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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.
Surgical spinal decompression
Surgical spinal decompression can be performed in two common procedures. These procedures are known as microdisectomy, or microdecompression, and laminectomy, or open decompression.
Microdisectomy 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 traction 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.
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 the traction 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. IDD Therapy is a similar yet advanced technique.
In a small randomized study of 44 subjects, Vax-D was shown to have a clinical success rate of 68.4%, far more effective than surgical options. In a study with a non-randomized sample of just 33 subjects, IDD Therapy was shown to have a clinical effectiveness of 86%. It is believed the addition of heat and electrical muscle stimulation therapy as well as a second variable force that generates a pumping motion within the disc increasing the amount of water, blood, and nutrients it may absorb during the therapy is responsible for the greater clinical effectiveness of this device.
The 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:Template:Bquote
- Sherry, Eugene; Kitchener, Peter; Smart, Russell (October 2001). "A prospective randomized controlled study of VAX-D and TENS for the treatment of chronic low back pain". Neurological Research 23 (7): 780–784. doi:10.1179/016164101101199180. PMID 11680522. One author disclosed a proprietary interest in Vax-D.
- Shealy, C Norman; Koladia, Nirman; Wesemann, Merrill M (July 2005). "Long-term Effect Analysis of IDD Therapy in low back pain: a retrospective clinical pilot study" (PDF). American Journal of Pain Management (American Academy of Pain Management) 15 (3): 93–97. ISSN 1059-1494. http://www.namcorporation.com/pubpdf/wesemann.pdf. Retrieved 2009-03-19. The authors disclosed a proprietary interest in IDD Therapy.
- Wang, Grace (2004-06-14). "Powered Traction Devices for Intervertebral Decompression" (PDF). Health Technology Asessment Update. Office of the Medical Director - Department of Labor and Industries - State of Washington. http://www.lni.wa.gov/ClaimsIns/Files/OMD/TractionTechAssessJun142004.pdf. Retrieved 2009-08-20.
- Martin, Craig W (February 2005). "Vertebral Axial Decompression For Low Back Pain" (PDF). WCB Evidence Based Practice Group - Program Design Division - Workers' Compensation Board of British Columbia. http://www.worksafebc.com/health_care_providers/Assets/PDF/vertebral_axial_decompression_low_back_pain.pdf. Retrieved 2009-08-20.
- Macario, A; Pergolizzi, JV (September 2006). "Systematic literature review of spinal decompression via motorized traction for chronic discogenic low back pain". Pain Practice 6 (3): 171–8. doi:10.1111/j.1533-2500.2006.00082.x. PMID 17147594.
- Jurecki-Tiller, Marie; Bruening, Wendy; Tregear, Stephen; Schoelles, Karen; Erinoff, Eileen; Coates, Vivian; ECRI Institute Evidence-based Practice Center (2007-04-26). "Decompression Therapy for the Treatment of Lumbosacral Pain" (PDF). Technology Assessments. Agency for Healthcare Research and Quality - United States Department of Health and Human Services. http://www.cms.hhs.gov/determinationprocess/downloads/id47TA.pdf. Retrieved 2009-08-20.