Spinal decompression
Encyclopedia
Spinal decompression is a term that describes the relief of pressure on one or many pinched nerves (neural impingement) of the spinal column.
Spinal decompression can be achieved both surgically and non-surgically and is used to treat conditions that result in chronic back pain such as disc bulge, disc herniation, sciatica
, spinal stenosis, and isthmic and degenerative spondylolisthesis
.
, or open decompression.
Microdiscectomy is a minimally invasive surgical procedure in which a portion of a herniated nucleus pulpolsus is removed by way of a surgical instrument or laser while using an operating microscope or loupe for magnification.
Laminectomy is an invasive surgical procedure in which a small portion of the arch of the vertebrae (bone) is removed from the spine to alleviate the pressure on the pinched nerve. This is an elective procedure for those that have not found relief of their back pain through more conservative treatment options.
device applied through an on-board computer that controls the force
and angle
of disc distraction, which reduces the body’s natural propensity to resist external force and/or generate muscle spasm. This enhanced control allows non-surgical spinal decompression tables to apply a traction force to the discs of the spinal column reducing intradiscal pressure, unlike previous non-computer controlled traction tables.
Inversion therapy
, which involves hanging upside down, is a form of mechanical traction used for spinal decompression.
The practice is promoted as safe and effective without the normal risks associated with invasive procedures such as injections, anesthesia or surgery. Spinal decompression works through a series of 15 one minute alternating decompression (using a logarithmic decompression curve) and relaxation cycles with a total treatment time of 30 minutes. During the decompression phase the pressure in the disc is reduced and a vacuum type of effect is produced on the nucleus pulposis. At the same time nutrition is diffused into the disc allowing the annulus fibrosis to heal. Very rarely is the nerve root compressed from the herniated disc and usually the back and leg pain associated with these conditions is a result of irritation to the nerve root sleeve by the inflammatory chemicals that are released as a result of inflammation in the disc.
The treatment has several varying versions, including articulating spinal decompression or range-of-motion (ROM) decompression, which enables the doctor or therapist to adjust the patient's spinal posture
during the decompression. Varying the spine
's posture enables the decompressive pulling forces to reach into spinal areas and tissues that basic linear decompression misses. The Antalgic-Trak is a brand name for an articulating decompression system.
, thereby creating a suctioning effect or vacuum phenomenon in order to retract or reduce the size of the herniated or bulging disc's gelatinous internal nucleus pulposus
, thus diminishing or eliminating nerve compression, while at the same time creating an osmotic gradient which helps bring nutrients and water into the disc. Since intervertebral discs have poor circulation, they depend upon receiving their nutrition through diffusion across the end plates
of the vertebrae above and below.
The appeal of non-surgical spinal decompression is that it is a non-invasive, non-surgical, drug-free alternative treatment for low back pain, sciatica, disc degeneration, disc bulges, disc herniations, and facet syndrome. There is copious anecdotal evidence of its effectiveness and more case studies are being published demonstrating very positive results in patients who have tried other conservative treatments that have failed.
force being applied to reduce muscle guarding and spasm. In 2004, Vax-D Medical Technologies introduced an enhanced version of this table called the G2 that replaced the pneumatic technology with more precise electrically driven components and also added an enhanced on board computer control system that instituted a logarithmic curve.
Many other doctors, scientists, and corporations have developed other non-surgical spinal decompression tables, each with features believed to mimic or enhance the effectiveness of the original concept. Intervertebral differential dynamics (IDD) therapy is a similar technique.
A 2004 report by the State of Washington Department of Labor and Industries concluded "Published literature has not substantially shown whether powered traction devices are more effective than other forms of traction, other conservative treatments, or surgery." A 2005 review of VAX-D (including the Sherry study above) by the Workers' Compensation Board of British Columbia concluded "To date there is no evidence that the VAX-D system is effective in treating chronic LBP associated with herniated disc, degenerative disc, posterior facet syndrome, sciatica or radiculopathy."
A 2006 systematic review of studies of spinal decompression using motorized traction devices conducted between 1975 and October 2005 (including the two mentioned above) concluded that "...the efficacy of spinal decompression achieved with motorized traction for chronic discogenic low back pain[ remained] unproved", and called for "Scientifically more rigorous studies with better randomization, control groups, and standardized outcome measures … to overcome the limitations of past studies." A technology assessment conducted in 2007 by the Agency for Healthcare Research and Quality
(for which the two studies cited above were included for analysis) said "Currently available evidence is too limited in quality and quantity to allow for the formulation of evidence-based conclusions regarding the efficacy of decompression therapy as a therapy for chronic back pain when compared with other non-surgical treatment options."
A 2007 critique of research studies, including the two cited above, said:
Spinal decompression can be achieved both surgically and non-surgically and is used to treat conditions that result in chronic back pain such as disc bulge, disc herniation, sciatica
Sciatica
Sciatica is a set of symptoms including pain that may be caused by general compression or irritation of one of five spinal nerve roots that give rise to each sciatic nerve, or by compression or irritation of the left or right or both sciatic nerves. The pain is felt in the lower back, buttock, or...
, spinal stenosis, and isthmic and degenerative spondylolisthesis
Spondylolisthesis
Spondylolisthesis describes the anterior or posterior displacement of a vertebra or the vertebral column in relation to the vertebrae below. It was first described in 1782 by Belgian obstetrician, Dr. Herbinaux. He reported a bony prominence anterior to the sacrum that obstructed the vagina of a...
.
Surgical spinal decompression
Surgical spinal decompression can be performed in two common procedures. These procedures are known as microdiscectomy, or microdecompression, and laminectomyLaminectomy
Laminectomy is a spine operation to remove the portion of the vertebral bone called the lamina. There are many variations of laminectomy. In the most minimal form small skin incisions are made, back muscles are pushed aside rather than cut, and the parts of the vertebra adjacent to the lamina are...
, or open decompression.
Microdiscectomy is a minimally invasive surgical procedure in which a portion of a herniated nucleus pulpolsus is removed by way of a surgical instrument or laser while using an operating microscope or loupe for magnification.
Laminectomy is an invasive surgical procedure in which a small portion of the arch of the vertebrae (bone) is removed from the spine to alleviate the pressure on the pinched nerve. This is an elective procedure for those that have not found relief of their back pain through more conservative treatment options.
Non-surgical spinal decompression
Non-surgical spinal decompression is achieved through the use of a mechanical tractionTraction (orthopedics)
In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system.There are two types of traction: skin traction and skeletal traction....
device applied through an on-board computer that controls the force
Force
In physics, a force is any influence that causes an object to undergo a change in speed, a change in direction, or a change in shape. In other words, a force is that which can cause an object with mass to change its velocity , i.e., to accelerate, or which can cause a flexible object to deform...
and angle
Angle
In geometry, an angle is the figure formed by two rays sharing a common endpoint, called the vertex of the angle.Angles are usually presumed to be in a Euclidean plane with the circle taken for standard with regard to direction. In fact, an angle is frequently viewed as a measure of an circular arc...
of disc distraction, which reduces the body’s natural propensity to resist external force and/or generate muscle spasm. This enhanced control allows non-surgical spinal decompression tables to apply a traction force to the discs of the spinal column reducing intradiscal pressure, unlike previous non-computer controlled traction tables.
Inversion therapy
Inversion therapy
Inversion therapy involves hanging upside down or at an inverted angle with the intention of therapeutic benefits. However, it is rarely regarded as a serious treatment for back pain.-Traction and stretching:...
, which involves hanging upside down, is a form of mechanical traction used for spinal decompression.
The practice is promoted as safe and effective without the normal risks associated with invasive procedures such as injections, anesthesia or surgery. Spinal decompression works through a series of 15 one minute alternating decompression (using a logarithmic decompression curve) and relaxation cycles with a total treatment time of 30 minutes. During the decompression phase the pressure in the disc is reduced and a vacuum type of effect is produced on the nucleus pulposis. At the same time nutrition is diffused into the disc allowing the annulus fibrosis to heal. Very rarely is the nerve root compressed from the herniated disc and usually the back and leg pain associated with these conditions is a result of irritation to the nerve root sleeve by the inflammatory chemicals that are released as a result of inflammation in the disc.
The treatment has several varying versions, including articulating spinal decompression or range-of-motion (ROM) decompression, which enables the doctor or therapist to adjust the patient's spinal posture
Neutral spine
A neutral spine or good posture refers to the "three natural curves [that] are present in a healthy spine."- Posture :The word "posture" comes from the Latin verb "ponere" which is defined as "to put or place." The general concept of human posture refers to "the carriage of the body as a whole, the...
during the decompression. Varying the spine
Vertebral column
In human anatomy, the vertebral column is a column usually consisting of 24 articulating vertebrae, and 9 fused vertebrae in the sacrum and the coccyx. It is situated in the dorsal aspect of the torso, separated by intervertebral discs...
's posture enables the decompressive pulling forces to reach into spinal areas and tissues that basic linear decompression misses. The Antalgic-Trak is a brand name for an articulating decompression system.
Theoretical foundations
The theory behind non-surgical spinal decompression is that significant distractive forces, when applied to the lumbar spine in variable directions, can create a negative pressure in the center of the intervertebral discIntervertebral disc
Intervertebral discs lie between adjacent vertebrae in the spine. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together.-Structure:...
, thereby creating a suctioning effect or vacuum phenomenon in order to retract or reduce the size of the herniated or bulging disc's gelatinous internal nucleus pulposus
Nucleus pulposus
Nucleus pulposus is the jelly-like substance in the middle of the spinal disc. It is the remnant of the notochord . It functions to distribute hydraulic pressure in all directions within each disc under compressive loads. The nucleus pulposus consists of chondrocyte-like cells, collagen fibrils,...
, thus diminishing or eliminating nerve compression, while at the same time creating an osmotic gradient which helps bring nutrients and water into the disc. Since intervertebral discs have poor circulation, they depend upon receiving their nutrition through diffusion across the end plates
Neuromuscular junction
A neuromuscular junction is the synapse or junction of the axon terminal of a motor neuron with the motor end plate, the highly-excitable region of muscle fiber plasma membrane responsible for initiation of action potentials across the muscle's surface, ultimately causing the muscle to contract...
of the vertebrae above and below.
The appeal of non-surgical spinal decompression is that it is a non-invasive, non-surgical, drug-free alternative treatment for low back pain, sciatica, disc degeneration, disc bulges, disc herniations, and facet syndrome. There is copious anecdotal evidence of its effectiveness and more case studies are being published demonstrating very positive results in patients who have tried other conservative treatments that have failed.
History
Non-surgical spinal decompression was originally developed and pioneered by Dr. Allan Dyer, PhD, MD in 1985 and the first non-surgical spinal decompression table, the Vax-D was introduced by him in 1991. This original device was controlled by a pneumatic system and gradually applied and released, with the tractionTraction
- Engineering :*Forces:** Traction , adhesive friction or force in the context of vehicle** Traction vector, in mechanics, the force per unit area on a surface, including normal and shear components...
force being applied to reduce muscle guarding and spasm. In 2004, Vax-D Medical Technologies introduced an enhanced version of this table called the G2 that replaced the pneumatic technology with more precise electrically driven components and also added an enhanced on board computer control system that instituted a logarithmic curve.
Many other doctors, scientists, and corporations have developed other non-surgical spinal decompression tables, each with features believed to mimic or enhance the effectiveness of the original concept. Intervertebral differential dynamics (IDD) therapy is a similar technique.
Effectiveness
In a small randomized study of 44 subjects, in which one author disclosed a proprietary interest in Vax-D, it was shown to have a clinical success rate of 68.4%.A 2004 report by the State of Washington Department of Labor and Industries concluded "Published literature has not substantially shown whether powered traction devices are more effective than other forms of traction, other conservative treatments, or surgery." A 2005 review of VAX-D (including the Sherry study above) by the Workers' Compensation Board of British Columbia concluded "To date there is no evidence that the VAX-D system is effective in treating chronic LBP associated with herniated disc, degenerative disc, posterior facet syndrome, sciatica or radiculopathy."
A 2006 systematic review of studies of spinal decompression using motorized traction devices conducted between 1975 and October 2005 (including the two mentioned above) concluded that "...the efficacy of spinal decompression achieved with motorized traction for chronic discogenic low back pain
Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality is a part of the United States Department of Health and Human Services, which supports research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective...
(for which the two studies cited above were included for analysis) said "Currently available evidence is too limited in quality and quantity to allow for the formulation of evidence-based conclusions regarding the efficacy of decompression therapy as a therapy for chronic back pain when compared with other non-surgical treatment options."
A 2007 critique of research studies, including the two cited above, said: