Wednesday, October 1, 2008

Spinal Decompression: New Hope or Big Hype? A Critical Review

Spinal Decompression: New Hope or Big Hype? A Critical Review
Spinal Decompression in NYC
Back Pain Treatment

Spinal Decompression: Hope or Hype?

No doubt by now you’ve read the ads “New Hope for Disc Pain & Sciatica,” “Miracle Disc Treatment”, “How the Space Age Cracked the Back Pain Code” and the myriad others in the papers. You’ve seen the TV ads or heard spots on the radio all purporting to have the answer to the leading cause of disability in the U.S. – Back pain. The ads speak of back pain relief using space age technology without drugs or surgery for even the worst herniated discs. But is Non-Surgical Spinal Decompression (NSSD) or Intervertbral Disc Distraction (IDD therapy) really a “space age” miracle or just hype? These ads appear everyday in the New York Post and the NYC version of the AM paper and New York Metro paper.

Back Pain Facts Derived from the American Chiropractic Association:

•One-half of all working Americans admit to having back pain symptoms each year.

•Back pain is one of the most common reasons for missed work. In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.

•Most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer.

•Americans spend at least $50 billion each year on back pain—and that’s just for the more easily identified costs.

•Experts estimate that as many as 80% of the population will experience a back problem at some time in our lives. While others report the number to be as high as 90%.

With that many people suffering from back pain and that much money and time being spent on it, its no wonder doctors are eager to find a cure.

Cure for Serious Back Pain is Elusive:

The claims made by spinal decompression physicians are incredible and seem too good to be true. It is well known that for serious back pain — back pain caused by intervertebral disc herniations or “slipped discs”, degenerative disc disease, stenosis, etc – most popular treatments are not effective.

Traditional medicine’s approach of medications, periods of rest, home exercises, steroid injections and eventual surgery fail more times than not. A Scandinavian study published in the December 2001 journal “Spine”, found that a dismal 1 in 6 patients undergoing spinal fusion had an “excellent” result 2 years after surgery. Overall, back surgery is clinically reported to be at best 50% effective and involves tremendous risk. Second or repeat surgeries are common and lead many into long-term pain management centers.

More conservative approaches such as physical therapy, yoga, chiropractic and acupuncture all claim to deal with back pain. Unfortunately, while they are much less risky than drugs or surgery and have been proven to help with common low back problems from strains, poor posture, etc, there are no long-term studies that point to any of them as being successful for curing or relieving pain from more serious conditions such as disc herniations or stenosis.

Dehydration and Breakdown of the Disc is at the Root of Serious Back Pain:
The difficulty seems to be in the nature of the problem itself. The disc is a fibrocartilagenous structure that provides space between the vertebrae or spinal bones to allow nerves to exit freely and communicate with the rest of the body. The discs also act as mini “shock absorbers” dissipating the energy and stress from standing, walking and bending against gravity. The disc must rely on water and nutrients it gets from the body at night while resting to replenish itself.

Injuries to the spine can cause the vertebrae or bones to get stuck not allowing the disc to open up and get replenished at night. Injuries to the disc itself can cause it to leak out much needed water. The result is dehydration and eventual breakdown of the disc, which causes it to bulge outward towards the nerves. If the condition is severe enough, the outer disc layers are actually torn or split open to allow the internal disc material or jelly to protrude outward and contact sensitive nerves.

Non-Surgical Spinal Decompression proponents claim to restore water to the disc and reduce disc herniations and/or bulges through the use of a specially made decompression machine, but do these machines really work?

Decompression vs Traction

A review of the many so-called decompression machines on the market reveals some interesting facts. First, most machines commercially available are nothing more than traction machines. Traction has been around along time, but unfortunately has not been proven to decompress the discs to any great degree. No peer-reviewed journal articles exist that conclusively show that the discs are opened up or re-hydrated by simple traction.

There are very few machines that can actually be classified as decompression machines. Spinal decompression therapy has been tested and shown favorable results. A clinical research project was conducted to determine the response of over 200 back pain subjects suffering with disc bulging, herniation and/or degeneration to non-surgical spinal decompression.

Global Proof of Spinal Decompression?
The results were shocking. Over 90% of the subjects reported significant pain relief. Fully 86% of the test subjects reported immediate resolution of their pain following treatment. Further, nearly 90% of the test subjects reported lasting pain relief beyond 90 days. Clinical evidence suggests that these were not isolated findings. Non-surgical spinal decompression therapy has been shown in several papers around the globe to provide relief of back pain and leg pain due to disc herniation, bulging disc, degenerative disc disease, stenosis and failed back surgery.

Readers must be cautioned however that the clinical trial and resulting journal article was based on the research done on a specific spinal decompression unit and not merely a traction machine. Traditional traction machines have not been able to show nearly the results that spinal decompression has. However, this has not stopped “traction machine” manufacturers from making claims of 86% success rate for their machines despite their lack of documentation.

Beware of Imposters

Many clinics are popping up claiming to provide spinal decompression therapy, while merely employing traction units using the advertising and marketing materials created by Axiom Worldwide, Inc. a leader in spinal decompression and manufacturer of the DRX9000. Many of these machines use simple electrical winches with a rope to pull on the spine, while others are actually roller massage tables that you lie on as rollers move up and down your back. These are hardly new technology and have been plied by chiropractors and physical therapists for 30 years and more.

Axiom Worldwide, Inc. claims their patented process of “True Spinal Decompression” is unique and has garnered a lions’ share of the decompression market since entering the field in 2001.

DRX9000 Spinal Decompression the Real Deal?

So it would appear that at least in the case of a DRX9000, non-surgical spinal decompression may be the real deal. The medical literature seems to support it and more and more clinical data is coming in anecdotally supporting this new medical procedure.

Questionable Practices
Some prospective patients report some spinal decompression practitioners to be all too eager to put just about anyone with back pain on their machines. A careful review of procedures for Axiom’s DRX9000 indicates several contraindications for treatment including previous back surgery where rods, screws, bolts or wires are used, severe osteoporosis, fracture, tumor and others. These are conditions or situations where spinal decompression is not recommended due to safety concerns. Barring this, the treatment appears safe. The FDA gives clearance to the DRX9000 as a medical device and there are no reported side effects. Obviously, a careful history and examination by a spinal decompression specialist would be in order prior to treatment.

Spinal decompression is gaining popularity making it too hard for some clinics to resist making a quick buck, by employing cheap traction machines operated by ill-trained employees. Worse yet, and making safety a chief concern, is that some clinics that were polled didn’t even bother to have a doctor of any sort perform an exam. Technicians were used to evaluate a patient’s suitability for this treatment that has many potential dangers for the wrong type of patient.

Any prospective patient should be aware of these facts and select the facility that adheres to safety and qualification standards set by the manufacturer have an actual licensed physician perform an examination and are staffed by certified technicians. If a clinic is ready to “sign you up” after only a cursory evaluation, beware. They may be putting their bottom line ahead of your safety.
In my NYC Spinal decompression I use the DRX 9000 which in my opinion combined with the Cox flexion distraction table is the best Spinal decompression treatment available today.

But is Spinal Decompression a “Cure All”?
As for a “cure all” as some of the ads hyping the process lead health care consumers to believe, the answer is an emphatic “no.” Many conditions cannot be treated by spinal decompression and it is not intended for minor back pain that responds quickly to therapy or chiropractic care. But for the millions of people suffering from serious back pain and leg pain associated with disc herniation, bulging discs, degenerative disc disease, facet syndrome, sciatica, spinal stenosis, chronic low back pain or failed back surgery, spinal disc decompression therapy using the DRX9000 has been medically proven to be 86% effective.

The Bottom Line: Costs

Costs of spinal decompression programs vary as do all medical procedures from location to location. An average cost for Manhattan and New York City area for spinal decompression range from $4,000 to $7,000. In our NYC Spinal Decompression clinic we utilize the Spine Force for advanced spinal rehab and have found that it helps to increase patient outcomes.
Important points to remember are that claims of “Medicare accepted” or “Work Comp Approved” or other claims of insurance acceptance are deceptive advertising claims. At the present time there are no insurance codes for spinal decompression. That means insurance will not pay specifically for spinal decompression. Some clinics have resorted to these claims to attract new business. Once the patient is in the door they are either notified Medicare will not cover the service or the clinic may be intentionally mis-coding their claims to get paid for something that is not covered. We have had certain insurance policies cover the treatment 100% and others cover for the Physical therapy portion. It is best to contact the office and schedule a no-cost consultation first to determine if you are a candidate for the procedure and we can verify insurance coverage at that point in time.

Some components of a spinal decompression program may be covered by insurance. It all depends on what type of insurance you have and if there are any limitations to certain procedures. Many patients with insurance are fortunate to have their insurance company pay the bulk of their care, but no insurance will pay for everything because of the lack of coding for spinal decompression and because insurance coverage seems to shrink year by year.

Much like Laser eye surgery or cosmetic surgery, spinal decompression although valid and helpful, is still considered an elective procedure and “too new” to be issued an insurance code. Cost is generally not the best criteria to make a medical decision on. A loaf of bread is pretty much the same no matter where you buy it.

But for a serious problem like a disc herniation, consumers should make their final decision based on:

Which doctor is best qualified to handle their problem
What is their educational background?
How many years of experience do they have?
How long have they performed spinal decompression
How many patients with similar conditions to yours have they successfully treated?
Are they a specialist dedicated to disc disorders and spinal decompression or are they merely jumping on a lucrative band wagon putting a traction device into an empty room in their clinic?
How’s your rapport with the doctor and staff?
Are they accessible and easy to ask questions?
You are more likely to be satisfied with the best possible service and the most qualified specialist rather than take a chance on a lesser clinic that may not have the requisite experience to handle your unique disc problem and therefore charge under the market rate for the service. Just like everything else in life, you get what you pay for.

In summary, claims of “New Hope for Disc Pain” or “Space Age Miracle Sciatica Treatment” may very well be true. With the advances in technology derived from computer medical technology at least one company, Axiom Worldwide, has put their money where their mouth is and proven their machine to work. With FDA clearance, an 86% success rate and no reported side-effects, DRX9000 Non-Surgical Spinal Decompression treatment provided by a qualified spinal decompression specialist is well worth a try for back pain and leg pain sufferers who haven’t been able to find relief anywhere else and wish to avoid surgery.

Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116.

Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.

Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD, Summer 1994.

Thomas A. Gionis, MD, JD, MBA, MHA, FICS, FRCS, Eric Groteke, DC, CCIC, Spinal Decompression, Orthopedic Technology Review Nov/Dec 2003, Vol. 5, No. 6

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