pg(26-61) 3/29/07 8:22 AM Page 46 Decompression Spinal Decompression Therapy, Does Your Practice Need It? By: Gregory C. Lewis, D.C. pinal decompression therapy (SDT) has in recent years become a hot topic with much controversy in healthcare, and especially in the field of chiropractic. Many have seen the advertisements in various publications where some companies trumpet one’s ability to have a multi-gazillion dollar cash practice using spinal decompression therapy, and also many of you have noticed the “We are the only company with real, bona-fide, genuine, actual, complete, honest-to-goodness, out-of-this-world decompression” by which some Scompanies attempt to jockey for top sales position on the retail end of the decompression marketplace. Looking past the advertising “hype,” does spinal decompression therapy have a legitimate therapeutic role to play in the chiropractor’s office? I believe the answer is yes. First let’s review briefly some history regarding the evolution of SDT: Axial lumbar traction has been around in one form or another since antiquity. One can find ancient Chinese and Greek drawings depicting rather crude variations of it with ropes and strong men being used in a therapeutic sense. In the early middle ages, axial traction was used in a not-so-therapeutic sense. It would be difficult today to find a physi- cal therapy office or chiropractic office that does not have a traditional traction table in one form or another. The bottom line is spinal traction is not a new concept. What is new, however, is the marriage of this ancient form of therapy with today’s computer technology, and an application of basic physics. Back in the early 1980’s, the basic concept of traction was re-invented in an effort to develop a device that would deliver a traction- like effect in a more focused manner in an effort to target specific disc levels. As a procedure for disc herniation, the goal was made to be able to deliver enough force to the target disc, to create a vacuum effect in that disc. This would actually cause the extruded nuclear material to be retracted or “sucked back in,” thus “decompressing” the nerve and surrounding structures, and attempting to relieve symptoms associated with those structures being compressed. What was found in the earlier devices was that it was possible to apply a distractive force safely, yet not so comfortably, with various degrees of success. Since then, there have been significant improvements in table design and technological innovation. This includes the ability to change the angle of pull, thus allowing one to try to theoretically target a specific disc level with more of the distractive force than that of the surrounding disc levels. Although there is no current research on this topic, this concept obviously makes sense if the patient has a herniated disc at one level, with no or minimal pathology at the other disc levels around it. One can’t totally avoid some distractive force being applied at all disc levels when the modality includes traction in its delivery, but one would prefer not to affect the non-pathological disc levels with the same decompressive force as the disc level one is targeting. One of the unique technological advances with SDT, is the ability to bypass the soft tissue stretch reflexes that would normally trigger muscle spasm when one’s spine is receiving conventional traction. This is achieved by a computer-driven actuator that continually monitors the patient’s status in real-time, and makes micro adjustments in the amount of logarithmic force and application of force being used. This allows for the procedure to be given to an (appropriately triaged) acute patient with less risk of worsening the patient’s symptoms due to reactive muscle spasm. Also some table design technology allows for computer monitoring of the patient’s decompression status during the procedure, and will self-abort the procedure if the parameters in the computer program are not satisfied. I have routinely used SDT on very acute patients with disc herniation, and radiating leg pain in my office with remarkable success. These patients, who are often too acute to tolerate manipulation, have responded very well in my office on my decompression equipment, and they typically are so comfortable, they often fall asleep during SDT. In contrast, I’ve seen acute patients put on traditional traction tables suffer symptom exacerbation, and can not tolerate it due to increased muscle spasm. Obviously, one must use good judgment in triaging patients, and be mindful of indications and contraindications for SDT. Neurologic sta- tus must be monitored on patients, and some will not be good candidates for SDT. Those patients should be referred out for surgical or other medical opinion. 46 D.C. PRODUCTS R EVIEW PM pg(26-61) 3/29/07 8:22 AM Page 48 Decompression Basic physics comes into play in SDT technology through its abili- variety of patients who want to pursue conservative, non-surgical ty to target disc levels. By changing the angle of force application, approaches prior to considering spinal surgery. I have seen amazing one can better localize the focus of the procedure in an attempt to results in patients with decompression therapy in my own practice zero in on a specific disc level. In the lumbar spine, the greater the that I could never achieve with traditional intermittent traction or angle of pull, the higher up the spine (cephalad) is the focus of the other modalities for that matter. distraction force. The opposite is true in the cervical spine where the If one can wade through the advertising hype and controversy, greater the angle of pull, the lower down the cervical spine (caudad) one will find that spinal decompression therapy is a valid therapeu- the focus. Contrast this with traditional spinal traction, where force tic modality that has merit, and compliments the care that is com- is applied diffusely over the entire thoraco-lumbar, or cervical-tho- monly offered in chiropractic practices and other health care prac- racic spine, subjecting each disc level to traction force indiscriminate- tices that deal with back pain. ly. In future articles, I will discuss various decompression-related The angle of pull is changed manually by the table operator either topics including: “What conditions are appropriate for spinal decom- by positioning the cable that attaches to the harness up or down a pression therapy?”; “Is spinal decompression therapy really nothing “tower” that is connected to the decompression table, or in other more than just traction?”; “Spinal decompression therapy: Should it cases, the table itself raises up or down. In yet another design, the be a private pay or insurance-reimbursed modality?”; “What are the pelvis is “captured” directly by the table, and that section of the table indications and contraindications for spinal decompression thera- rotates the pelvis to change the focal point of the distractive force. py?”; “Case studies on spinal decompression therapy patients.” While scientific research on SDT has not yet caught up with the This article is based upon my opinion and my experience in using evolving technology, looking at the roughly 25 year history of SDT SDT in my chiropractic practice. I would invite you to write to or being used around the world, it appears that SDT is safe, effective email this publication with your questions or comments on this and low risk. Judging by its growth trend worldwide, one could topic. conclude that it does offer therapeutic benefits. Things that don’t About The Author work tend not to have 25 year consistently-expanding growth trends. Dr. Lewis is a 1986 magna cum laude graduate of Logan Chiropractic From a personal perspective, with today’s spinal decompression College, and completed a one-year hospital residency in chiropractic technology, I believe that one can safely provide a modality for a family practice in 1987. He currently practices in Maryland. FOR MORE INFO CIRCLE 34 ON REPLY CARD 48 D.C. PRODUCTS R EVIEW.