The Effects of Vertebral Axial Decompression On Sensory Nerve Dysfunction
in Patients with Low back Pain and Radiculopathy:
Frank Tilaro, M.D. Dennis Miskovich, M.D.
Canadian Journal of Clinical Medicine Vol 6, No 1, January 1999
(page two of five)
CPT measures are stated in units equivalent to 0.01 milliamperes (mA) of output intensity. Below 0.10 mA, CPT measures are resolved in increments of 0. I CPT. A CPT of 100 indicates a stimulus output intensity of 1.0 mA, a CPT of 9.5 indicates an output intensity of 0.095 mA. The output range of the CPT device is 0.001 mA (CPT = 0. 1) to 9.99 mA (CPT = 999).
The Neuval CPT Evaluation and Database software evaluates and stores a patient's CPT value and generates a report detailing the condition of the nerves tested. These evaluations are based upon comparisons with standardized ranges of healthy CPT values and ratios included in the software. Two types of analyses are performed. Range analysis quantifies neuropathies from the hyperesthetic through the hypoesthetic stages by comparing values at 2 KHz, 250 Hz, and 5 Hz from a test site to normal values. Ratio analysis compares the different CPT measures for each of the 3 frequency readings within a nerve fiber. Two types of ratio analyses are performed on the patient's CPT values. The within site ratio analysis compares ratios of the different frequencies obtained from the same test site, in this study the test sites over the peroneal or sural nerves. The between site analysis compares ratios of the different frequencies obtained from contralateral sites i.e. values from the left sural or peroneal nerve compared to the right sural or peroneal nerve. The ratio analyses comparisons are sensitive in the earliest stages of neuropathy, whereas the range analyses represents greater functional impairment.
Range analysis quantifies neuropathies on a scale from -1 to +4, representing mild hyperesthesia to anesthesia. Within site ratios and between site ratios are assigned values between 1 to 2 which represent the slightest sensory dysfunction to mild dysfunction.
The grading system takes into account that in order of severity an anesthetic condition is more severe than a hypoesthetic condition, which is more severe than a hyperesthetic condition, which is more severe than a within site ratio abnormality, which is more severe than a between sites ratio abnormality.
The Neuval software analyses the CPT test values for range and ratio analyses scoring and assigns the test stimulus with the highest CPT score its corresponding Grade value while any additional scores are assigned their respective Adder grade values. Table 1 illustrates the CPT parameters for achieving a grade. A grade of 0 means no abnormality, grades I to 4.82 the very slightest to mild sensory dysfunction and grades 5 to 12 represents mild hyperesthesia to anesthesia.
The clinical population of this study were patients who suffered from chronic dysfunction averaging 17.2 months in duration. These patients were refractory to various forms of conservative care including bed rest, traction, physical therapy, medications, chiropractic, and injections. This group of patients then received VAX-D therapy and CPT evaluation was performed before and after VAX-D therapy.
| Analysis |
Score |
Grade |
Adder |
Max. Grade |
Commentary |
| Range |
4 |
10 |
1 |
12 |
Anesthetic |
| Range |
3 |
9 |
0.45 |
9.9 |
Severe hypoesthia |
| Range |
2 |
8 |
0.41 |
8.82 |
Moderate hypoesthesia |
| Range |
1 |
7 |
0.37 |
7.74 |
Mild hypoesthesia |
| Range |
-2 |
6 |
0.31 |
6.62 |
Moderate hyperesthesia |
| Range |
-1 |
5 |
0.27 |
5.54 |
Mild hyperesthesia |
| W/S Ratio |
2 |
4 |
0.41 |
4.82 |
Mild sensory disfunction |
| W/S Ratio |
1 |
3 |
0.35 |
3.70 |
Very mild sensory disfunction |
| B/S Ratio |
2 |
2 |
0.39 |
2.78 |
Slight sensory disfunction |
| B/S Ratio |
1 |
1 |
0.33 |
1.66 |
Slightest sensory disfunction |
| All |
0 |
0 |
0 |
0 |
No abnormal measures |
|
1 | 2 | 3 | 4 | 5
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