Pain Management, A Practical Guide to Clinicians (5th Edition)
Chapter 20: New Concepts in Back Pain Management: Decompression, Reduction, and Stabilization, C. Norman Shealy, M.D., Ph.D., F.A.C.S., Pierre Leroy, M.D., F.A.C.S.
New advances centering on the use of specific segmental distraction (lumbar decompression therapy*) as an adjunct to managing low back pain with or without sciatica are reported here. These should be of special interest to both primary care and multidisciplinary medical specialists when symptoms persist despite comprehensive management of acute back pain.
In summarizing the literature from medieval times to present one can conclude:
Outcomes are highly variable
There exist many different types of traction techniques
Various angles can be applied
Different weight sequences can be utilized
Time scheduled sequences are describes without specific guidelines
Significantly, numerous studies have shown that older techniques utilizing traction have actually caused increased (rather than decreased) pressure in the lumbar discs.
This review of the literature demonstrates lack of quantification. Ramos and Martin published the first application of quantitative analysis related to traction therapies in 1994 (see below).
Borrowing from this literature on traction, in 1997 Shealy and Borgmeyer introduced a new biomedical application device that can apply each of the positive attributes of traction to individual disc levels. This system of treatment has been called "The DRS System". DRS* stands for decompression, reduction, and stabilization. Treatment parameters include the following:
Distraction/decompressive forces determinations must be based on patient weight.
Knees must be flexed to facilitate relaxation of the patient.
The level of the spine to be treated determines the angle of distraction (e.g. L2-3 vs. L5-S1)
Treatment is applied with the assistance of a computer that allows for the delivery of a precise and custom cycle of distractive forces.
During the program of care, patients are instructed in the use of ice and exercise aimed at stabilization.
Dr. Shealy performed a study on 50 patient with chronic low back pain (23 with herniated discs and 27 with facet (lumbar joint) pain).
Many of the patients with herniated or ruptured intervertebral discs showed marked improvement.
Some of those with facet problems also showed marked improvement
Most patients with pain reduction exhibited increased flexibility as well as increased capability to perform physical activity.
The use of computer assisted decompressive therapy is a welcome addition to the problematic low back syndrome.