Neck and back pain are significant health and socioeconomic problems in our society, affecting over 80% of North Americans. Symptoms are often recurrent, even if the original presentation resolves, and some people suffer chronic, unremitting symptomatology.
Disc degeneration, bulges and herniations are primary causes of neck or low back pain. Surgical intervention, often with fusion, is frequently suggested, but the end result can be reduced mobility, stiffness and continuing pain - the "failed back syndrome." Lipson, in a 2004 paper in the New England Journal of Medicine,(1) states that 151,000 spinal fusions are done each year in America. He advocates restraint because of the complications and typically modest benefits associated with surgery.
The high incidence of chronicity, recurrence of pain and 'failed back syndrome' for patients with neck and back pain suggests that management protocols need to be revisited.
Spinal decompression is essentially the evolution of traction
With respect to neck or back application, traction can be defined as an intermittent or continuous force applied along the long axis of the spine, in an attempt to elongate the spine, or the act of pulling or stretching muscle or joints. However, pain relief with traction has been inconsistent and short-lived.
Why spinal decompression differs from traction therapy
When traction is applied, the body's reaction is to pull in the opposite direction. Spinal decompression equipment, on the other hand, contains sensitive computer-feedback mechanisms, such as strain gauges, to overcome this phenomenon and allow for maximum therapeutic results. A strain gauge is designed to convert mechanical motion into an electronic signal. This allows the equipment to continuously monitor muscular reaction and to compensate by re-adjusting its distraction parameters. Each treatment is centered on a variety of adjustable logarithmic ramp-up, hold and release protocols implemented by the computerized system designed to bypass the proprioceptive response of ligaments and muscles to distraction. By comparison, physiotherapy, traction, chiropractic or osteopathy cannot adequately bypass the body's protective proprioceptive response and therefore cannot create negative intradiscal pressure for extended periods
A study by the Department of Neurosurgery and Radiology, Rio Grande Regional Hospital and Health Sciences Center, University of Texas, demonstrated the specific and important clinical action of decompression therapy that makes it effective. Intradiscal pressure measurement was performed by connecting a cannula inserted into the patient's L4-L5 disc space to a pressure transducer. Spinal decompression was introduced and changes in pressure were recorded at a resting state and again while controlled tension was applied by the equipment. The results of this study indicate that it is possible to lower pressure in the nucleus pulposus of herniated lumbar discs to below -100 mm Hg when distraction tension is applied according to the protocol described for decompression therapy. The lowest intradiscal pressure measured during progressive traction was 40 mm Hg compared to 75 mm Hg resting supine.(2) Standard decompression therapy, therefore, differs from standard traction by creating a unique clinical circumstance of prolonged negative intradiscal pressure.
Nurtrifying the disc
The avascular nature of discs necessitates that imbibition is the mechanism by which a disc obtains its nutrients and oxygen, and for removal of metabolic waste products. With spinal decompression's precise, computer-controlled tension, the appropriate disc levels are gently and painlessly distracted to achieve a negative pressure within the disc. The negative pressure created in the nucleus pulposus allows compressed discs to be reoxygenated, rehydrated and renutrified as they draw in moisture and nutrients from the surrounding body tissues as well as promote retraction of bulging or herniated discs.
Indications, contra-indications and course of management
A typical course of management consists of approximately twenty spinal decompression sessions, at a frequency ranging from daily to weekly, with each treatment lasting approximately 30 minutes. Decompression therapy is performed on patients while fully clothed. Ice may be applied after treatment. The treating doctor can make modifications in the angle of distraction, position of the spine, and the amount of force applied in order to target appropriate spinal levels.
Spinal decompression has the capability of relieving pressure on the spinal nerves caused by disc herniations and degenerative disc disease, and is helpful for conditions such as sciatica and facet syndrome. Spinal decompression therapy is used to treat acute or chronic neck or low back pain and associated neurological symptoms. If neck or low back symptoms have not resolved with other types of treatment, spinal decompression therapy should be considered for people with diagnoses of disc bulge, disc herniation, degenerative disc disease, facet syndrome, sciatica and spinal stenosis.
Inclusion criteria for decompression therapy include pain due to herniated and bulging lumbar discs that is more than four weeks old; recurrent pain from a failed back surgery that is more than six months old, persistent pain from degenerated discs not responding to four weeks of therapy, patients available for the duration of treatment protocol, and, patients should be at least 18 years of age.(3)
Contraindication criteria include pregnancy, spinal fusion with metallic rods, severe osteoporosis, unstable spondylolisthesis, lumbar vertebral compression fracture below L1 (recent), local spinal osteomyelitis, meningitis, aortic aneurysm, primary malignant or metastatic spinal neoplasm, pelvic/abdominal malignancy, local bilateral pars defects, severe peripheral neuropathy, hemiplegia, paraplegia, cognitive dysfunction, cauda equina syndrome and disc pathology with sequestration.
An increasing number of studies are demonstrating the efficacy of spinal decompression therapy.
In a recent study of 219 patients with herniated discs and degenerative disc disease, 86 percent who completed the therapy showed immediate improvement and resolution of their symptoms; 92 percent improved overall; five patients (2 percent) relapsed within 90 days of initial treatment.(4)
Gose et al (5) state: "We consider decompression therapy to be a primary treatment modality for low back pain associated with lumbar disc herniation at single or multiple levels, degenerative disc disease, facet arthropathy, and decreased spine mobility. We believe that post-surgical patients with persistent pain or 'Failed Back Syndrome' should not be considered candidates for further surgery until a reasonable trial of decompression has been tried."
Eugene et al (6) report: "For any given patient with low back and referred leg pain, we cannot predict with certainty which cause has assumed primacy. Therefore surgery, by being directed at root decompression at the site of the herniation alone, may not be effective if secondary causes of pain have become predominant. Decompression therapy, however, addresses both primary and secondary causes of low back and referred leg pain. We thus submit that decompression therapy should be considered first, before the patient undergoes a surgical procedure which permanently alters the anatomy and function of the affected lumbar spine segment."
Recommendations and conclusions
While results obviously vary, many back pain patients who undergo decompression therapy, including those who are long-term chronic or post-surgical cases, are able to resume normal activities. Patients not showing significant improvement by the 15th to 18th session may be referred for further diagnostic evaluation. Age, body morphology, smoking, previous surgery, chronic use of narcotic or steroid medications, obesity, and large amounts of daily caffeine may negatively affect the outcome.
Surgery should only be considered following a reasonable trial of the decompression protocols.
Spinal decompression therapy is safe, comfortable and painless. As decompression therapy becomes better known, patients are likely to look to chiropractors as a source of information, referral or treatment. Knowledge about the technique is a good place to start for those who wish to educate their patients about alternatives to surgery.
1 Lipson SJ. Spinal Fusion Surgery – Advances and Concerns. N Engl J Med 350(7):643-4; Feb 2004
2 Ramos G, Martin W. Effects of Vertebral Axial Decompression on Intradiscal Pressure.
J Neurosurg 81(3): 350-3; Sep 1994.
3 O'Hara K, editor. Decompression: A Treatment for Back Pain. Clinical Care Update. Occ Med 11(10); Oct 2004. 6
4 Glonis T, Groteke E. Spinal Decompression. Orth Tech Review 5(6):36-39; Nov-Dec 2003.
5 Gose E, Naguszewski W, Naguszewski R. Vertebral Axial Decompression Therapy for pain associated with herniated or degenerated discs or facet syndrome: an outcome study. J Neuro Research 20(4):186-90; Apr 1998.
6 Eugene S, Kitchener P, Smart R. A Prospective Randomised Controlled Study of VAX-D and TENS for the Treatment of Chronic Low Back Pain. J Neuro Research 23(7); Oct 2001.
Dr Arnie Deltoff, a 1990 CMCC graduate, is the clinical director of Central Chiropractic Group in Toronto and co-founder of Welcome Back Spinal Care Centers offering spinal decompression therapy. Learn more about spinal decompression at www.welcome-back.ca.