Spinal Conditions &
Outcomes
Dr. Gregg Mantonya
The Mantonya Chiropractic
Centers
Newark ~ Hebron
My background
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Undergraduate study - Ohio U. &
Marycrest Intl. U.
4 year Doctor Chiropractic Degree from
Cleveland Chiropractic College-KC
Completed year-long study from Spine
Research Inst. of San Diego for spine
injury during vehicle crashes
Past Team Doctor for High Schools
Additional post-graduate study in
Pediatric Chiropractic, Rehab, Nutrition
www.mantonyachiropractic.com
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Recent Talk Handouts
Chiropractic
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Required 2-4 yrs undergrad, 4 year
Chiropractic School
 Extensive training in Musculo-skeletal and
nervous systems - More hours than Medical
school
 Detect & correct joint mis-alignments
~ These can affect nerve function
 Do not prescribe medication
 Physicians through Medicare, Ohio BWC,
Court
 PCP for many of our patients
Chiropractic
Therapy
Modalities
Adjusting
Table
Rehab
Low-force Instruments
Conditions, Causes, Prognosis
 Sprain/Strains
 Repetitive
Stress
 Arthritis
 Discs
 Scoliosis
 Chronic
Pain Patients
Sprain/Strain
Sprain/Strain
Will heal within 6-12 week, right?...
...Remodeling phase of healing, up to 12
months or more (Kellet: Acute Soft Tissue Injuries - a review of lit.
Med Sci Sport Exerc, 18(5);489-500, 1986)
Sprain/Strain
Whiplash – It’s estimated that 50% of
those exposed to trauma will be
injured…
 50% will recover within weeks or
months…
 Leaving 20% of the initial 100%
exposed to late whiplash symptoms…
 Approximately 5% will be disabled
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Sprain/Strain
Whiplash – At Risk For Acute Injury
 Female
 History of neck injury
 Poor head restraint/tall patient
 Use of seatbelt - 1.5 - 3 x more likely
 Out of Position/Head turned
 Non-aware of impending impact
 Increasing age (middle age & beyond)
 Impact by vehicle of greater mass
Sprain/Strain
Whiplash – At Risk for “Late Whiplash”
 Female, especially if small body mass
 Immediate/early onset of symptoms
 Ligament/Joint instability
 Greater # of symptoms
 Use of seatbelt - 34% vs 20%
 Initial limited range of motion
 Initial neurological symptoms
 Loss or reversal of cervical curve
Sprain/Strain
Mercy Guidelines Factors that Complicate Recovery
Used by Ohio BWC
 Pain longer than 8 days - 1.5 x longer
 Severe pain - 2 x longer
 4-7 previous episodes - 2 x longer
 Injury on underlying condition - 2 x longer
 Poor compliance
 Biomechanical Stress
 Psychosocial Stress
Repetitive Stress Injury
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Carpal Tunnel
Syndrome
Common in those
performing assembly
line work
Women 3:1
Surgery up to 90%
successful…?
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Tendonitis
DJD – Osteoarthritis
DJD – Osteoarthritis
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Wear & Tear Arthritis
Large percent are remarkably
asymptomatic
More common in males until age 45,
Females 10:1
Hip degeneration – reduced risk of
osteoporosis
Recent problems with pain medication
Vioxx, Bextra, Celebrex etc
Disc Conditions
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Discs are the spongy thing between the spinal bones
– Shock absorbers
– Spacers for nerve to exit
Up to 50% of people asymptomatic have lumbar disc
degeneration on MRI
Up to 60% in cervical spine
~ MRI of 98 people without back pain:
only 36% had a normal disc at all levels.
52% bulge at least one level
27% protrusion
1% extrusion
38% had abnormality at more than one level
Discs
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Can’t “slip”
Swollen
Bulge - No outer fibers are torn, center has
moved toward the outer rings
Protrusion - Sometimes used in place of
bulge
Herniation - Some tearing of outer ring
fibers, center moves toward outer rings
Rupture - Piece of Center has gone outside
of disc
Discs - normal, top view
Discs - bulge, front view
Discs - herniation, front view
Discs - rupture, front view
Pain Meds/Chiropractic, Rehab
Discs
Shots, Nerve Block, Surgery
Rupture most likely to need surgery.
 One study showed 83% of patients
with herniations and radiating pain
improved up to 2.5 years after…73%
had actual herniation improved or
resolved not just the symptoms
(non-operative treatment).
 Surgery - Studies vary on it’s
success, as little as 50% or worse
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Back Surgery - What studies say
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50-70% have complete relief
of back and leg pain when
followed-up at 5 years
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10-15% will have worse pain
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18-29% will undergo further
surgery
Scoliosis
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Idiopathic (unknown cause) most
common type
Most rapid progression during growth
spurt
10-15 degrees progression during adult
years
Complications – cardiopulmonary dz.,
DJD, pain, curve progression
Tx – stretches, braces, Chiropractic,
massage, surgical bracing
Scoliosis
In my practice
experience, pain and
disability depend upon
patient’s...
•Physical Fitness
•Activity Level
•Severity of Scoliosis
•Occupation
Spondylolisthesis
50% never have pain
 Most of the others that do
have another cause
 Rarely progresses during
adulthood
 Studies showed no worsening
with strenuous sports
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High Risk
Chronic Pain Patients
The longer a patient is disabled from
work, the less likely they are to return.
1 in 6
Americans live
with chronic
pain.
$120 billion a
year in
medical costs
and lost
productivity.
BWC Data
Pharmaceutical Reimbursement
1998
$57,026,132
2003
$130,000,000
Chiropractic Costs
2002
$64,467,227.00
Actual cost of Chiropractic vs. Medical Claims new
injury, 1998- 2002
Allopathic care + drugs = $709,709,700.95
DC care = $167,396,045.11
Long-term care costs 2002
DC - $34 million
MD + Drugs - $189.6 million
Chronic Pain Patients
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30,000 hospitalizations/yr from NSAIDS use
One study showed only 25% resolved from original
pain complaint one year later
Recent Increase in Pain Management Centers
Chiropractic 1-2 visits/month shown to be beneficial
Fibromyalgia - 3-6 million Americans
~Tenderness particularly in the neck, spine, shoulders,
and hips - usually after trauma.
~Most able to be fully active, may need job modification.
Chiropractic Terms
Adjustment vs. Manipulation
 Subluxation, Subluxation Complex
 Intersegmental Dysfunction
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Info Outlets
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www.mantonyachiropractic.com
~ “Chiropractic info”
~ “Kids & Chiropractic”
 ACA - www.amerchiro.org
~ “insurance & managed care”
 Spine Research Inst. - www.srisd.com
~ sprain/strain info/research
 My email - mantonyachiro@yahoo.com