Features November 2011 Issue

Non-Surgical Spinal Decompression: Don’t Be Fooled by the Claims

Despite manufacturer contentions, there is little solid scientific evidence to support the use of this widely promoted intervention.

If you have chronic back pain, you may be tempted to try one of today’s most widely touted techniques—non-surgical spinal decompression. In essence, this is a fancy term for motorized traction devices or so-called “therapeutic tables.” A review article published a few years ago in the journal Chiropractic Osteopathy looked at research available on the tables—a few small studies—and concluded that use of the technique is rarely warranted, especially when, according to the author of the study, many scientifically sound, less expensive alternatives are available. 

Non-surgical spinal decompression involves automated, motorized traction. Manufacturer and practitioner claims to the contrary, there is little evidence to support its use.

Indeed, Daniel Mazanec, MD, vice chairman of the Cleveland Clinic Spine Institute and head of the Section of Spine Medicine, says, “There is little to no evidence the technique is effective, despite exaggerated claims in advertisements. It is essentially an automated form of traction done 20-28 times over four or five weeks—almost daily.” 

Mostly used by chiropractors and physical therapists in their offices, the technique is reported to cost $50 to $150 or more per session, and in some cases, treatment extends beyond the five weeks noted by Dr. Mazanec—and the procedure is not covered by Medicare or most insurance companies. So, it can be an expensive—as well as an unproven—intervention.

Not FDA-Approved
Companies that produce non-surgical decompression devices claim that they work by exerting a controlled force on the lower back in order to create negative pressure inside the disc. The negative pressure creates a vacuum that draws bulging disc material back into the disc, thereby releasing pressure on the nerve or spinal cord between the discs. Dr. Mazanec says he is aware of at least one report of a complication from a device that required “urgent spinal surgery.”

Some practitioners of non-surgical spinal decompression state in their advertising that the treatment is approved by the U.S. Food and Drug Administration (FDA). This is not true. FDA-approved products (devices or drugs) have been tested in clinical trials, and the trials have demonstrated that the benefits (safety and effectiveness) of the product outweigh the potential harm that the product can cause. 

By contrast, commonly used non-surgical spinal decompression equipment has been “FDA-cleared.” This simply means the Food and Drug Administration is allowing the use of the product because it is similar to an existing product.   

In other words, “new and revolutionary” non-surgical spinal decompression devices, despite the claims of their manufacturers, are essentially the same as older devices, with some mechanical alteration or addition (for example, a computerized feedback system).

Proven treatments
If you have persistent back pain, you have plenty of  treatment choices. According to R. Douglas Orr, MD, director, Cleveland Clinic Center for Spine Health, regular exercise along with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen is a good way to start. The idea is to treat the pain while the body heals. If pain continues, your doctor may prescribe a narcotic pain medication or a steroid injection. But it pays to be patient; in many cases, pain will resolve without further intervention.

If your pain doesn’t go away within a few months and your ability to function normally or engage in recreational activities is hampered, “surgery is a reasonable option,” says Dr. Orr. 

The standard procedure for removing herniated disk material is microdiscectomy. Generally, this can be done as an outpatient procedure. After surgery, you’ll gradually increase your activities, so by three months you should be back to your usual activities.