Experts discuss the effectiveness of a back pain treatment that offers an alternative to surgery.
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.
For instance, a study on VAX-D published in a 1998 issue of Neurological Research reported a 71% success rate among the 778 subjects who underwent VAX-D treatment. While these results sound promising, the weakness of the study design dampens them. The study's glaring problem? It contained no control group. Investigators did not compare the effectiveness of VAX-D against subjects who received no treatment, placebo treatment, or some other type of treatment.
While Mazanec does not perform VAX-D in his practice, some of his patients received it elsewhere before coming to him. "For those patients who did report benefits, the benefit was very short lived. Or, they were simultaneously given oral steroids [to treat] sciatica, making it hard to determine what improved the pain," Mazanec tells WebMD.
Would he be willing to try it on his patients? "There need to be better studies before I would be comfortable believing that it's an effective part of a treatment regimen," Mazanec says.
Other clinicians who do incorporate VAX-D into their practice report favorable results.
Such is the case with Philippe Chemaly, DO, MPH, a physiatrist. He uses VAX-D on patients as part of a comprehensive treatment approach rather than a singular solution to back pain. "With VAX-D, there is no substitution for good physical therapy. Physical therapy teaches you techniques to do at home, which I think add to your long-term outcomes," he tells WebMD.
Though he claims a high success rate with VAX-D -- between 70% and 80% -- he acknowledges that not all patients achieve optimal outcomes. "Younger patients do better. Typically they're less obese, have less [spinal] degeneration going on, more abdominal strength and better flexibility," he says.
Chemaly has halted VAX-D in patients who experience pain during the procedure. "I warn them, 'If we do try this and you experience pain, we'll stop. Some clinics say, 'Let's go for it.' Pain is your body's way of saying there's something going on," he says. Most patients who experience pain with VAX-D have spinal stenosis along with herniated discs, Chemaly says.
Strategies for Success
Still interested in VAX-D? Then you may want to follow this advice from seasoned VAX-D practitioners.
Use caution when choosing where to get treatment. "Look for places that do VAX-D with physical therapy. Mills -- places that do only VAX-D -- tend to be profit motivated. And you're not going to get the proper care and evaluation in a mill," Chemaly tells WebMD.
Follow protocol for the recovery process. "If patients receive this treatment five days a week, for a month, 70% of them will be free of pain," Dyer tells WebMD. "What do they do when it's done? They go skiing. Dumb!" he says. "When the pain is gone, that doesn't mean the fracture is completely healed. Exercise does nothing for an intradisk lesion or a herniated disk. What it does is put stress on a disk that's trying to heal." Dyer tells his patients to engage only in walking during the month-long recovery process.
When it comes to treatment for something as fragile as an ailing back, it's imperative to exercise caution when choosing treatment. As for Reiner, he's convinced he's made the right choice. "I'm sure I'll have a flare-up here and there, and I'll know where to go," he says.
Published June 20, 2005.
SOURCES: Allan E. Dyer, PhD, MD, developer of VAX-D. Daniel J. Mazanec, MD, spine specialist with The Cleveland Clinic. Philippe Chemaly, DO, MPH, physiatrist in private practice in New Jersey.
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