“How can Cox® Technic help if there's no disc left?” Spinal Stenosis

An unexpected yet thought-provoking question - “How can Cox® Technic help if there's no disc left?” - recently came to the Cox® Technic Team. 

The reputation of Cox® Technic Flexion Distraction Decompression often focuses on its benefit for managing disc-related pain conditions, (mis)leading some to wonder about its effect on non-disc related conditions (a discussion for another time – facet syndrome, spondylolisthesis, transitional segment, degenerative scoliosis, etc.!) and one condition like spinal stenosis in which condition the disc is “gone” or dramatically deteriorated/degenerated.

Let’s begin with basic understanding of disc degeneration and spinal stenosis. On page 130 of the textbook Low Back Pain: MECHANISM, DIAGNOSIS AND TREATMENT 7th ed is the Pfirrmann classification of disc degeneration which is a gold standard to grade disc degeneration. Grades 2-4 are disc degeneration findings that accompany loss of disc height and foraminal narrowing including disc herniation. Here Protocol I is implemented to drop intradiscal pressure, increase foraminal area, increase disc height and reduce mechanical and chemical inflammation of the nerve root complex and dorsal root ganglion.

Pfirrmann grades 4 to 5 represent advanced disc degeneration resulting in spinal stenosis that shows disc space height loss increase, ligamentum flavum thickening, end plate Modic changes, facet arthrosis and degenerative spine stenosis. Here Cox® Technic distraction spine mobilization and manipulation (SMM) is implemented to reverse these findings to decrease mechanical nerve and dorsal root ganglion (DRG) compression and relieve cytokine inflammation.

Therefore, the basic answer to this question is that early disc degeneration is seen with disc herniation and treated as shown above. Advanced disc degeneration results in spinal stenosis described above necessitating distraction and physiological range of motion delivery.

For a fuller and more detailed discussion, please consider studying

  • pages 130 to 148 for detailed explanation of the circulatory changes on the arterial blood vessels supplying the nerve roots and DRG, the chemical cytokines involved with neural compression, neuropathic pain developed with disc herniation and its resultant chemical inflammation, correlation of mechanical compression of the DRG and nerve root from disc herniation with neurological deficits, postural alterations, and reflex and motor changes, facet joint as sciatica cause, staging of disc degeneration, metabolic and nutritional principles of disc herniation and stenosis. So much information!
  • pages 228 to 247 cover the discographic descriptions of disc degeneration and the five major causes of disc herniation.

We did a webinar on Spinal Stenosis in July 2023 with more discussion as well as demonstration of treatment protocol on The Cox®8 Table by Haven. The course is called Hour 25 of the 2023 Online set of courses titled "Parts I/II - BONUS Hour 25 - Spinal Stenosis - Cox".

Thank you for allowing this review of disc dehydration resulting in disc degeneration leading to spinal stenosis. The referenced text will hopefully add to your answer to the question of how Cox® Technic distraction SMM can help advanced disc degeneration. You are referred to this work as it gives an organized explanation that would require me to reproduce the text in this short article. Please allow further discussion. 

Respectfully submitted,

James M. Cox, DC, DACBR