Mechanical deformation and glycosaminoglycan content changes in a rabbit annular puncture disc degeneration model.

Gregg F. Moses DC

moseschiropractic.com

Improvement of Chronic Back Pain or Failed Back Surgery with Vitamin D Repletion: A Case Series

Journal of the American Board of Family Medicine January–February 2009; Vol. 22; No. 1; pp. 69 –74

Gerry Schwalfenberg, MD; from the Department of Family Medicine, University of Alberta, Canada.

KEY POINTS FROM THIS CASE SERIES:

1) This article reviews 6 selected cases of improvement/resolution of chronic back pain or failed back surgery after vitamin D repletion in a Canadian family practice.

2) Chronic low back pain and failed back surgery may improve with repletion of vitamin D from a state of deficiency/insufficiency to sufficiency.

3) Vitamin D insufficiency is common; repletion of vitamin D to normal levels in patients who have chronic low back pain or have had failed back surgery may improve quality of life or, in some cases, result in complete resolution of symptoms.

4) “Back pain is the most common neurological complaint in North America, second only to headache.”

5) “Low back pain (LBP) and proximal myopathy are also common symptoms of vitamin D deficiency and osteomalacia.”

6) In this report, there were 4 patients who had chronic back pain for more than a year and 2 patients who suffered for more than 3 years from failed back surgery.

7) “Repletion of inadequate vitamin D levels (>80 nmol/L) demonstrated significant improvement or complete resolution of chronic LBP symptoms in these patients.”

“Vitamin D is required for the differentiation, proliferation, and maturation of cartilage cells and for the production of proteoglycan synthesis in articular chondrocytes.”

9) “Patients who have chronic, nonspecific LBP or have had failed back surgery may have an underlying vitamin D insufficiency/deficiency.”

10) Risk factors for persistence or recurrence of LBP after surgery include infection, smoking and low vitamin D levels.

111) “All patients had tried various pain treatments, including physiotherapy, visiting a chiropractor, acupuncture, or visit to a pain management clinic, all without much benefit.”

12) Physicians should have a high index of suspicion for low vitamin D levels in patients with LBP.

13) “The patients in this study who responded best used between 4000 and 5000 IU of vitamin D3/day.”

14) “This case series supports information that has recently become apparent in the literature about vitamin D deficiency and its influence on back pain, muscle pain, and failed back surgery. Doses in the range of 4000 to 5000 IU of vitamin D3/day may be needed for an adequate response.”

Cox Decompression Technique very effective for treatment of chronic lower back pain and failed back surgery cases.

Check out our redesigned website: moseschiropractic.com

Dr. Gregg F.Moses

1800 Forest Hill Blvd.

Suite A8-10

West Palm Beach, FL 33406

561-641-9211

Spinal pain related conditions that may benefit from Cox Technic Flexion Distraction and Decompression may include:

• spondylolisthesis
• persistent pain after back surgery
• disc herniation
• subluxation
• scoliosis
• stenosis
• whiplash
• synovial cyst
• Lumbar disc herniation
• Cervical disc herniation
• Neck and Arm Pain
• Low Back and Leg Pain
• Thoracic disc herniation
• Spondylolisthesis
• Stenosis
• Degenerative disc disease
• Facet syndrome
• Pelvic pain
• Headache
• Compression defects
• Loss of spine lordosis
• Loss of range of spinal motion
• Whiplash-type injuries
• Persistent pain after back surgery
• Scoliosis (not to cure, but to maintain mobility of the curve)
• Osteoporosis
• Transitional segment
• Pregnancy back pain
• Subluxation
• Postural faults
• Mechanical back pain
• Osteoarthritis of spine
• Patients unable to tolerate vigorous adjustment
• Synovial Cyst
• Coccydynia
• Mechanical back pain (such as that accompanying ankylosing spondylitis, collagen vascularizing diseases, pelvice pain, pregnancy)
• Fibromyalgia
• Neurological Diseases (such as multiple sclerosis, cerebral palsy, stroke)

Cervical radiculopathy treated with chiropractic flexion distraction manipulation: a retrospective study in a private practice setting

Jason S Schliesser, DC, MPHa, Ralph Kruse, DCb, L.Fleming Fallon, MD, DrPHc

Received 12 February 2002; received in revised form 25 June 2002

I am very proud to also practice this technique.

Gregg F.Moses, D.C.

moseschiropractic.com

Medical Hypotheses 2008, Vol. 70, No. 1, pp. 66-69

Trygve Holmøy From the Institute of Immunology, University of Oslo, Medical Center and Department of Neurology, Ulleval University Hospital, Norway

FROM ABSTRACT

Multiple Sclerosis (MS) risk is associated with low vitamin D status prior to disease, and Epstein Barr virus (EBV) infection seems to be a prerequisite for MS.

Vitamin D receptors are expressed on EBV infected B cells, antigen presenting cells and activated lymphocytes, and the bioactive vitamin D metabolite dihydroxyvitamin D3 suppresses antibody production and T cell proliferation and skews T cells towards a less detrimental Th2 phenotype.

EBV infected B cells constitute a constant challenge to the immune system, also during seasonal periods of relative low vitamin D status.

I propose that vitamin D modulates the immune response to EBV, and that detrimental activation of auto-reactive T cells leading to MS is more likely if the vitamin D status is suboptimal.

THIS AUTHOR ALSO NOTES:

Environmental factors are important in the etiology of MS. “Vitamin D and Epstein Barr virus (EBV) top the list of potential environmental factors associated with MS.”

Primary Epstein Barr virus infections are usually clinically silent. Epstein Barr virus can activate and expand auto-reactive T cells. Vitamin D3 has important immunoregulatory effects.

“Vitamin D protects against MS by modulating the immune response to Epstein Barr virus, and that low vitamin D status facilitates detrimental activation of auto-reactive T cells and skews the immune response to Epstein Barr virus in a pro- inflammatory direction.”

Vitamin D levels are lower during the winter.

1“The epidemiological evidence linking Epstein Barr virus and MS is strong. Virtually all adult and pediatric MS patients have been infected with EBV.”

Epidemiological evidence supports a role for vitamin D in MS: • Sunshine is essential for vitamin D synthesis in the skin, and MS risk is significantly higher as one moves away from the equator.

• MS is inversely correlated with past exposure to UV irradiation. • “Vitamin D supplementation protects against MS.”

Epstein Barr virus persists in memory B cells throughout life.

Both acute and persistent Epstein Barr virus infection is controlled by a strong T cell mediated immune response.

“Epstein Barr virus has a great growth-transforming potential, and EBV infected B cells must be constantly surveilled by the immune system throughout life. Even transient perturbation of the immune response to EBV at any time during or after primary infection may therefore be relevant for induction of autoimmunity.”

“Dihydroxyvitamin D3 is a potent regulator of immune responses.”

Most immune system cells have (express) vitamin D3 receptors, and vitamin D3 is an important factor in the regulation of the cells immune response.

“Several airway infections, most striking influenza type A, display a marked and recurrent seasonal variability with incidence peaks during the winter, which may be attributable to seasonal variation in vitamin D status.”

2

SUMMARY POINTS FROM DAN MURPHY

Epstein Barr virus (EBV) causes infectious mononucleosis.

Once infected, the Epstein Barr virus remains in the body throughout life.

The T cells constantly survey the body for the Epstein Bar virus, and when necessary increase production of anti-Epstein Barr virus IgG antibodies.

“Virtually all adult and pediatric MS patients have been infected with Epstein Barr virus.”

These anti-EBV IgG antibodies create an autoimmune response against myelin proteins, resulting in their degradation, and a diagnosis of multiple sclerosis.

Vitamin D3 reduces the production of anti-Epstein Barr virus antibodies that react against myelin proteins, thus protecting against multiple sclerosis.

Most initial Epstein Barr infections are clinically silent, but still increase the risk for multiple sclerosis.

At times of low vitamin D status (i.e. winter), the immunological response against the Epstein Barr virus may trigger multiple sclerosis.

Anyone who has ever had mononucleosis or been infected with the Epstein Barr virus, should consume high doses of vitamin D3, especially during winter months.

The lab we use to test blood vitamin D3 [25(OH)D3] uses a finger prick analysis: ZRT Laboratory 8605 SW Creekside Pl Beaverton, OR 97008

866-600-1636

www.zrtlab.com

Vitamin D Testing Finger prick

The vitamin D3 my family takes is Complete Hi D3, from Nutri-West (5,000 IU): 800-443-3333

The primary researcher on this product was Don Bellgrau, PhD. Dr. Bellgrau is a tenured Professor of Immunology and Medicine at the University of Colorado, Denver, where he is a Program Leader in Immunology and Immunotherapy at the Cancer Center on vitamin D3 supplementation. Dr. Bellgrau has conducted experiments with nutrients/vitamin D and immune cells. He has published in over 100 peer-reviewed articles, including the Journal of Neurooncology, Nature, Clinical Immunology, Cancer Research, Cancer Immunology and Immunotherapy, and Cell Transplantation.

Gregg F Moses, D.C.

moseschiropractic.com

Gregg F. Moses, D.C.

moseschiropractic.com

BERTOLOTTI’S SYNDROME: MANAGEMENT OF A TRANSITIONAL L5 SEGMENT WITH AN L4-L5 DISC EXTRUSION COMPRESSING THE L5 ROOT SLEEVE BUT CREATING CLASSIC S1 DERMATOME RADICULITIS

submitted by Roy Siegel DC New York, NY October 29, 2010 also presented at NYCC Post Grad Cox® Course on December 4, 2010

Case History: On June 25, 2010, a 43 year old male presented with complaints of pain in the right lower back, buttock, posterior thigh and leg. Paresthesia was present in the lateral portion of the sole of the right foot that had started one week prior. His VAS was 3 while in the supine position and 10 concentrated in the right buttock while sitting. Standing and walking produced moderate pain. He could lift heavy weights without extra pain. Pain reduced his ability to sleep by 50%. Pain reduced his ability to sit for more than 1/2 hour. One week earlier he had been given prednisone for inflammation relief. He mentioned that he had suffered with periodic back pain ever since he was 12 years old. Radiographs taken at that time revealed a scoliotic spine.

Health History: The patient mentioned that he has been diagnosed with psoriatic arthritis in the past. He was not taking any medications.

Physical Examination: The patient is 5′ 11″ tall and weighs 179 pounds. Observation revealed a significant left lumbar antalgia. An apparent right short leg was present in supine and prone position.

 SPINAL RANGES OF MOTION: Pain radiation into the right acetabular area resulted from cervical flexion (60 degrees). Lumbar flexion of 30 degrees created severe right buttock pain.

 ORTHOPEDIC EXAMINATION: Lasegues test created severe right buttock pain at 40 degrees. Achilles reflex was 1 on right, 2 on left. Braggards, Leg Drop Test and Fabre Patrick all were negative. Toe walking increased the right foot parasthesia. No motor deficit was present, including dorsiflexion and plantar flexion of the first toes.

Lumbar Spine Imaging: MR of the lumbar spine was performed on June 30, 2010 and revealed at L3-L4 a small central disc extrusion extending rostrally behind the L3 vertebral body. This was superimposed upon mild disc annulus bulging. In combination with facet and ligament hypertrophy there was a mild central canal stenosis. See Figure 1. At L4-L5 there was a large inferiorly extruded disc fragment on the right extending inferiorly into the lateral recess at the upper margin of the transitional L5 vertebral body. This was compressing the right L5 nerve root sleeve in the lateral recess. Hypertrophic degeneration facet arthropathy and ligamentum flavum hypertrophy contributed to mild to moderate central canal stenosis. There was bilateral foraminal stenosis as well. See Figures 2 and 3. At L5-S1, there was no disc herniation, neural impingement or spinal stenosis. A transitional L5 vertebra is present at the lumbosacral junction and is considered a partially “sacralized” L5. This may be why the dermatome radiation seems to be the typical S1 nerve root pattern.Cox® Technic Case Report #90 December 2010 2

Figure 1. This is the axial image showing the L3-L4 small central disc extrusion. (see arrow)

Figure 2. This is the axial image showing the extensive right sided and central large disc extrusion from the L4-L5 disc level (see arrow) that extends from central to the right lateral recess to stenose the vertebral and osseoligamentous canal. This axial image is posterior to the L4-L5 intervertebral disc space. This is capable of compressing the right L5 nerve root within the lateral recess as well as the cauda equina containing the sacral nerve roots within the cauda equina.

Cox® Technic Case Report #90 December 2010 3

Figure 3. Note the free fragment of L4-L5 sequestered disc material lying within the central canal. (see arrow) that contacts the L5 nerve root. This axial view is taken behind the transitional L5 segment, representing the fragment of disc seen has migrated inferior behind the fifth lumbar vertebral body which is a transitional segment.

Figure 4. Here is the sagittal image showing the L3-L4 disc protrusion (small arrow) and the L4-L5 disc extrusions and free fragment. (large arrow) The transitional segment is at the double arrow.

Cox® Technic Case Report #90 December 2010 4

Diagnosis: Large extrusion with disc sequestration of L4-L5 on the right side with resultant probable L5 and S1 nerve root compression and chemical inflammation. A small central L3-L4 disc protrusion is also present. The combined L4-L5 disc herniation and the transitional segment at the L5 level is termed Bertolotti’s syndrome.

Treatment plan: Treatment consisted of Cox® flexion-distraction decompression adjustments of the L4-L5 intervertebral disc, adjustments of the pelvis at the right pubic bone, right superior femur and right calcaneus. Targeted goading of involved musculature (adductors, multifidi, gemelli, obturators, gluteus maximus, hamstrings) was performed., Frequency specific micro- current and infra-sound were applied to the L4-L5 disc area. Home care included minimizing sitting, smiling to increase risorius neuro-muscular feedback, posture improvement, epson salt baths using maximum magnesium sulfate concentration, utilizing a racquet ball against a wall to self goad the paraspinal, gluteal and tensor fascia lata musculature .

Clinical Outcome: After the 3rd visit lumbar flexion increased from 30 degrees to over 90 degrees and produced no pain. After the 6th visit less discomfort was noted while driving. Less paresthesias was noted when toe walking. Psoas muscles were less contracted.

After the 10th visit (approximately 2 months after treatment started) the patient reported “I’m good”. Most numbness was gone, pain was better in the right buttock. Intermittent cramping was still present and the patient was reminded to take the epson salt baths to maximize magnesium input and increase muscle relaxation. After the 11th visit (2 weeks later) the right Achille’s reflex had returned to an optimal 2 level, equal to the left Achille’s reflex.

Conclusion:

The patient is co-owner of swimming pool company and has found field work to be less irritating. Until he stops sitting as well as reducing other mechanical and mental stress, he has agreed that Cox® Tchnic applied every 2 weeks shall allow him to maintain his improved state of health.

Gregg F. Moses, D.C.

West Palm Beach, FL 33406

moseschiropractic.com

A new study finds that care for low back pain initiated with a doctor of chiropractic (DC) saves 40 percent on health care costs when compared with care initiated through a medical doctor (MD), the American Chiropractic Association (ACA) announced today. The study, featuring data from 85,000 Blue Cross Blue Shield beneficiaries, concludes that insurance companies that restrict access to chiropractic care for low back pain treatment may inadvertently pay more for care than they would if they removed such restrictions.
Low back pain is a significant public health problem. Up to 85 percent of Americans have back pain at some point in their lives. In addition to its negative effects on employee productivity, back pain treatment accounts for about $50 billion annually in health care costs—making it one of the top 10 most costly conditions treated in the United States.
Published in the Journal of Manipulative and Physiological Therapeutics (JMPT), the new study, “Cost of Care for Common Back Pain Conditions Initiated With Chiropractic Doctor vs. Medical Doctor/Doctor of Osteopathy as First Physician: Experience of One Tennessee-Based General Health Insurer,” looked at Blue Cross Blue Shield of Tennessee’s intermediate and large group fully insured population over a two-year span. The insured study population had open access to MDs and DCs through self-referral, and there were no limits applied to the number of MD/DC visits allowed and no differences in co-pays.
Results show that paid costs for episodes of care initiated by a DC were almost 40 percent less than care initiated through an MD. After risk-adjusting each patient’s costs, researchers still found significant savings in the chiropractic group. They estimated that allowing DC-initiated episodes of care would have led to an annual cost savings of $2.3 million for BCBS of Tennessee.
“As doctors of chiropractic, we know firsthand that our care often helps patients avoid or reduce more costly interventions such as drugs and surgery. This study supports what we see in our practices every day,” said ACA President Rick McMichael, DC. “It also demonstrates the value of chiropractic care at a critical time, when our nation is attempting to reform its health care system and contain runaway costs.”
The full study is available online and will appear in print in the December issue of JMPT.

Gregg F. Moses, D.C.

1800 Forest Hill Blvd.

West Palm Beach, FL 33406

moseschiropractic.com