The Effects of Vertebral Axial Decompression On Sensory Nerve Dysfunction
in Patients with Low back Pain and Radiculopathy:
Frank Tilaro, M.D. Dennis Miskovich, M.D.
Canadian Journal of Clinical Medicine Vol 6, No 1, January 1999

ABSTRACT

Effective non-surgical decompression of the nerve root has not been available to this date. The vertebral axial decompression (VAX-D) therapeutic table has demonstrated an ability to significantly reduce intradiscal pressure to a negative 150mmHg., allowing for disc decompression. The purpose of this study was to determine if VAX-D therapy could externally decompress the nerve root. Patients with radiculopathy and abnormal sensory function determined by the Current Perception Threshold (CPT) Neurometer who had received VAX-D therapy were retrospectively studied. CPT readings on 22 peripheral nerves were taken before and after VAX-D therapy.

Only patients with initial abnormal CPT readings, symptoms of sciatica, positive SLR, and positive imaging studies were reported on. The results after therapy were as follows: 14/22 nerves (64%) returned to normal function, 6/22 (27%) improved, 1/22 (4.5%) had no improvement and 1/22 (4.5%) showed deterioration. The average neurometer grade before therapy was 6.36 and after therapy 2.09 (a score of zero indicates normal function). Overall improvement was 67% (p<0.05). Theoretical considerations regarding the mechanism of action are expounded upon in this paper .

INTRODUCTION

Patients with nerve root compression secondary to a herniated disc are frequently treated surgically although there is evidence they may be managed conservatively. Spangfort's computer assisted analysis of surgically treated disc herniations concluded that disc herniations were best treated surgically (1). This data has been refuted by Weber who conducted a randomised controlled trial between surgically and conservatively treated patients (2). Hakelius reported that patients with neurological deficits did not have any difference in outcome whether treated surgically or conservatively (3). Saal and Saal studied the natural history of radiculopathy and conducted an outcome study in 64 patients with radiculopathy treated non-surgically and concluded that patients with disc herniations could be managed non-surgically (4,5). Bush has reported his results on the successful non-surgical treatment of radiculopathy (6).

Although the literature demonstrates success for treating herniated discs conservatively, many patients still undergo a surgical procedure for patients with nerve root compression. To this date, a non-surgical method to decompress the nerve root has not been available. Non surgical decompression could have significant advantages over the surgical methods currently in use. These may be reduced cost, early back to work, lower morbidity, a reduction in post operative complications and elimination of the failed back syndrome. Medical decompression could constitute a reconstructive process since spinal biomechanics and metabolism should be favorably altered in order to achieve decompression. Surgery does not favorably alter the biochemistry and physiology of the disc.
The vertebral axial decompression (VAX-D) therapeutic table has demonstrated its effectiveness in treating low back pain with and without radiculopathy (7). The table asserts its effects through decompression of the intervertebral disc and has reduced intradiscal pressures to a negative 150mmHg (8). It's assumed that reduction of intradiscal pressures to such significant levels should produce nerve root decompression but this has not been specifically investigated. The purpose of this study was to determine if VAX-D therapy effectively decompresses nerve roots. There was no attempt to correlate the results of this study with the patients outcome.

MATERIALS AND METHODS
A retrospective review of patient charts from an outpatient clinic was conducted. All patients had Current Perception Threshold (CPF) neurometer testing before instituting VAX-D therapy and immediately after completion of a course of therapy. Only patients with abnormal CPT grades who had sciatica, positive SLR, and imaging studies that correlated with the observed clinical syndrome were reported on.

A total of 17 patients qualified, 22 nerves were studied since some patients had multilevel involvement. The nerves measured were the peroneal and sural nerves from the LA-5 and L5-S I nerve roots rsespectively. Sensory nerve dysfunction was measured by the CPT neurometer.

The CPT neurometer relies on transcutancous electric nerve stimulation at multiple sinusoidal frequencies to determine current perception thresholds (9). Its effectiveness has been well established in numerous studies (10,11,12). The CPT measure represents the minimal amount of a painless, neuroselective, transcutaneous electrical stimulus required to reproducibly evoke a sensation at least half the time it's presented. Three independent CPT measurements are obtained from each site tested using three different frequencies of electrical stimuli: 2000 Hz, 250 HZ and 5 Hz representing respectively the large myelinated, small myelinated and small unmyelinated fibers(13). Abnormally low CPT measures indicate a hypersensitive nerve function (seen in early stages of dysfunction) while elevated CPT measures indicate a loss of nerve function reflecting a hypoesthetic condition seen in advanced stages of dysfunction.

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