American Journal of Pain
Management Vol. 7 No. 2 April 1997
DECOMPRESSION, REDUCTION, AND
STABILIZATION OF THE LUMBAR SPINE: A COST-EFFECTIVE TREATMENT FOR
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
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
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
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 (13).
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
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 force.
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
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
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
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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