Vertebral Axial Decompression Therapy for pain associated with herniated or degenerated discs or facet syndrome: An outcome study
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Each decompression phase, during which the tension is increased, normally lasts for one minute. The force is increased more slowly in the latter part of the decompression phase. The tension is then gradually decreased, over a period of 30sec, to about 20 pounds, which is maintained during the rest phase. Another cycle then starts. The avoidance of paravertebral muscle contraction, stimulated by homeostatic proprioceptor and axon reflex mechanisms allows the distraction of the vertebral bodies necessary to achieve decompression of the intervertebral disc. The therapy is administered via an automated logic control mechanism which systematically applies distractive tensions and rest periods in a cyclic fashion. The typical therapy session consists of 15 cycles of tension and relaxation.

This periodic process allows patients to withstand stronger forces than can be tolerated when static techniques are used and it promotes accommodation and relaxation during the therapy session. The upper body is fixed by means of the patient grasping adjustable hand grips, designed to eliminate the use of a thoracic corset. Consequently, there is no risk of circulatory or respiratory compromise. The pelvis is secured with a specially designed harness that adjusts snugly and applies forces primarily to the lateral pelvic alae, thus minimizing anterior-posterior pressures and reactive muscle spasm during the distractive period of each cycle.

VAX-D treatment has been shown (11) to decompress the nucleus pulposus to pressures below -100mmHg. This creates a tremendous potential diffusion gradient across the disc space, which is otherwise an avascular structure. Glucose and oxygen enter the disc at the end plate region while sulphate ions needed for the production of new glycosaminoglycans enter from the annulus fibrosis (12). Thus therapy may augment nutrient flow into the disc, facilitating structural restoration of the disc and promoting disc rehydration, since proteoglycans bind water (13). These effects may be cumulative with repetitive therapy sessions.

MATERIALS AND METHODS

Data was collected from twenty two medical centers in the USA for patients who received VAX-D therapy for low back pain. Only patients who received at least 10 treatments and had a diagnosis of herniated disc, degenerated disc, or facet syndrome, which was confirmed by imaging studies, were included in the study.The average number of treatments was 17 for facet syndrome, 19 for degenerative disc disease, and 20 for other diagnoses. The data contained the patients' assessment of their own pain, mobility, and ability to walk and sit.

The pain scale ran from no pain (0) to severe pain (5). The mobility limitation scale was: No limitation (0), slightly limited (1), very limited (2), and completely immobile (3). The activity limitation scale was: walks frequently (0), walks occasionally (1), chairfast (2), and bedfast (3). The treatment schedule, including the use of other modalities, the duration and frequency of VAX-D therapy, and medication was also recorded, as well as the patient's history. The symptoms were recorded at the beginning, mid-point, and end of the treatment schedule. The patients' satisfaction with the treatment was quantified as: not satisfied (0), slightly satisfied (1), very satisfied (2), and completely satisfied (3).

The data were divided into five groups:

1. The first group which contained 34 cases, included all patients with extruded herniated discs, whether or not additional lesser problems were present.
2. The second group contained 195 cases of multiple herniated discs, without extrusion, with or without degenerative disc disease.
3. The third group consisted of 382 patients with a single herniated disc, regardless of degenerative disease.
4. The fourth group contained 147 cases of degenerative disc disease, without herniation.
5. The fifth group contained 19 cases with facet syndrome had a pain reduction to 0 or 1 before 10 treatments, and one that had a reduction to 2, received less than 10 total treatments, so they were not included in the data base.

RESULTS

If treatment success is defined as a reduction in pain to 0 or I on a 0 to 5 scale, the treatment was successful in 71% of the 778 cases. The success rate varied from 53% for the patients with extruded herniated discs, to 73% for patients with a single herniated disc. It was 72% for people with multiple herniated discs and 68% for facet syndrome. On a pain scale of 0 to 5, the people with extruded herniated discs had an average pain of 4.16 at the beginning of treatment and an average of 1.82 after treatment, a reduction of 56%. The cases of multiple herniated discs went from 4.13 to 1.18, a reduction of 71%. The patients with a single herniation had a reduction from 4.16 to 1.09, or 71%. The degenerative disc cases reduced from 3.93 to 1.17, a 70% reduction. The patients with facet syndrome had a reduction of 4.00 to 1.13, a 72% reduction in pain. Overall, 71 % of the patients experienced a reduction in pain to 0 or 1. The reduction in the average pain score was also 71%. One percent of the patients reported increased pain, 7% had no change, 92% improved by 1 unit or more, 87% improved by 2 units or more, and 70% improved by 3 units or more. A summary of these findings is shown in Table 1.

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