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VAX-D: Treating Back Pain Without Surgery

Experts discuss the effectiveness of a back pain treatment that offers an alternative to surgery.

WebMD Feature

Reviewed By Charlotte Grayson

Before a sudden onset of excruciating back pain left him barely able to stand, retired internist Ernie Reiner, MD, was busy volunteering at a health clinic in Tampa, Fla., and improving his golf and tennis game. After several tests showed a herniated disk and lumbar stenosis (narrowing of the spine in the lower back), he reluctantly scheduled back surgery. Having been through the slow and painful recovery from back surgery once before, he dreaded another round.

Searching for alternatives, Reiner discovered vertebral axial decompression therapy (VAX-D), a relatively new, noninvasive form of traction-like therapy for low back pain. After 28 treatments lasting 45 minutes each, he considered himself recovered. "I canceled my surgery date and never rescheduled," Reiner says. Six years later, the 85-year-old continues to swing a golf club and a tennis racket vigorously.

How VAX-D Works

In principle, VAX-D works by alternately stretching and relaxing the lower spine, thereby relieving pressure on structures in the back (the "cushion" disks and vertebral bones) that cause low back pain.

During a VAX-D treatment session, the patient lies face down on a computerized "split" table, a pelvic harness around the hips. The patient's arms extend forward, and his hands grasp two patient-operated handgrips. As treatment begins, the table literally separates in two, creating a stretch in the patient's lower back. If at any point in the session the patient experiences discomfort, releasing the handgrips immediately halts the treatment. A single session typically lasts 45 minutes.

Allan E. Dyer, MD, PhD, who developed VAX-D, explains how the treatment "fixes" herniated disks, a frequent cause of lower back pain: "Your bones are separated by a cushion. That cushion is always under positive pressure, even at rest. VAX-D lowers that pressure to negative levels by creating a partial vacuum that can retract the disk. Even a large, protruding disk can be retracted where it's supposed to be," he says. Dyer recommends that patients undergo 20 treatment sessions for optimal results.

VAX-D Medical Technologies, manufacturer of VAX-D, recommends the treatment for people suffering from herniated or degenerated disks resulting in low back pain and/or sciatica. But it's not for everyone, including those with spine tumors, osteoporosis, infection, cancer, severe and unstable spondylosis (spinal arthritis), and many other conditions. "Noncandidates can be ruled out by X-rays," Dyer says.

The Issue of Safety

Is VAX-D safe? Apparently, that depends on whom you ask, and under what circumstances the treatment is performed.

While the manufacturer touts VAX-D as safe, literature on VAX-D from Cedars-Sinai Medical Center in California lists the following risks: development of sharp, burning, or radiating pain during treatment; stress to the shoulder and rotator cuff muscles; and overstretching of the soft tissues of the back.

As for the potential to experience pain, Dyer says: "The patient participates by holding hand grips. The patient can always let go, a natural reaction if pain is experienced."

The clinician also plays an important role. "With good clinicians, patients do not experience shoulder pain," Dyer tells WebMD. "The practitioner needs to be a good clinical observer."

Can patients suffer injuries during VAX-D treatment? Current literature from the VAX-D manufacturer states that "not one single injury has been sustained by a patient." A published report in a 2003 issue of Mayo Clinical Proceedings disputes that statement. The report describes a severe complication suffered by a patient during VAX-D treatment. The authors describe a "sudden, severe exacerbation of radicular pain" during a treatment session. Images of the subject's lumbar region showed significant enlargement of the disk protrusion after VAX-D, requiring emergency surgery. To date, this is the only published report of an adverse effect caused by VAX-D.

How Effective Is It?

Does VAX-D really work? To date, anecdotes such as that reported by Reiner and others offer the most persuasive evidence in favor of VAX-D's effectiveness. But what do studies tell us about VAX-D?

"There are some studies suggesting that VAX-D is effective. Most people would say they're fairly flawed. The studies out there are not high quality," says Daniel J. Mazanec, MD, a spine specialist with the Cleveland Clinic. Lack of controls and the use of "sham treatments" (or placebo) for controls demonstrate poor quality of existing studies, he explains.