Non-Surgical Spinal Decompression – Fact or Crap?

Yesterday, a patient came to my office and told me her medical doctor sent her to me to see if I did spinal decompression.  For those of you who don’t know, non-surgical spinal decompression uses a specialized type of chiropractic table that provides computer assisted traction in order to separate the spinal bones and promote disc and ligament healing.  Devices are known as the DRX-9000, VAXD, Lordex, DRS and others.  The problem is, there are too many problems.

  • Spinal decompression is a good procedure but has not been shown to be any better than techniques like Flexion-Distraction.
  • Providers of spinal decompression almost always claim superiority of their technique over others.
  • Spinal decompression devices are much, much, much more expensive than traditional flexion-distraction devices.
  • In order to pay for their expensive, computerized tables, many spinal decompression doctors resort to false or misleading advertising, pre-paid treatment plans and other unethical practices.
  • Decompression chiropractors frequently prescribe a 20 visit minimum treatment protocol (usually at about $200 per visit!!) for which there is no clinical rationale.  Many of these patients would get better faster with other treatment methods.

I don’t have a problem with the DRX-9000 or other SD tables in and of themselves.  The theory is pretty good and mirrors the excellent results we obtain with flexion-distraction for disc herniations and bulges.  I have a major issue with the false and misleading practices, the high-pressure sales tactics, the false claims of superiority and the pre-paid treatment plans.  I also don’t feel like paying an extra $60k to hook my table up to a computer. 

I sent the MD who inquired about the technique a nice letter along with a copy of some of the articles naming lawsuits concerning the spinal decompression practices and some of the major insurance company positions on decompression (is it considered experimental and no better than currently available procedures).  It would be nice to see this become a legitimate piece of equipment as a tool for chiropractors to use but as of now, there is too much controversy and too many unethical practices associated with it.

Dr. Brett Kinsler is a chiropractor in Rochester, NY.  He gets excellent results with patients who have disc injuries in his Rochester chiropractic office and does not need to resort to hype and lies. His website is http://www.RochesterChiro.com

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25 Comments

  1. June 4, 2008 at 5:50 pm

    Pretty cowardly article, doc. I applaud the MD who was looking for a non-drug/non-surgical solution for his or her patient’s disc problem, and I’m truly disapointed that you may have steered his patients right back to the world of “insurance-approved” drugs and surgery. Hopefully that MD is smart enough to keep looking.
    I herniated my 5th lumbar disc 12 years ago playing basketball. The pain was excruciating. I increased my adjustment schedule to 4 times a week (I had previously been adjusted once a week for years) and after 3 months of care, the pain was still unbearable, …maybe 10% improved. Being a DC myself I wanted Chiropractic to help me from both a personal and professional point of view. The honest truth is that if I were not a chiropractor I would have given in to drugs and surgery after 20 or 30 visits of no relief. Many of my past patients have, and I’m sure so have yours (Unless of course you have a 100% success rate, in which case just ignor this comment, with my apologies). Through shear determination (or obstinance) I got relief after about six months. But that experience lead me to look into an effective adjunct to Chiropractic. I see you’ve been in practice 10 or 11 years, and if you treat herniated disc patients (and you’re honest), you’ll admit to a frustrating number of failures. I’ve been in practice over 30 years, and prior to adding Decompression Therapy to our office it saddened me to see 15 to 20 patients a year having to be referred out for surgery, and others who left for Physical Therapy, Pain Management, or a lifetime of drugs and misery. Flexion Distraction helped most of our patients (I was trained by James Cox himself in the late ’70s and low back pain has always been our forte), but Decompression Therapy put us in a whole new league. Now I’m very happy to say that several local MDs, DCs and MTs refer their advanced cases here instead of the surgeon’s office. Yes, we still have failures, but we’ve saved hundreds of patients from the pain and misery of surgery. Instead of criticizing decompression, look into it and refer a few of your tough cases to a nearby chiropractor who is not sitting around waiting for Aetna’s approval before trying something new. I guarantee many of them will thank you. You’ll not only help them and save them from surgery, but you’ll have them singing Chiropractic’s praises and referring others to you as the doc who cares more about his patient’s health than Aetna’s “position on decompression”. By the way, I can’t believe you’re touting their “position” and following their dictates. Do you have a spine yourself? If you want unbiased research, write to me and I’ll be happy to send you some.

    I don’t mean to come down hard on you, doc. I’m sure you’re doing a great job, and I love that you’re spreading the word through your weblog. Just don’t throw stones. We have enough coming our way from the medical profession. –Rich Therkelsen, DC http://www.lordexnj.com

  2. cmnacnud said,

    June 4, 2008 at 11:58 pm

    I agree. The principle of the machines is great the cost and marketing that goes with it is lousy. I actually have a cheaper model in my office, but that is all I needed, and if you’re just setting up practice you can decide between a cox table or a decompression unit. They both work great for the patient, just weigh the costs against the benefit before you buy. For patients don’t pay extra money just because a doc went too far on his overhead.

  3. June 5, 2008 at 12:12 am

    Thanks for your comments, docs.

    Dr. Duncan makes some good points especially that patients shouldn’t pay more for a doc’s overhead.

    Dr. Therkelsen, your comments illustrate much of the problem. I too applaud the MD’s search for non-surgical/non-drug solutions to spinal injuries but I am past the point of accepting everything other chiropractors do as ethical and legitimate just because they are fellow chiropractors.

    I think decompression is a fine treatment…no better or worse than others. I think the 86% statistic that you and others cite is based on weak research and I think the premise that 20-30 visits are needed right off the bat is a downright unethical. I take serious issue with the marketing methods and I assert that if you are putting that much faith in a machine rather than the doctor, then it is actually you who is throwing stones at chiropractic. After all, can’t a PT or MD flip a switch just as well as a DC can?

    Do I have a spine myself you asked? Yes…that’s why I am not afraid to write articles like this and publish comments that may not agree with my own.

  4. Rick D. said,

    August 22, 2008 at 8:31 pm

    May I leave you with 2 resourceful links of physicians you may have heard of speaking on this form of treatment?

  5. August 22, 2008 at 11:01 pm

    Simply because two doctors with recognizable names are on the payroll for the Axiom DRX-9000 company, this does not make the equipment work any better or make the clearly unethical marketing practices any more acceptable.

  6. Rick Durand said,

    August 29, 2008 at 4:57 pm

    I see you hold no value to the integrity of those who wrote the very textbooks you read in Chiropractic College. Oxymoron perhaps?

    Dr. Terry Yochum is an extraordinary physician and it is a sad day for a fellow Chiropractor to question his integrity.

    You are entitled to your opinion of course, which you have expressed by blogging on a treatment alternative you do not even offer and have zero experience with.

    FYI: Dr. William Martin is not employed by Axiom. A knowledgeable decompression therapy physician would recognize Dr. Martin as the co-author of “Effects of Vertebral Axial Decompression On Intradiscal Pressure” Journal of Neurosurgery 81: 350-353, 1994 .

  7. September 2, 2008 at 8:15 pm

    The fact that an otherwise credible person gives celebrity-like endorsement to a product with questionable marketing does not give more credibility to the product but rather detracts from his. Yochum did indeed write a fine set of radiology texts which I used in college and currently own. That does not entitle him to absolute lack of scrutiny in his endorsements…especially when he is endorsing a product that is not radiological in nature.

    Vertebral axial decompression is an expensive high-tech form of mechanical traction that can provide relief in some cases of back pain but is widely promoted with unsubstantiated claims. When the FDA cleared these tables as traction devices, it set limits on what the manufacturers could claim. These limits have been dramatically exceeded. This therapy may provide relief for properly selected patient but I have very good reasons to believe that I can usually accomplish the same thing more quickly, safely, and less expensively.

  8. September 5, 2008 at 10:33 pm

    So I went looking for the article that “a knowledgeable decompression therapy physician would recognize.” It seems you are basing a great deal of value on a study of 5 subjects and the results are only provided on three of them. The authors conclude that further study is needed to establish a relationship between clinical outcomes and a reduction in intradiscal pressure.

    But thanks for the idea of another blog article.

  9. david walters said,

    September 8, 2008 at 1:50 pm

    You’re “bottom line” is INCORRECT and your selective use of quotes from the article are misleading.

    Here’s the real bottom line–ALL of the studies examined in the article demonstrate POSITIVE outcomes for non-surgical decompression.

    The article is a literature review and not a scientific study on the efficacy of Non-Surgical Spinal decompression.

    The conclusion of the article is not a commentary on the efficacy of the treatment, but rather the lack of good scientific research to back up the claims expressed in the research that has been done to date.

    Fortunately, clinical trials are currently underway, http://clinicaltrials.gov/ct2/show/NCT00704210?term=spinemed&rank=1. This double blind randomized controls that compare the non-surgical decompression to a placebo–the gold standard in medical research and is the study that’s needed to substantiate the claims.

    You raise the question, “how can doctors get away with claiming superiority (of Spinal Decompression), as compared to traditional conservative treatment options (exercise, spinal manipulation, PT…)?”

    For the same reason you would claim flexion-distraction for disc herniations and bulges is more effective than rest and conservative pharmacological care—history, your personal experiences, and the collective experiences of others have shown it to be effective. Not because either one has been proven by clinical research.

    Any doctor that see back pain patients will tell you that many patients who suffer from discogenic pain are intractable. These patients simply do not respond to traditional conservative modalities. They have run the gambit of conservative care options being bounced from doctor to doctor, with no relieve. Now, they are facing the prospect of surgery even though they are not immediate or even ideal surgical candidates

    Non-surgical decompression is a prudent and effective next step helping patients avoid the risks and recovery associated with spinal surgery. Not offering it as a treatment option is simply removing a useful tool that has demonstrated to be effective for those patients who meet the correct clinical requirements.

    In addition, more and more research is suggesting that traditional treatments don’t work:

    Check out the report from the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology; suggest that there is, “insufficient evidence to make any recommendation for the use of epidural steroid injections to treat radicular cervical pain.

    Or, the New England Journal of Medicine’s article on “Surgery versus Prolonged Conservative Treatment for Sciatica” which concluded that, “The 1-year outcomes were similar for patients assigned to early surgery and those assigned to conservative treatment with eventual surgery if needed, but the rates of pain relief and of perceived recovery were faster for those assigned to early surgery.”

    You object to the marketing claims made by doctors regarding Spinal Decompression by pointing out that the claims made cannot be substantiated by creditable medical research.

    I have the same objection to the Chiropractic industry as a whole.

    -dwalters

  10. September 8, 2008 at 8:56 pm

    You are incorrect, David (Dr.?) Walters. The article I was told to look at (Effects of Vertebral Axial Decompression On Intradiscal Pressure. Journal of Neurosurgery 81: 350-353, 1994) is a clinical case study, not a literature review.

    The article I discuss in my other blog article, “More Spinal Decompression Lies You Should Know” is a literature review and I do not believe I ever stated otherwise.

    The conclusions of that literature review were “Only one small randomized controlled trial and several lower level efficacy studies have been performed on spinal decompression therapy. In general the quality of these studies is questionable. Many of the studies were performed using the VAX-D® unit which places the patient in a prone position. Often companies utilize this research for their marketing although their units place the patient in the supine position….Only limited evidence is available to warrant the routine use of non-surgical spinal decompression, particularly when many other well investigated, less expensive alternatives are available.”

    You will also note that I have never stated that non-surgical decompression doesn’t work…only that it has not been proven to be as good as the claims.

    As for creditable research in the field of chiropractic…it’s there. Not as plentiful as I would like to see but certainly a great deal stronger than what we’ve seen for decompression.

    You will also note that when I see chiropractors make claims about chiropractic that I do not think can be backed up with evidence, I will take them to task on that as well.

  11. david walters said,

    September 9, 2008 at 7:20 pm

    My post above is in reference to your blog, “We’re Spinal Decompression Lies You Should Know”. I mistakenly posted my reply here. I’ve reposted it there–apologies.

    I understand that you never stated that non-surgical decompression doesn’t work, and that your complaint is that the technology has not been proven to be as good as the claims.

    How are you defining PROVEN?

    As I stated, all the research that’s been done to date points to very high success rates for non-surgical spinal decompression.

    If you defining PROVEN as double blind Clinical Trials, then you’re 100% correct. Non-surgical spinal decompression is unproven.

    But where is the Flexion-Distraction clinical trial, and for that matter the Manual Manipulation clinical trials that PROVE that these techniques?

    Here’s a good article for you to read, “Spinal Manipulation for Low Back Pain: An Updated Systematic Review of Randomized Clinical Trials.” Conclusion: The efficacy of spinal manipulation for patients with acute or chronic low back pain has NOT been demonstrated with sound randomized clinical trials.

    The problem with your argument is that fundamentally it’s about money.

    Your problem with Spinal Decompression is the fact that patients have to pay more for it than for other procedures that you feel are equally as effective. (Even though they are equally unproven)

    How can doctors make such claims?

    These doctors have experienced firsthand the success this technology has on patients many who have failed at every other conservative procedure (including traditional chiro care). And, they recognize that for some patient, non-surgical decompression the best option for the patient. (yes, better that flexion-distraction(*gasp).

    They recoginze that paying thousands of dollars is a small price to regain qulaity of life and advoide the risk and recovery of spinal surgery (which for obvious reason is also never been clinicaly proven to be effective).

    As much as I don’t like underhanded spinal decompression marketing, I detest doctors that have “the god complex”–“there’s no way a machine can help a patient better than me actually touching them”. And, I hate doctors that biopsy a patient’s wallet before they present patients with their care options.

    Of course, I would never suggest that your one of those doctors.

  12. September 9, 2008 at 9:34 pm

    Dave, give me a break! The article you cite is from 1996 and the full conclusions were: The efficacy of spinal manipulation for patients with acute or chronic low back pain has not been demonstrated with sound randomized clinical trials. There certainly are indications that manipulation might be effective in some subgroups of patients with low back pain. These impressions justify additional research efforts on this topic. Methodologic quality remains a critical aspect that should be dealt with in future studies.

    Since that article was published, there have been other studies and reviews showing positive clinical results. Some show that spinal manipulation is equally effective to traditional medical treatment for low back pain. I am not going to go citation for citation with you.

    I have neither the “God Complex” as you describe it (I use Graston tools and cold laser – both of which do things I could not do better with my hands) nor do I evaluate a patient’s ability to pay prior to offering them treatment options. My goal is to provide the most effective treatment for a patient without wasting their time or money — no matter how much of each they have to spare.

    And your anecdotal reports of doctors seeing better results with decompression fail to sway me at all. People were positive the world was flat for a very long time…it still didn’t make it so.

  13. Rick D. said,

    September 9, 2008 at 10:30 pm

    Dr. Kinsler,

    You are definitely not the first physician to post on this topic, as I have read numerous “skeptic” physicians say the same exact thing in their blogs. The truth of the matter is that those doctors who you feel are in Axiom’s payroll felt EXACTLY the same way. ALL OF THEM !!! Until they had an opportunity to “TEST” the technology.

    A great example would be Dr. William Martin who was there when it all began in 1994 !!

    I CAN TRULY SAY THAT IF $$$ WAS NOT AN ISSUE, 90% of back pain specialists would own one of our units. The other 10%, are not practicing on M, Th, F !!!

    Rick D.

  14. David Walters said,

    September 9, 2008 at 11:58 pm

    Wait a second doctor.

    If you’re now going to practice evidence based medicine, you shouldn’t pick and choose which evidence you’re going to follow.

    Volume 22, Issue 4, Pages 879-889 (October 2001)

    Spinal Manipulation: A Systematic Review of Sham-Controlled, Double-Blind, Randomized Clinical Trials

    Edzard Ernst, MD, PhD, FRCP (Edin), Elaine Harkness, BSc

    Accepted 28 December 2000.

    Abstract
    For many years, spinal manipulation has been a popular form of treatment. Yet the debate about its clinical efficacy continues. The research question remains: Does spinal manipulation convey more than a placebo effect? To summarize the evidence from sham-controlled clinical trials of spinal manipulation as a treatment of various conditions, and to assess the methodological quality of these studies, a comprehensive search strategy was designed to locate all sham-controlled, double-blind, randomized trials of spinal manipulation as a treatment of any medical condition. Data were extracted from these trials and validated by two independent reviewers in a standardized fashion. All trials were critically analyzed and their methodological quality evaluated. Eight studies fulfilled the pre-defined inclusion/exclusion criteria. Three trials (two on back pain and one on enuresis) were judged to be burdened with serious methodological flaws. The results of the three most rigorous studies (two on asthma and one on primary dysmenorrhea) do not suggest that spinal manipulation leads to therapeutic responses which differ from an inactive sham-treatment.This analysis demonstrates that sham-controlled trials of spinal manipulation are sparse but feasible. The most rigorous of these studies suggest that spinal manipulation IS NOT ASSOCIATED WITH CLINICALLY-RELEVANT SPECIFIC THERAPEUTIC EFFECTS.

    My point isn’t to NOT to say that there’s no benefit to manual manipulation.Of course there is. The ANAECDOTAL evidence it too great to disput.

    I just think it funny that a chiropractor would dismiss a treatment like non-surgical decompression that is showing such promise becuase it is not yet passed a clinical trial.

    Sorry doctor, there go all your unproven/unregulated herbal supliments and the theory of Vertebral subluxation.

  15. September 10, 2008 at 1:28 pm

    Well, now you’re just being silly. Evidence based practice does not mean using every single study from the beginning of time. If it did, we all might need to go back to practicing phrenology.

    Also, I have not “dismissed” non-surgical spinal decompression. Rather, I have questioned the exaggerated claims, the additional expense and the unethical marketing practices. On the contrary, there is no reason decompression shouldn’t work…it’s just another form of mechanical traction.

    Furthermore, which “unproven herbal supplements” did you see in my office and to which of my patients did I espouse subluxation theory? I’ll give you the answer in case you were wondering….none.

  16. cmnacnud said,

    September 10, 2008 at 11:07 pm

    Give up Dr. Kinsler, He’s not even listening to your statements. We all know decompression has worked with low back pain patients. You’re concerned with a company their prices and their advertising. Everyone who is reading this without bias is wondering where this topic went.

    As a note I believe I saw these words, “90% of back pain specialists would own one of OUR units,” (emphasis added) come out in a post from someone not claiming any other expertise in this area. He sounds like a salesman, addressing the wrong concern.

    I like HIS product, and like what it does, and like the benefit patients can get from it. I think it costs too much for the relief provided that can be provided by other means just as effectively. It’s a great product don’t get me wrong, and I’m sure it decompresses the spine.

    Companies are loosing law suits over the advertising that they do though. From the advertising done to chiropractors to the advertising done to patients. Here is one example the Oregon Department of Justice publication on the topic: http://www.doj.state.or.us/releases/2007/rel062907.shtml

  17. cmnacnud said,

    September 10, 2008 at 11:12 pm

    If there is credible research on the topic, why not use it. Why go and make some up and credit it to NASA? Or, just tell people the truth, that you have a very overpriced decompression machine, because you have to make up your development costs somehow.

  18. September 11, 2008 at 9:21 am

    Thanks for the link to the Oregon DOJ decision! Here is one interesting part:

    “The companies stated that the Food and Drug Administration (FDA) approved the devices and substantiated their claims of effectiveness. DOJ found the device had merely been cleared as similar to preexisting devices. They also misrepresented the DRX 9000 by claiming it was a scientific and medical breakthrough that resulted from NASA discoveries when, in fact, NASA discoveries had no relationship with the device.”

  19. Rick D. said,

    September 11, 2008 at 9:02 pm

    Yes of course, we shall conclude the debate of treatment efficacy with this form of response.

    I was merely attempting to discuss how our product (Considering our copyrighted image and our product name is being featured on this blog) is helping patients get better.

    That’s all…

    Not to worry, you shall not here from me again. I do ask for a small favor from those of you who seemingly wish to bring up the past.

    Everyone is entitled to his or her own personal opinions, but when there are blatant contradictions it does get to be rather bothersome.

    Dr. Kinsler, I wish you the best in the future and urge you to continue writing educational posts for visiting patients to learn more about chiropractic.

    I believe patients do gain great results with chiropractic treatment and I hope your local community takes advantage of having a physician as yourself next door.

    Good luck to you sir.

    Rick D.

  20. September 20, 2008 at 4:14 pm

    […] of my blog articles have caught more attention or been the subject of more flack than when I tell the truth about non-surgical spinal decompression like the VAX-D, DRX-9000 and other pieces of equipment that are similar.  You will recall that I am […]

  21. Dr. Timothy Durnin said,

    November 22, 2008 at 1:32 am

    It is the circumduction component that makes F/D superior, more economical with proven research results. I own both and will not prescribe SD without the augmentation of F/D. Since F/D is done recumbent and most S/D machines are require supine positioning with exception to the DTS machine, adds another major deficiency to SD therapy. I believe SD is a dog and pony show that is glorified traction unit with angulation. F/D, unequivocally can and does introduce the biomechanical vacuums necessary to decompress a herniation superior to that of SD.

  22. Dr Joseph Lawrence said,

    September 20, 2009 at 2:08 am

    Hmmm…”circumduction component makes F/D superior”,unfortunately,with all due respect,this sounds like the magic is in the machine.It is not.The one major advancement decompression therapy has exposed is the requirement of capable doctors to improve their examination skill set in order to determine if an individual would be a good candidate for decompression/traction let alone what patient position,time/force relationship etc is required.Yes the marketing hyperbole has left a black eye on decompression therapy.However,speaking for myself,the suprising reality I observed when implementing decompression into my practice was that a signifigant proportion of patients we were seeing for S/D stated that they had no interest in chiropractic co management of their disc problem because they had a bias against chiropractic or were a chiropractic failure.For the record I have seen my share of chiropractic successes,but if your only tool is a hammer every problem looks like a nail.

  23. October 25, 2009 at 1:27 pm

    Spinal decompression is a TOOL, just like any other tool you have access to in your practice. No body ever said that once you buy a DRX9000 or any other spinal decompression table that you should stop be a clinician and stop using your critical thinking skills to treat your patients – not their condition. With all new technologies there will always be those that are for and those that oppose for one reason or another. The bottom line is the DRX9000 works – I know because I have one in my practice and it’s helped hundreds of people regain function and eliminate pain.

    Do I use hard sell techniques? No, absolutely not. Do I hold it on a pedastool and tell them that it will cure all that ails them? No, of course not. If you are a reasonable practitioner you will make reasonable decisions that are good for both your practice and your patients.

    I’m sick and tired of all these people ragging on the SD machines who have little or no experience with them. I get referrals ALL the time from MD’s, other DC’s, PT’s and patients who are satisfied with the therapy.

    As long as you don’t mis-represent it there should be no problems. The bottom line is you have to do the right thing.

  24. Will C. said,

    February 17, 2010 at 11:42 am

    Hello all, First I would like to say, I applaud open discussions. I have been practice 10 years. I use F/D and S/D therapy. The patients’ problem is what disctates what therapy I will use. I can tell you I have been utilizing S/D for 2 years, and the results are outstanding. Well over 90%. The key is picking the proper candidate. I keep in contacts with the patients’, after two years, no pain. The patients’ are happy and have their life back. I do no advertising, all word and mouth.

  25. chiromed06 said,

    August 11, 2010 at 10:47 pm

    I agree with ChiropractorNYC. Of course you must also know what to do with these machines nowadays.

    Chiropractor


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