3-Point Bending Traction for Scoliotic Curvatures Using the New 3-D Denneroll Traction System: A Case Report

INTRODUCTION

In a study from 1893 regarding scoliosis treatment, Bradford and Brackett,¹, stated, “there is not only nothing irrational in the method of treatment by forcible mechanical correction when feasible, but it is manifest that when shortened ligaments in spinal curvatures are situated so that they serve as a check to muscular action.”¹ They continue, “when they [ligaments] are strong enough to withstand muscular action, gymnastics [exercises] alone are inadequate as a system of correction.” ¹ Bradford and Brackett’s¹ mechanical traction protocol required patients to undergo traction for a half-hour daily. Because this study was done prior to the invention of x-ray, reported results were not very accurate. More than a century later, CBP® researchers and clinicians have found agreement with Bradford and Brackett that exercises should be combined with short duration, high-force mechanical traction in order to obtain the most effective results in scoliosis reduction.

• CBP's Mirror Image® Traction for Scoliosis

The traction employed by the CBP® practitioner for scoliosis management requires critical reasoning and a thorough understanding of the displacements of the spine and posture. Generally speaking this traction is of the 3-point-bending type of load application or a transverse load applied at the apex of the curve with and without lateral bending, axial rotation, or other movements depending on the specific case. The traction set-up must always be performed in a pre-determined optimum sequence of movements using stress x-rays to guide the decision making process. Mirror Image® traction sessions and duration should be a minimum of:

• At least 3-5 times per week. If the patient will traction more than 1 time per day this would be beneficial as long as the patient is not becoming overly painful from the increased frequency of treatment.
• Traction duration should be 20-30 minutes. The patient starts with 2-3 minutes and over consecutive sessions progresses in time.

CASE REPORT       

            The current patient had a history of thoracic pain and had been under chiropractic care for many years which she indicated gave her temporary relief. Now at 13 yrs old, her pain and frequency have worsened over the last 4 months to a stage where she was experiencing daily headaches and thoracic pain rated as severe on a numerical rating scale (7-8 / 10).

• Initial Radiography

1. Primary Right Thoracic curve = 43 degrees (see Figure 1).
2. Secondary Left Lumbar Curve = 28 degrees (see Figure 1).

• 1st in traction x-ray using the Denneroll Table and the Scoli-Roll Fulcrum System

            The first in-traction x-ray showed that the thoracic spine was well effected however the lumbar spine was bending and under the stress in the incorrect direction (see Figure 2). This showed us that we needed to raise the lumbar spine off the table to help stretch the lumbar spine correctly.

• 2nd in traction x-ray

            In response to the first in-traction x-ray, we decided to raise the pelvis to a level of +2 (two blocks under the right hip to address the concerns of the lumbar spine translation. You will see in the 2^nd in-traction x-ray that raising the pelvis height did not decrease the effects of the ScoliRoll under the thoracic spine. This is obviously achievable due to the downward pressure of the two straps pulling on the thoraco-lumbar spine and upper thoracic region. The specific effects of using the block system to raise the pelvis is really evident when you look at the stress x-ray in figure 3.

From these in-traction x-rays we can accurately assess that the block under the pelvis is best for the patient’s spine. It also shows how x-rays are essential in establishing the best possible traction position.

• CHIROPRACTIC INTERVENTIONS

            Due to the positive findings of the stress radiographs, the patient was recommended to undergo corrective chiropractic care including Mirror Image traction on the denneroll table, Mirror image adjusting, and Mirror Image Exercises. She was seen for 3 x week for 1-month (with a couple of interruptions) and was advised on doing home exercises on the days she was not being treated in the office.

•  Mirror Image® Exercises and Adjustments

            We believe that both postural based exercises and adjustments are vital in consolidating the benefits of the effective spine stretching using the denneroll 3-point bending traction table. During the patient's exercise, neurological stimulation was added by impulsing the spine during her exercise movements; thus turning the exercise into the adjustment.

After 5 weeks and 13 sessions, we can see the corrective improvements in the patient’s spine. The patient’s symptoms have been reduced 90%. Thus, she is symptomatically doing very well and began improving after her 1^st session and has reported no symptoms at all for the last 3 weeks.

• 5 weeks-Follow up Radiography

            A one month follow up radiographs of the thoracic and lumbar spines were obtained to identify if the recommended and applied treatment was having the desired effect. Obviously scoliosis of this magnitude might require more frequent and increased numbers of sessions. However, only a follow up radiograph can truly determine what extent more care or different care is required.

            A remarkable reduction of the AP Thoracic scoliotic curve was identified from 41 degrees down to 28 degrees on the post (a 13° net improvement). Similarly, the AP Lumbar curvature demonstrated improvement. See Figure 5.

SUMMARY

            This case presents the initial successful reduction of a primary thoracic scoliosis in an adolescent female with a history of chronic pain. After 5 weeks and 13 sessions, we can see the corrective improvements in the patient’s spine. The patient’s symptoms have been reduced 90%. We believe the results are due to the combined effect of the Mirror Image treatment methods including the 3-point bending traction employed using the 3-D Denneroll Traction Table. The patient is continuing care and perhaps a future article will address her response.

References

1. Bradford EH, Brackett EG. Treatment of lateral curvature by mean of pressure correction. 1893.

CBP Chiropractors: We Must Practice What We Teach

Cindy Boyd, BS, DC

Private Practice of Chiropractic Alameda, CA

Faculty Life Chiropractic College West

&

Deed E. Harrison, DC

President CBP Seminars, Inc.

Vice President CBP Non-Profit, Inc.

Chair PCCRP Guidelines

Editor—AJCC

INTRODUCTION

In previous issues of the AJCC, we have presented a number of articles on the indications and contra-indications of the cervical denneroll orthotic device as a method for restoration of an abnormal cervical lordosis. Also, several patient case studies have been presented describing the successful ability of the cervical denneroll orthotic device in restoring the cervical lordosis and improving patient health disorders as a consequence. In the current case, we report on the improvement in the cervical spine with a large disc herniation and complex injury-buckling of the cervical segments including retro-listhesis, hyper-extension, and flexion at different cervical spine joints. This report represents the actual conditions of one of the authors (CB) and these are her results.

Key Case Features

A 34 year old female presented with chronic neck pain, decreased range of motion, headaches with extension of the head and neck and a recent onset of heart palpitations of unknown etiology. The symptoms were reportedly getting worse over the past few months, and causing the patient to refrain from practicing in her chiropractic clinic providing one on one patient care. After administering 1-2 adjustments on any given day, the symptoms were exacerbated causing disability and significant discomfort.

The patient had a past history of two head and neck injuries. The first direct impact injury was sustained during a bicycle accident that occurred in the spring of 2008. The patient was riding a bicycle at a high speed and traversed over old railroad tracks at an awkward angle causing an immediate crash. Her head hit the pavement with significant force, and unfortunately she was not wearing a helmet. Fractures were ruled out and no lacerations were present. A mild concussion was sustained. Bruising and swelling was present in the right zygomatic region at the site of direct impact. 

Two years later, a double direct impact injury occurred during a snowboarding accident where the patient fell on an ice patch directly landing on the sacrum and a second impact occurred during the same fall when she fell backwards and hit her skull on the ice patch with significant force. This time the patient was wearing a helmet.  

• ·      Health Status, Pain, and Disability Questionnaires

The short form (Sf)-36 health status questionnaire, numerical rating scale for pain intensity and the neck disability questionnaires were administered. The patient had considerable pain, disability, and depressed health. See Figure 1 for the initial NDI and SF-36 abnormalities.

Figure 1. Patient initial neck disability and SF-36 scores indicating considerable pain, disability, and abnormal health status.

• Radiographic Evaluation

Lateral Cervical Radiograph:

On 8/24/11 a digital lateral cervical was obtained. See Figure 2. The radiographic analysis was done using the Posture RayÒ computerized radiographic mensuration system. The patient’s radiographic displacement values are shown in Figure 2B and are compared against normal. Several cervical spine subluxation-displacements are present including: an abnormal kyphosis from C4-C7, a C3-C4 segmental retro-listhesis, and a considerable hyper-extension of C2-C3 were identified. The radiographic and clinical findings indicated a possibility of herniation one or more cervical discs and instability in multiple levels of the cervical spine.  Thus, an MRI was obtained, and the findings confirmed a central/sub-ligamentous disc herniation at C2/C3 and C5/C6 with concomitant instability.

Figure 2. Initial lateral cervical radiograph and abnormal findings of alignment compared to ideal values. The PostureRay™ system was used.

Lateral Thoracic Radiograph:

            On 8/24/11 a lateral thoracic radiograph was also obtained. Figure 3 depicts the patient's lateral thoracic radiograph. Relative to the CBP ideal thoracic elliptical model, the patient's upper and mid-thoracic segments are in a relative subluxated extension position. This is consistent with an extension abnormal postural position of the thorax relative to the pelvis or lumbar spine.

Figure 3. Lateral thoracic radiograph. The green elliptical line is the Harrison ideal thoracic model representing the proper path of the posterior vertebral bodies of the thoracic spine. Note that the patient has extension-backwards bending of the upper-mid thoracic spine relative to the lower thoracic spine.

Denneroll Stress Radiography:

These values and findings indicate the patient’s candidacy for the Denneroll Cervical Orthotic. Based on MRI findings and significant abnormal segmental cervical translation measurements, Denneroll stress X-rays were taken using the large cervical Denneroll. Figure 4 depicts the lateral stress x-ray. Based on the initial radiographs, it was determined additional upper thoracic flexion and translation was needed in this setup to make a considerable correction in the injured and postural distorted regions. Thus, a 10 millimeter foam block was used under the denneroll device to increase the height of the orthotic in order to induce additional upper thoracic flexion and translation during the stress study.  The peak of the denneroll was placed in the lower cervical spine. Particular attention was given to the hyperextended upper cervical segments, and another block measuring 10 millimeters in height was placed under base of the skull during the stress analysis. Further, to limit the amount of skull extension and upper cervical extension, the patient was asked to actively flex-tuck her chin (although painful) at the time the radiograph was taken. Figure 2 shows the upper cervical spine extension on the initial patient x-ray. 

The stress analysis study showed considerable correction in the cervical abnormal values including the segmental translations and relative rotation angles that were present on the neutral lateral cervical study.

Figure 4. Denneroll stress lateral thoracic radiograph to ensure proper location of the denneroll peak and if the denneroll is effectively improving the cervical alignment.

• Denneroll Cervical Orthotic Intervention

Based on the outcomes of the stress radiographic analysis, the patient agreed to participate in a study to determine the outcome of cervical curve correction using the Denneroll home traction device.  No other forms of treatment were administered. Spinal manipulation, CBPÒ drop table adjustments, Mirror ImageÒ exercises and in office traction types, were all avoided during this particular patient treatment phase with the Denneroll. 

The large cervical Denneroll was used at a frequency of 1-2 times daily, 4-6 days a week for a 30 day period. Each home session involved the patient lying supine on the large cervical Denneroll with a 10 millimeter block under the device. Refer to Figure 4 for the denneroll setup. In addition, a 10 millimeter block was placed under the skull to limit the amount of upper cervical extension.  The patient was also instructed to actively flex the chin while on the device. The amount of upper cervical hyperextension and thoracic extension measured on the lateral cervical and thoracic radiographs warranted the degree of specificity in this setup. Between the dates of 8/24/11-9/22/11 approximately 36 home Denneroll sessions were performed at a duration of 10-18 minutes each.

A follow up lateral cervical x-ray was taken on 9/22/11 to determine if the intervention had made any significant changes.

• Case Outcome

      Subjectively, at the end of the 1-month treatment phase, the patient was asymptomatic including the disappearance of the heart palpitations, headaches and pain.  There were significant improvements in the SF-36 and neck disability outcomes. The follow up lateral cervical radiograph exam showed significant improvements in all cervical regions that were abnormal initial. Figure 5 and Table 1 describe these results.

Figure 5. One-month follow-up lateral cervical. Note that this x-ray was taken a minimum of one day with no treatment interventions. There are considerable improvements in all radiographic abnormalities.

RRA’s (-) values = extension (+) = flexion		Segmental Translation (-) values = posterior	Translation C2-C7
C2/C3	12°	-1.6 mm	21.6mm
C3/C4	-1.7°	-2.4mm
C5/C6	0°	-0.8 mm
ARA C2-C7	-26°

CONCLUSION

            This case report represents the actual conditions of one of the current study authors (C.B.). The uniqueness of this case lies in the severity of the cervical spinal displacements and the concomitant improvements in structural and functional abnormalities using the cervical Denneroll as the exclusive treatment intervention. While the patient's follow-up radiograph is still not considered to be within normal limits and further care is warranted, the improvements over the course of one-month are promising. The patient (C.B.) has committed to continuing her Denneroll intervention program to continue rehabilitating her cervical spine. Afterall, as a CBP Chiropractor, we must practice for ourselves what we teach our patients to do.