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Vertebral Axial Decompression Therapy for Pain Associated with Herniated
or Degenerated Discs or Facet Syndrome: An Outcome Study,
Journal of Neurological Research, Vol. 20, April 1998 Gose, W. Naguszewski and R. Naguszewski
Herniated discs, degenerative discs, facet syndrome - 778 cases, 71% successful in decreasing pain to 0-1 on a 0-5 pain scale. Improved mobility as well as activities of daily living.
For most patients the cause or causes of persistent low back pain remains poorly understood. Although imaging procedures, including CT and MRI, are able to accurately define structural pathology, the correlation of these anatomic findings with physiology, back pain, and other clinical complaints is imprecise. Although surgical decompression, epidural blocks, and spinal instrumentation can sometimes help patients suffering from low back pain, these treatments do not completely take the biomechanical function of the disc into account, and may leave patients unrelieved of their suffering. In addressing the dysfunction of the disc with discectomy or surgical instrumentation, the biomechanical and physiological function of the disc is permanently disrupted.
Activity related to mechanical low back pain is aggravated by activities that increase axial loading on the spine, such as sitting, standing and lifting. Patients may describe some relief with walking, but more particularly, by lying down, which unloads the spine and reduces intradiscal pressure.
The causes of mechanical low back pain may include degenerative disc disease, degenerative spondylosis with limitation of range of motion, facet arthropathy, relative lateral recess stenosis from a combination of the above, microenvironment pressure changes affecting the thecal and epidural space from disc bulging, subligamentous and/or extruded herniation, and segmental instability. Pain Generation - The research involved in the identification of pain associated with degenerative disc disease states that it is likely multifactorial.
- With the loss of disc height and therefore spacing between vertebra there is increased loading on the spine. The resultant increase in mechanical loading is thought to cause pain that will continue to be a source of irritation as long as there is decreased disc height.
- As a result of decreased spacing between vertebra ligaments that attach to adjacent vertebrae buckle, potentially pushing on nerve roots and into the central (spinal) canal.
- Distortion and/or damage to the othermost fibers of the lumbar discs cause a pain response.
Blood Flow - Even slight compression (less than one pound per square inch) on the nerve roots within the central canal can cause complete blockage of blood flow to these nerve roots.
Distraction:
- Cadavers exposed to sustained contraction demonstrated significant increases in pressure within the vertebral column.
- This effect of increased length has been observed to hold longer in the more elderly spine.
- This effect of lengthening has been hypothesized as being the result of disc rehydration or fluid being flushed back into the disc itself.
- This rehydration process creates a tremendous diffusion gradient allowing for glucose, oxygen as well as key nutrients (e.g. sulphate ions) to enter the damaged disc and facilitate structural restoration of the disc.
Physical changes as a result of lumbar decompression:
- Fourteen patients with lumbar disc prolapse were treated with decompression therapy. Ten showed definite clinical improvement with reduced back and sciatic pain.
- Nine of these patients showed complete resolution of the disc defect with subsequent epidurogram. Gupta and Ramarao (Arch Phys Med Rehabilitation 1978; 59:322-327) concluded that disc protrusions may be safely treated by traction/decompression.
- One of the decompression machines that is in use today has been shown to decompress the center structure of the disc to below - One machine has been show to generate a negative 100 mmHg at the center of the damaged disc.
Discussion of traction therapy:
"Intuitively, lumbar traction should be successful in alleviating many of the conditions which cause low back pain and associated radiculopathy (in the low back - leg pain that results from nerve root irritation)." Up until now studies have not been reflective of this belief.
"Technological advances have now led to the development of equipment that can achieve decompression of lumbar discs without stimulating the reactive effects of the lumbar musculature that can otherwise overcome efforts to effectively distract vertebral bodies."
"The equipment applies distractive/decompressive forces in a gradual, progressive fashion, designed to achieve distraction of the vertebral bodies without eliciting reactive reflex muscular resistance."
Each decompression phase, during which tension is increased, normally last for one minute. This is followed by a rest phase where tension is gradually decreased over a period of 30 seconds. Another cycle then starts. The typical therapy session consists of approximately 15 cycles of tension and relaxation lasting about 25 minutes.
The Study:
- 778 patients suffering from low back pain were included in this study. These patients were treated at 22 medical centers in the United States.
- Diagnosed with herniated disc (including extrusion and multiple herniated discs), degenerative disc or facet syndrome
- Each must have received at least 10 sessions of decompression therapy to be included in the study results.
- All qualified participants were scored for levels of pain, mobility, activity and satisfaction both before and after completion of their respective treatment programs.
The Results:
- 71% of these low back pain sufferers experienced a significant reduction in pain. This reduction in pain was a decrease in pain to a level of 0-1 on a 0-5 scale.
- Most of the gains in both pain relief and mobility were achieved in the last half of the treatment programs.
- 77% of patients experienced at least a 33% increased in mobility.
- 78% of patients experienced at least a 33% increase in activity.
- Patient satisfaction was rated between "very satisfied" and "completely satisfied".
- In this study 31 patients had previous lumbar disc surgery. These patients were found to tolerate decompression therapy well. 65% of these patients had pain reduction to a level of 0-1 on a 0-5 scale.
Discussion:
- The authors concluded that decompression therapy should be considered a primary treatment modality of low back pain associated with lumbar disc herniation at single or multiple levels, degenerative disc disease, facet arthopathy, and decreased spine mobility. They go on to state that post-surgical patients with persistent pain or "Failed Back Syndrome" should not be considered candidates for further surgery until a reasonable trial of vertebral axial decompression has been tried.
- In summary, pain, activity and mobility scores all greatly improved after decompression therapy.
- Decompression therapy may more precisely address the physiology of persistent low back pain when compared to conventional therapies.
"We consider it to be a front line treatment for degenerative spondylitis, facet syndrome, disc disease and non-surgical radiculopathy."
*Vertebral Axial Decompression AKA Computerized Spinal Decompression or CSD
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