interacting with the patient, models or props are often the best strategy to relay information about their problem.

Other resources include youtube videos, posters, and charts. Other patient education materials can come by way of pamphlets and education seminars.

discogenic pain

Seasoned practitioners understand that each patient can be a little different and often is judged on a case-by-case basis. They use their experience to detect which patients and when to engage in patients education. Often, the doctor will encounter situations when time is of the essence in clinic that requires a certain pace to keep on schedule. Some doctors are good at being on time and others not so much. It is the goal for all spine practitioners to remain on time but this is difficult when the time for patient education is required.

At Dynamic Disc Designs we understand that both a patient’s time and a doctor’s time is valuable. We also understand that at the crux of this doctor-patient relationship is communication. Because patients often have more questions than time with their doctors, and because most of these questions are centered around pain generators and therapy, we believe having the most accurate spine model available for the doctor can help both parties.

A dynamic spine model to show :

  • Dynamic disc bulge
  • Disc herniation
  • Facet inflammation
  • Disc height loss
  • Degenerative disc disease
  • Nerve pinching
  • Stenosis
  • Medial branch innervation
  • Discogenic problems
  • Annular fissures

All with a dynamic disc helps the patient understand which postures that are aggravating and also which postures that can help.

Using this kind of a model can quickly assist in doctor-patient communication–an essential part of any spine practice.

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Patient Goals vs. Doctor Goals in Managing Low Back Pain

low back pain - patient education

In a recent paper published in Patient Education and Counseling, these authors looked at how a doctor’s goal lined up with the patient’s goal in the management of low back pain.

Low back pain is the leading cause for disability worldwide, with a lifetime incidence of 80%.

What the authors of the research titled: “Patient led goal setting in chronic low back pain—What goals are important to the patient and are they aligned to what we measure? ” looked at was how the goals of a doctor was different to a patient’s goals.

The use of standardized outcomes for back pain often utilizes pain scales, range of motion, especially the act of bending forward without pain. Pain scales are perhaps important to the doctor but the goals of the patient includes a return to normal activity prior to injury.

Using bending forward as an outcome for function is well off the mark for outcomes as flexion stress in the disc often promotes inflammation and granulation tissue within the disc itself. Encouraging patients to ‘touch their toes’ as an outcome misinforms the discogenic pain patient (which is large percentage of back pain patients) of the movements that indicate outcomes.

Flexion stress on the spine compresses intervertebral discs that often leads to ongoing back pain in the long run. It may provide temporary relief from facet related pain, but disc height loss is inevitable if the spine is continuously flexed in this direction.

In Patient Education and Counseling, the authors looked at what was important to patients in goal setting of chronic low back pain. What they found was a patients’ goals were idiosyncratic and were not in line with therapists goals that usually include commonly used clinical measures.

Interpretation of the research:

The quirkiness of a patient’s goal often is governed by the education a patient receives about ‘why they hurt’. Chronic pain patients often struggle with understanding their own pain generators because of the plethora of mis-information about their diagnosis and solutions related to their problems. Giving a patient the understanding of their own dynamic spinal anatomy is one of the most powerful tools a therapist, doctor, spine surgeon, or chiropractor can do to help in the management of their symptoms. Teaching them something as simple as flexion and extension and how it relates to load is at the foundation of spine education.

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Anatomical Spine Models – Attention to detail

Anatomical Spine Modes - Dynamic Disc Designs

Dynamic Disc Designs looks to provide the provider the best anatomical spine models.

Some of the attention to detail includes a dynamic disc to allow complete visualization of the intervertebral disc.

The foundation in the development of any of the lumbar or cervical models begins with Dr. Jerome Fryer carefully understanding the anatomy involved in pain generation. The selection of the appropriate materials and key anatomical features is at a focus with the busy doctor in mind. Saving precious clinical time is critical in patient care. To have access to effective spine education in arms reach helps the spine professional relay important patient education details.

Anatomical Spine Models - Attention to Detail

Using elastomeric materials to show a dynamic look into the tissues, careful hand-painting of delicate nerves are showcased in the outer annulus of the Professional LxH Model, for example. Other details include scattered particles within the nucleus pulposus to allow visualization of the migration patterns through vertebral lens. Disc herniation is visualized by hands-on compression through an annular fissure and abuts the descending nerve root dynamically.

Flexion movement causes posterior annular stress. This is an important concept to convey when patients have pain with bending forward activities. Driving the point across to motivate the patient to avoid flexion loads is important in improving outcomes for back pain. Dynamic disc models can quickly teach patients neutral and flexion load. When patients see, they believe, and when they believe, they comply.

Often compliance to treatment plans governs outcomes for spine professionals. When a patient truly understands the pain source in back pain, they will work to avoid activities that generate further inflammation. Having accurate spine models, that are dynamic in nature, allows patients a clear look into why they got injured to begin with while the doctor crafts a treatment plan.

 

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Dynamic Disc Model – Educate to Motivate

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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