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American Journal of Pain Management Vol.
7 No. 2 April 1997
Emerging Technologies: Preliminary Findings
DECOMPRESSION, REDUCTION, AND
STABILIZATION OF THE LUMBAR SPINE: A COST-EFFECTIVE TREATMENT FOR LUMBOSACRAL
C. Norman Shealy, MD, PhD, and Vera
Borgmeyer, RN, MA
C. Norman Shealy MD, PhD, is Director of
The Shealy Institute for Comprehensive Health Care and Clinical Research and
Professor Of Psychology at the Forest Institute of Professional Psychology.
Vera Borgmeyer is Research Coordinator at the Shealy Institute for
Comprehensive Health Care and Clinical Research. Address reprint requests to:
Dr. C. Norman Shealy, The Shealy Institute for Comprehensive Health Care and
Clinical Research , 1328 East Evergreen Street, Springfield, MO 65803.
Pain in the lumbosacral spine is the most
common of all pain complaints. It causes loss of work and is the single most
common cause of disability in persons under 45 years of age (1). Back pain is
the most dollar-costly industrial problem (2). Pain clinics originated over 30
years ago, in large part, because of the numbers of chronic back pain patients.
Interestingly, despite patients' reporting good results using "upside-down
gravity boots," and commenting on how good stretching made them feel, traction
as a primary treatment has been overlooked while very expensive and invasive
treatments have dominated the management of low back pain. Managed care is now
recognizing the lack of sufficient benefit-cost ratio associated with these
ineffective treatments to stop the continued need for pain-mitigating services.
We felt that by improving the "traction-like" method, pain relief would be
achieved quickly and less costly.
Although pelvic traction has been used to
treat patients with low back pain for hundreds of years, most neurosurgeons and
orthopedists have not been enthusiastic about it secondary to concerns over
inconsistent results and cumbersome equipment. Indeed, simple traction itself
has not been highly effective, therefore, almost no pain clinics even include
traction as part of their approach. A few authors, however, have reported
varying techniques which widen disc spaces, decompress the discs, unload the
vertebrae, reduce disc protrusion, reduce muscle spasm, separate vertebrae,
and/or lengthen and stabilize the spine (3-12).
Over the past 25 years, we have treated
thousands of chronic back pain patients who have not responded to conventional
therapy. Our most successful approach has required treatment for 10-15 days, 8
hours a day, involving physicians, physical therapists, nurses, psychologists,
transcutaneous electrical nerve stimulator (TENS) specialists, and massage
therapists in a multidisciplinary approach which has resulted in 70% of these
patients improving 50-100%. Our program has been recognized as one of the most
cost-effective pain programs in the US (I 3). The average cost of the
successful pain treatment has been cited as less than half the national average
Our protocol combined traditional,
labor-intensive physical therapy techniques to produce mobilization of the
spinal segments. This, combined with stabilization, helped promote healing. In
addition we used biofeedback, TENS, and education to reinforce the healing
processes. We wanted to produce a simpler and more cost-effective protocol that
could be consistently reproduced. The biofeedback and education could be easily
replicated. The problem was producing spinal mobilization to the degree that we
could decompress a herniated nucleus and relieve pain. Stabilization would come
after pain relief.
The DRS System was developed specifically
to mobilize and distract isolated lumbar segments. Using a specific combination
of lumbar positioning and varying the degree and intensity of force, we
produced distraction and decompression. With fluoroscopy, we documented a 7-mm
distraction at 30 degrees to L5 with several patients. In fact, we observed
distraction at different spinal levels by altering the position and degree of
We set out to evaluate the DRS system
with outpatient protocols compared to traditional therapy for both ruptured
lumbar discs and chronic facet arthroses.
Subjects. Thirty-nine patients were
enrolled in this study. There were 27 men and 12 women, ranging in age from 31
to 63. Twenty-three had ruptured discs diagnosed by MRI. Of these, all but four
had significant sciatic radiation, with mild to moderate L5 or S1 hyperalgesic.
All had symptoms of less than one year.
The facet arthrosis patients also
underwent MRI evaluations to rule-out ruptured discs or other major
pathologies. They had experienced back pain from one to 20 years. Six had mild
to moderate sciatic pain with significant limitations of mobility.
Patients were blinded to treatment and
were randomly assigned to traction or decompression tables. Traction patients
were treated on a standard mechanical traction table with application of
traction weights averaging one-half body weight plus 10 pounds, with traction
applied 60-seconds-on and 60-seconds off, for 30 minutes daily for 20
treatments. Following the traction, Polar Powder ice packs and electric
stimulation were applied to the back for 30 minutes to relieve swelling and
spasm, and patients were then instructed in use of a standard TENS use to be
employed at home continuously when not sleeping. After two weeks, the patients
received a total of three sessions with an exercise specialist for instruction
in and supervision of a limbering/strengthening exercise program. They were
re-evaluated at five to eight weeks after entering the program.
Decompression patients received treatment
on the DRS System, designed to accomplish optimal decompression of the lumbar
spine. Using the same 30 minute treatment interval, the patients were given the
same force of one-half the body weight plus 10, but the degree of application
was altered by up to 30 degrees. The effect was to produce a direct distraction
at the spinal segment with minimal discomfort to the patient.
Eighty-six percent of ruptured
intervertebral disc (RID) patients achieved "good" (50-89% improvement) to
"excellent" (90-100% improvement) results with decompression. Sciatica and back
pain were relieved. Only 55% of the RID patients achieved "good" improvement
with traction, and none excellent."
Of the facet arthrosis patients, 75%
obtained "good" to excellent" results with decompression. Only 50% of these
patients achieved "good" to "excellent" results with traction.
Table 1. Patient assessment of pain
relief secondary to decompression and to traction.
Since both traction and decompression
patients received similar treatment (except for the differences in the traction
table versus the decompression table) with similar weights, ice packs, and
TENS, the results are quite enlightening. The decompression system is
encouraging and supports the considerable evidence reported by other
investigators stating that decompression, reduction, and stabilization of the
lumbar spine relieves back pain. The computerized DRS System appears to produce
consistent, reproducible, and measurable non-surgical decompression,
demonstrated by radiology.
Of equal importance, the professional
staff facilities required, as well as the time and cost, are all significantly
reduced. Since the more complex treatment program of the last 25 years has
already been shown to cost 60% less than the average pain clinic, the cost of
this simpler and more integrated treatment program should be 80% less than that
of most pain clinics-a most attractive solution to the most costly pain problem
in the US. In addition, patients follow a 30-day protocol that produces pain
relief yet allows them to continue daily activities and not lose workdays.
We have compared the pain-relieving
results of traditional mechanical traction (14 patients) with a more
sophisticated device which decompresses the lumbar spine, unloading of the
facets (25 patients). The decompression system gave "good" to "excellent"
relief in 86% of patients with RID and 75 % of those with facet arthroses. The
traction yielded no "excellent" results in RID and only 50% "good" to
"excellent" results in those with facet arthroses. These results are
preliminary in nature. The procedures described have not been subjected to the
scrutiny of review nor scientific controls. These patients will be followed for
the next six months, at which time outcome-based data can be reported. These
preliminary findings are both enlightening and provocative. The DRS system is
now being evaluated as a primary intervention early in the onset of low back
pain-especially in workers' compensation injuries.
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