Efficacy of VAX-D on chronic low back pain: Study of dosage regimen
Gustavo Ramos M.D., Department of Neurology and Radiology
Rio Grande Regional Hospital, McAllen Texas
(page six of six)

DISCUSSION

The likely source of pain is the disc, yet traditional care does not direct therapy to the disc. Fortunately, the spontaneous remission rate for acute low back is high (36). Unfortunately, morbidity and disability waiting for spontaneous remission is also high.

Intradiscal pressures above end-plate capillary pressures may impede oxygen and nutrient diffusion to the avascular disc. Oxygen has a steep concentration gradient across the disc, with peripheral concentrations 20-30 times greater then the center of the nucleus (34). Disc metabolism is principally anaerobic, thus limiting repair and healing. Ohshima and Urban have shown that in common with other cartilage, a decrease in pH reduces proteoglycan and protein synthesis (26).

The VAX-D represents a medical procedure specifically designed to treat the disc. Both mechanical and biochemical mechanisms may explain its mechanism of action. The disc exhibits thixotrophic properties, it becomes more adhesive with compression and less adhesive with reduced intradiscal pressure (4). This property allows VAX-D to facilitate retraction of a protruding nuclear matrix to the center of the disc, relieving irritation and compression on pain sensitive structures. Augmenting the diffusion gradient by reducing the intradiscal pressure with VAX-D should facilitate the transfer of nutrients and oxygen into the disc enhancing metabolism hence healing and repair. A degraded nucleus can no longer accept compressive loads due to spinal loading. This function is now transferred to the annulus, and annular failure results (4,38). By presumably lowering levels of lactic acid in the center of the nucleus with VAX-D, the enzyme cascade responsible for disc degradation (matrix metalloproteinases) which is partially pH dependent, may be inhibited (7,12,21,29).

In this study, two groups of patients with chronic low back pain were subject to a different dosage regimen with the VAX-D. All patients failed previous conservative therapy (medications, chiropractic care, and physical therapy) before treatment with the VAX-D. Two significant observations can be made; the VAX-D achieved a high success rate, 76% achieved remission, and success appears to exhibit a dose-response relationship, (number of sessions administered).

We conclude the VAX-D is a very useful medical procedure for patients with low back complaints of discogenic origin. Patients with Quebec 1, 2, or 3 designation are candidates for VAX-D provided contra-indications are not present. The majority of patients in this study fit the Quebec 2 and 3 criteria. VAX-D should be utilized in all patients who are poor surgical candidates and before surgery is undertaken except in the emergent conditions.

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