Considerable controversy exists in regard to the various techniques currently employed. Aside from basic bed rest, there are few noninterventional modalities that have been adopted as standards of therapy. Manipulative techniques for mechanical low-back pain associated with posterior facet syndrome or muscle strain have not been found as useful in the management of herniated or degenerated lumbar discs. Similarly, other modalities including ultrasound treatments, various electrical stimulation techniques, short-wave therapy, acupuncture, steroid injections, and the administration of anti-inflammatory agents and muscle relaxants all have a following among some practitioners but fall short of addressing the underlying problems associated with intervertebral disc lesions. All of these treatment methods fail by comparison to surgery, in our opinion, because they have the common problem of not relieving the pain from neurocompression or from the stimuli associated with a prolapsed nucleus pulposus. The only noninterventional method that has been shown to hold any promise of relieving pressure on vital structures of the lumbar region is that of distraction of the lumbar vertebrae by mechanical forces applied along the axis of the spinal column.2,3,5,14
There has been some investigation into the effects of distracting segments of the spinal column excised from cadavers,11,14 as well as radiological studies that provided evidence that the application of certain forms of tension can distract vertebral bodies.3,5 On the other hand, there are equally pertinent studies that failed to demonstrate any positive effects from other methods of applying spinal traction.1,10 Nachemson and Elfstrom6–9 have studied the effects of movement and posture on intradiscal pressure. Their measurements show pressure changes caused by positioning and posture range between 25 and 275 mm Hg, suggesting that some positions and postures may be inadvisable for patients suffering from lumbar disc lesions. Anderson, et al.,1 and others have shown that certain traction techniques can actually cause an increase in intradiscal pressure, which would be undesirable in the treatment of low-back pain associated with herniated discs and a neurocompression etiology.
A new form of therapy, termed “vertebral axial decompression,” has recently been introduced in the physical therapy department of the Rio Grande Regional Hospital. This treatment modality has shown considerable promise in relieving low-back pain associated with herniated discs or degenerative disc disease of the lumbar vertebrae in patients who are not considered candidates for surgery. The purpose of this research project was to investigate the influence of this new treatment modality on intradiscal pressure in the lumbar spine of patients receiving this form of therapy.
The authors gratefully acknowledge the director and staff of the Department of Physical Therapy for their assistance in administering the vertebral axial decompression therapy.
VAX-D equipment manufactured by Vat-Tech, Inc., Clearwater, Florida.
Summit disposable single-line pressure transducer, Model No. 33–260, manufactured by Baxter Corp, Irvine, California.