Original Research by Dr. Rick Morris

Successful Treatment of Patients With Previously Failed Back Surgery: A Retrospective Case Series

Presented at The ACC/RAC International Research Conference 2012

Pfefer, M, Cooper,S and Morris,R

Patients that continue to experience chronic, disabling back pain one or more years following spinal surgery are said to have failed back surgery syndrome (FBSS). The incidence appears to be between 10 and 50% of all back surgeries.

Sufferers often experience intractable pain, work disability, impaired physical functioning, insomnia, and decreased quality of life (4-6).

Typical, current treatments offer limited benefit and inherent risk. Revision spinal surgery is a common remedial therapy, however with varying results (2,13,14). Other treatments include continuous intrathecal drug delivery (5,15), spinal cord stimulation (16-18), pulsed radiofrequency (19), epidural steroids (20, 21), and psychosocial therapies (22).

The Morris Spinal Stenosis and Disc Center developed a very comprehensive and precise program that included non-surgical spinal decompression, chiropractic, physical therapy, home, gym rehabilitation and occupational therapy.  

The Typical Patient Included in The Study:

• Number of Patients Studied With Failed Low Back Surgeries: 31

• Median Age: 60

• 58% were told they needed another surgery before treating here

• 58% failed prior chiropractic treatment

• 65% failed prior physical therapy treatment

• 68% failed epidural injections

• 26% failed acupuncture

• Mean number of years the patient had mild or moderate pain in that area:  15.6

• Mean number of months the patient had severe pain:  16

The Results of Treatment Were As Follows:

• The % decrease in daily pain medication:  69%

• The % decrease in daily narcotic use:  63%

• Mean low back pain improved: 66% (VAS 7.2 to 3.2 out of 10)

• Mean leg pain improved: 52% (VAS 8.2 to 3.9 out of 10)

• % of areas with decreased sensation that returned to normal following treatment:  38%

• % of areas with decreased muscle strength that returned to normal following treatment:  78%

• % of abnormal deep tendon reflexes that returned to normal   following treatment:  50%

• The ability to stand in minutes increased by: 100%.

• The ability to walk in miles increased by: 211%

Given the extreme morbidity and difficulty in treating these patients, the results were unusually good in all areas measured and without complications.  Future studies are warranted with larger numbers of patients and in other fascilities to see if these results can be replicated.

Conservative, Motimodal Treatment of Severe Spinal Stenosis and Disc Disease: A Case Series

Rick Morris DC, CCSP, QME

242 patients with severe spinal stenosis and/or disc disease were included in this study and treated at The Morris Spinal Stenosis and Disc Center from 2006-2011. Inclusion in this study included all patients who completed a 3-5 month treatment program for severe spinal stenosis and/or disc herniations/annular fisures, extrusions and sequestrations.

The Typical Patient Included In The Study:

• The median age of patient's with spinal stenosis was 64 years, while the median age of those with severe disc disease is 50.

• The median time the patient suffered mild or moderate symptoms: 8.5 years

• The median time the patient's symptoms were severe: 6 months

• 67% had evidence of nerve damage (altered deep tendon reflexes, myotomes or dermatomes)

• MRI findings demonstrated 28% with one or more Spondylolistheses, 49% with Central Spinal Stenosis, 34% with Lateral Stenosis, and 82% with disc pathology (i.e. herniation, protrusion, extrusion, sequestration or annular fissure)

The average patient failed 2.5 of the treatments listed below, before starting treatment in this program.

• 63% failed chiropractic treatment

• 57% failed physical therapy

• 52% failed epidural injections

• 24% failed acupuncture

• 15% failed prior lumbar surgeries (discectomies, laminectomies, laminotomies and fusions)

The treatment included a precise combination of these modalities for a 4-5 month period of time:

• Spinal Decompression

• Physical Therapy

• Electrical Feedback Training of Abdominal and Back Muscles

• Chiropractic Mobilization

• Exercise Rehabilitation

• Yoga Therapy

• Inversion (in some patients)

• Muscle Therapy (to lengthen shortened and aged tissue)

The results of the treatment were as follows:

The average back pain improved 65% from 7.8 (out of 10, which is the worse pain possible) to 2.7, and, their leg pain improved 68% from 7.5 to 2.4. These findings are especially significant since most patients were on pain medication at the time of their initial pain scale readings and without pain medication when recording their final pain numbers.

Daily prescription medication for pain dropped 78%

Daily narcotic use for pain dropped 77%

Evidence of nerve damage completely reversed themselves 54% of the time (132 v. 61 i.e. absent or lost deep tendon reflexes, dermatomes and myotomes).

The patients average standing and walking time increased by 300% and the number that could stand or walk without restriction increased 306%

The average disability score improved by 47% (45% to 24% disabiity/Oswestry Disability Index)

A Non-SurgicalApproach To The Treatment of Spinal Cord Compression Syndromes: A Case Series

Donald R. Murphy, DC, DACAN, Eric L. Hurwitz, DC, PhD, Rick H. Morris, DC, CCSP

The purpose of this study is to present an additional series of cases in which patients with the finding of spinal cord encroachment on MRI were treated with an approach that includes non-surgical specific joint mobilization with specific, supportive therapies.  This study will report the outcomes and complications, if any, of this treatment. This is the first of two studies performed at this office.  Due to a deadline for presentation at the 2013 ACC/RAC Research Conference, this one uses patients currently being treated for this condition and is therefore smaller.  The second will contain those that have been treated over the last five years and should be about three to four times larger. 

Patients with spinal cord compression often have severe neck, upper back, arm, shoulder and/or head pain, numbness and weakness; although, some may be without symptoms.  Other symptoms may include spasticity, discoordination, loss of balance, head and face symptoms, and may even effect hearing and vision.

Typical treatment often includes surgical fusion and carries with it the possibility of severe complications and almost certain accelerated degeneration of the cervical spine.  Therefore, a non-surgical approach that is safe and effective should be pursued.

The Study Design:

• 19 patients with MRI evidence of spinal cord compression seen between 6-9-11 and 8-12-12 (all patients meeting criteria were included).

• All patients had spinal cord compression as a result of disc herniation, osteophyte formation, hypertrophied ligamentum flavum or combination of these.

• Two treatment facilities were used (The Morris Spinal Stenosis and Disc Center and The Rhode Island Spine Center)

The Typical Patient Included In This Study:

• Mean age: 52 years

• Mean duration of symptoms:  3.4 years

• 2 patients showed myelomalacia (spinal cord damage/degeneration) on MRI

• 4 patients had examination findings of myelopathy (spinal cord damage)

The Results of Treatment:

• The mean % improvement in disability (BDQ):  40.5%

• The % of patients with clihnically meaningful improvement in disability (NDI):  88%

• The mean % change in VAS (visual pain scale): 50%

• 0 patients had adverse reactions or complications to treatment

• 1 patient had transient increase in pain and paresthesia that resolved in two weeks with continued treatment

Conclusions

Patients suffering from encroachment on the cervical spinal cord from degenerative changes of the cervical spine can be safely and effectively treated without surgery using a precise method of cervical mobilization/manipulation, physical therapies, rehabilitation and allied physical modalities designed specifically for this condition. This is especially meaningful since these patients had meaningful decrease in pain and disability while reducing or eliminating their pain medications.  This may give patients another treatment option without the risks of surgery.  This study coincides with others and warrants further larger studies to see if it can be reproduced by other facilities.

The Morris Spinal Stenosis and Disc Center has worked hard to become the leading office in the country specializing in the non-surgical treatments of Severe Spinal Stenosis, Disc Disease/Degeneration/Herniation and Spinal Cord Compression.

If you know of someone with these conditions and would not mind being part of our research studies, we encourage you to refer them to our office (call 310-451-5851). We are continuing the study for several years.