An Overview of Vertebral Axial Decompression, Canadian Journal of Clinical Medicine, Vol. 5, No. 1. F. Tilaro (post 1996)
The state of back pain diagnosis - "Effective diagnosis and therapy requires thorough knowledge of biomechanics. Our approach (typical medical approach) to back pain has been centered on a patho-anatomical model but unfortunately the model frequently fails to comply with the clinical picture."
"Adding to the confusion is the belief by too many physicians, patients and insurers that high tech imaging is the standard for establishing a diagnosis. However, the high rates of false positives and false negative findings point to the inadequacies of these studies identifying the pain generating lesions."
Typical medical treatments
"Studies on disc surgery emphasize inappropriate patient selection as the cause for surgical failure. In North America the incidence of surgical failed back syndrome is about 15% compared to 5% with most European countries. Comparisons between the United States and Europe indicate that the frequency of surgery in the U.S. is four times greater."
A randomized study demonstrates that percutaneous discectomy has little value.
The same is true for laser discectomy.
Chemonucleolysis has fallen into disrepute because of serious side effects including anaphylaxis and myelitis and should no longer be considered an option.
There is no support for adding a fusion to a routine discectomy.
Daily decompression therapy to the lumbar spine given Monday through Friday for approximately 20 sessions.
An occasional patient may require a short maintenance period where 2 to 3 treatment a week are given for 2 to 4 weeks post therapy.
The average patient required 20-25 sessions.
No serious side effects were found in this study nor have been reported with this form of therapy.
An understanding of spinal biomechanics is necessary to appreciate the mechanism of action of decompression therapy.
Fissures or breaks in the outer disc fibers allow this nucleus to migrate leading to disc herniation. These fissures are normally present by 30-35 years of age and increase with advancing age. Decompression of injured or diseased lumbar discs will allow the central part of the disc (nucleus) to relocate to a more proper position.
Within these fissures there can accumulate irritating fluid that can cause pain either by chemical irritation or mechanical traction of the sinuvertebral nerve. It is thought that through decompression and its associated cyclic action, pain relief is achieved through the displacing this irritating fluid from the outer portion of the disc.
There is evidence that indicates that decompression therapy could well create a circumstance whereby torn disc fibers can heal. Proposed mechanism of action would involve pumping out the inflammatory fluids from inside the injured disc allowing the borders of these fissures to approximate and heal.
The ability brought forth by decompression therapy to create a negative pressure within damaged discs plays a prominent role in affecting nourishment enabling repair of damaged tissues. It is thought that the low levels of oxygen found in damaged discs, is inadequate to support healing. Also, damaged discs have been shown to have high concentrations of lactic acid within the central portion of the disc. These high levels of lactic acid could facilitate chondrocyte cell death. High lactic acid levels are also associated with increased activity of degradation enzymes that promote the loss of proteoglycan cell matrix.
Creep is a physical phenomena that has to do with deformation as a result of a compressive load. It has been found experimentally in pigs that increased creep is associated with decreased levels of oxygen and sulfate as well as increased lactic acid within the disc.
The nerve root ganglion has an extensive venous plexus. Obstruction can result in venous hypertension and endoneural edema with resultant hypoxia, ischemia and pain. External decompression can be expected to relieve venous hypertension and reverse the pathognomonic process (back when this paper was published less was known. During the latter part of 2004 an article was published in Spine revealing more information regarding the process involved in pain related to disc degeneration.)
Through the significant reduction of intradiscal pressure, decompression therapy could shear a herniation from its connection to the nucleus. This in turn would create a severed fragment within the spinal canal that would be subject to small vessel invasion and digestion.
Inflammation very likely plays a role in disc pathology. To date the use of anti-inflammatories has been disappointing. Based on the mechanism of action, some think that the use of anti-inflammatories will become more effective if used in conjunction with decompression therapy and its associated pumping action.
(Vertebral Axial Decompression* therapy can be used to achieve a therapeutically or a prophylactic effect.)
Internal Disc Decompression vs. Traction
Dr. Frank Tilaro states in his article Vertebral Axial Decompression that in his review of the literature, he did not find any data showing that conventional traction reduced intradiscal pressure to a negative range.
Furthermore, he could not find any studies showing that conventional traction created any beneficial effects in treating nerve root compression and conditions associated with disc disease.
It is a well-known fact that chronic low back pain patients and low back surgery patients are very costly to society. As a result of his research, Dr. Tilaro has concluded that since many of these patients have favorable responses to this non-invasive form of treatment, it represents a considerable cost savings. This not to mention the associated return to function and decreased pain levels in those receiving benefit from lumbar decompression therapy.
* Vertebral Axial Decompression AKA Computerized Spinal Decompression or CSD