Prevalence of Spinal Disorders:

According to a study performed by the New England Journal of Medicine in 1988: approximately 80% of people will have experienced "Lower Back Pain" in their life time

Lower back pain is one of the most prevalent health condition in the US, second only to the common cold. The majority (abou 70%) of chronic lower back pain is related to malpositioning in spinal cord.

• 5 ﹪ of the lower back pain lasts for more than one month.
• According to statistics in the US, about 42 million people need to seek medical care due to headaches largely caused by malpositioning of the cervical vertebrae.
• 75% ～ 85% of people 65 years of age or above suffer from chronic bone spurs.
• Every year, more than 15 million Americans visit chiropactors to relieve their backaches, neck aches, headaches and other kinds of painful symptoms and disorders caused by common functional disorders.
• Every year in the United States, up to 1 million people required hospitalization due to lower back or sciatica pain, approximately 200,000 undergo surgery. The treatment cost exceeds $5 billion dollars annually.

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�Relationship between the Spinal Cord and the Human Body ：

Spinal cord, like the main structure of buildings, plays an extremely important role within the human body. It consists of 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, sacrum made of 5 sacral vertebrae and coccyx made of 3~5 tailbones. It forms the main structure for the entire back, which supports the head and torso. The spinal cord is also responsible for protecting the spinal nerves, production of blood cells (such as RBC, WBC, platelets) and storage of minerals (such as potassium, calcium, sodium…etc), which will be released appropriately through transportation of blood when required by the human body.

Intervertebral cartilage exists between the spinal cord and vertebrae （ Intervertebral Discs ）（ refer to Figure 1 ） .

The cartilage functions like cushions and enables the human body to bend and turn; in addition, it can alleviate the impacts from fierce exercise like running or jumping. Based on theory in medical science, the arrangement of adult spinal cord should be vertically symmetrical and aligned orderly when viewing from the front (however, no one can have this perfect alignment except in infants). While viewing from lateral positions, the spinal cord is not arranged straightly like a rod; rather, it has four curves where cervical and lumbar vertebrae protrude to the front, while thoracic and sacral vertebrae protrude to the back (as in Figure 2).

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Structure of Vertebrae

Thoracic and sacral curves are presented in infants, whereas cervical curve forms when the infant starts sitting due to the weight of the head. Lumbar curve develops when the infant begins to stand upright and walk. The curve in the spinal cord is mainly to lessen the shock from walking; thus, the impacts will not transmit to the brain directly. This kind of structure is truly a work of art by the Creator.

The center of the spinal bone is a hollow vertebral foramen where the spinal cord passes. Spinal cord is the extension of the brain nerve fiber tissue that acts as the neural passage when the brain transmits messages to the body tissue. The human body can assume appropriate actions responding to external stimulus because

external stimulus signals will travel to the brain through the neural passage. Upon receiving the signals, the brain will compile the message and command the response to the limbs via spinal nerves. Furthermore, the spinal cord is also the reflex center for messages transmitted by the organs and controls the functioning of organs and blood vessel. Spinal bone is the important tissue responsible to protect the spinal cord. Besides that, human’s unique upright spinal cord has distinguished us from other animals crawling with four legs by enabling us to walk and operate with two legs standing upright. However, the spinal cord has been compressed for a long time while supporting the heavy mass of the human body, leading to an elevated chance for disorder. Regardless of the cause of spinal injury and disorder, it will affect the normal function of organs and mobility of the limbs, especially with the inexplicit chronic disease and backache frequently observed clinically.

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Disc

• Intervertebral disc is composed of nucleus pulposus and annulus fibrosus.
• It is a circle of cartilage between each vertebra , and acts as a connector, spacer,
• shock absorber, shock distributor and allow the back to move.
• Healthy discs like cushions and enables the human body to bend and turn.

Ingredients of Intervertebral Disc

�Collagen (10 ～20 ％)

The function of collagen is to provide strength, anti-resistance and stability for intervertebral disk; thus, it prevents herniated intervertebral disk.

Proteoglycans (PGs) (4 ～7 ％)

It acts to stabilize collagen framework that provides tension and resists pulling by fortified collagen fibers. Major components of PGs are hyaluronic acid and glycosaminoglycans. With mucosity and water-retaining ability, hyaluronic acid plays an important role in maintenance of tissue structure and transmission between cells, and acts to help lubricate intervertebral disc. While glycosaminoglycans is essential for bone repair and health of intervertebral disc after collision. Hyaluronic acid and glycosaminoglycans can react to produce collagen and PGs with strong water catching and holding ability. Hence vertebral pulp protects the disk from collision with highest water content in all intervertebral structures. Polyglycoprotein is rich in chondroitin in the youth, but keratin when aged.

Water (65~80%)

It will be excreted under pressure to offset part of external force. It also acts to lubricate.

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Aging Spine

The spine goes through the aging process just like any other part of the body. Time, old injuries and bad habits take their toll on the spine as age.

The spine is made up of 32 bones, or vertebra, and 24 softer, gel-like discs. As the body ages, the discs in the spine dehydrate, or dry out, and lose their ability to act as shock absorbers. The bones and ligaments that make up the spine also become less pliable and thicken. One of the most common causes for spinal disorders is disc degeneration.

�Degeneration in the discs is normal and is not in itself a problem. The problem happens when these discs began to pinch and put pressure on the nearby nerve roots or spinal cord.

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Degenerative Disc Disease

�Degenerative Disc Disease (DDD) is a gradual process that may compromise the spine.

Degenerative changes in the spine are often referred to those that cause the loss of normal structure and/or function. The intervertebral disc is one structure prone to the degenerative changes associated with wear and tear aging, even misuse (e.g. smoking).

Since disc is a vascular, transportation of nutrients and waste is dependent on long-range diffusion and pumping action generated from mobilization of the spinal bone ..

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Degenerative Disc Disease

Discs depend on water to keep their height and perform efficiently. When we're young, discs have their own circulation that helps keep them hydrated. As we get older, this circulation ends and the collagen structure of the annulus fibrosus weakens. The discs become dehydrated and more vulnerable to cracks and fissures. They also begin to lose their height. Additionally, water and proteoglycan (PG) content decreases.

Then these discs compress and shrink, resulting in a distinct loss of height (generally between 0.5 and 2.0cm) between the ages of 50 and 55.

PGs are molecules that attract water. These changes are linked and may lead to the disc’s inability to handle mechanical stress. Understanding the lumbar spine carries a large portion of the body’s weight; the stress from motion may result in a disc problem (e.g. herniation) .

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Causes of Disc Degeneration (1)

Natural Aging Process

FMOD (fibromodulin) is known to interact with both types I and II collagen . Fibrillar collagens are binded by FMOD.

FMOD is present on collagen fibres (gap region) in cartilage, with a higher surface density on fibres in the superficial region and present in increased amounts in the interterritorial matrix of all layers .

As one grows , the amount of FMOD in annulus fibrosus declines, the ratio of glycoprotein and collagen declines too. As a result, disc begins to loss water and degenerate

Decreased cell nutrient supply and reduced activity.

Surrounding blood vessels will be atrophied under pressure due to lactic acid accumulation, cartilagehyperplasia, and vascular anoxia.

When complicated by calcification of intervertebral plate, it will cut off nutrition supply of chondrocytes and affect removal of metabolic waste due to diffusion disturbance.

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Excessive burden on spine (when lifting heavy objects or bearing excessive body weight) or uneven distribution of forces within intervertebral disk (due to improper posture or overburden at certain sites.

Cartilage will fail or even break due to fatigue under persistent and repetitive loading of enough pressure. In this case, breakage of collagen fibers and compression between joints will disturb cartilage nutrition and result in necrosis of chondrocytes and consumption of glycoprotein in matrices. Disc degeneration becomes inevitable when cartilage can’t bear compression and pressure during spine movement. Besides, when external force exerted on intervertebral disc is greater than internal inflation pressure, lubricant liquid membrane inside cartilage will shrink, disappear, and even lose lubricating effect. In this case, hard vertebras will directly tear and were disc and cause its rupture. The glycoprotein lose due to this abrasion.

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Long-time immobilization with the same posture.

Surrounding fibrous tissue will experience the following changes when the joint is immobilized for a long time

• Less water content
• Less collagen
• Less hyaluronic acid
• Less glycosaminoglycans
• Loss of glycoprotein

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Comparison of various spinal treatments with

Active ingredients and functions of

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