Tilaro_edit_EU.qxp 28/9/07 04:57 Page 90
Spinal Decompression
Vertebral Axial Decompression
a report by
Frank Tilaro
Doctor of Internal Medicine, Utah
Reduction of a nuclear protrusion by spinal distraction was practiSed is necessary to achieve lumbar distraction. With the split table,
even before the intervertebral disc was recognised. A 14th-century designed by Dr Allan Dyer, it is estimated that 25% of the traction
translation of Albucasis’s Surgery illustrates lumbar manipulation force is required for distraction to occur.
8
during spinal traction.
1
Apollonius of Kitium describes a form of
distraction 2,000 years ago. Guidi (1544) illustrates a traction table in The effects of distraction include tautening of the posterior
his Chirugia, and one of his tables can be found in the Wellcome longitudinal ligament, which exerts a centripetal force at the back of
Historical Museum of London. In their book on manipulation past and the joint. This manoeuvre may be of therapeutic value, particularly
present, Cyriax and Schotz
2
illustrate the employment of traction by if the protrusion is located anterior to and remains in close contact
Hippocrates (400 BCE), Galen (131–202 CE) and the Spanish-Arabian with the ligament. On the basis of biomechanical calculations,
physician Abu’L Qasim (1013–1106 CE). significant intradiscal negative pressure may be achieved during
sustained traction.
9
One study has shown that a traction load of 30kg
Today, two methods of performing traction are practised: the sustained caused the intradiscal pressure to drop from 30 to 10kp in the L3
manner, preferred by Cyriax, and various forms of intermittent traction. intervertebral disc.
10
Improvement in nutrition, deposition of reparative
Intermittent traction can be performed electronically, manually (by a collagen and healing of annular tears and fissures have all been
therapist) or by the patient (autotraction). The effects of sustained suggested as benefits of axial distraction.
Dr Allan Dyer, former Deputy Minister of Health from Ontario, Canada,
and a pioneer in the development of the external cardiac defibrillator,
designed the vertebral axial decompression (VAX-D) therapeutic table
The effects of distraction include
to apply distraction tension to the patient’s lumbar spine without
tautening of the posterior longitudinal
eliciting reflex paravertebral muscle contractions. A patented harness
is attached to a tensiometer during separation of the movable part of
ligament, which exerts a centripetal
the table. The distraction–relaxation cycles are automated or variably
force at the back of the joint.
timed. Distraction tensions and rates are continuously monitored and
measured by the tensiometer, and the output is shown on a digital
gauge and captured on a pen-write printout.
Procedure
traction have been investigated. An increase in body length of The VAX-D table utilises pneumatic cylinders coupled with hydraulic
10–30mm was demonstrated in healthy males when a sustained force damping as the drivel-damping mechanism for the pre-tension and
of 60kg was applied for one hour, and was lost at 4mm/hr.
3
In the therapeutic programme. The technology applies and maintains a
excised spine the greatest separation was in those subjects with wide baseline tension of 20–24lb (the pre-tension) to the patient’s pelvis
disc spaces, and the least in those with evidence of disc degeneration. throughout the treatment session (even during the rest periods), and
Other investigators confirmed an increase in stature over and above the distraction cycles then move from tile-pre-tension range up to a
that known to occur when the load is taken off the spine by lying pre-selected therapeutic tension. The above parameters are absolutely
down.
4
The findings suggest that most of the vertebral separation takes critical to the success of the treatment. The pneumatic hydraulic
place within the first 30 minutes. During normal traction, the cylinders separate the lower table section from the upper section and
enlargement between two consecutive lumbar end-plates is between apply the tensions to the patient’s pelvis. The pneumatic hydraulic
1 and 1.5mm. Other studies have demonstrated a widening of drive mechanism allows precise control of the amount of tension and
the lumbar intervertebral space of between 3 and 8mm, measured is able to apply tensions in a logarithmic time/force curve. The
radiographically during gravitational traction.
5,6
Anderson et al.
7
pneumatic hydraulic drive mechanism is applied in both the distraction
have shown an increase in intradiscal pressure with certain and retraction movements of the VAX-D table and provides a smooth,
traction techniques. controlled operation with gradual return of the patient to the starting
position each time. To achieve optimum control of the application of
The heavy lumbar paravertebral muscles exert resistance to distraction. distractive tensions, it was found essential to develop a harness that
At least 30–35kg of force is required to influence the lumbar spine.
5
would attach directly to an electronic tensiometer, which continuously
Other studies have shown that a force of at least 25% of bodyweight monitors and provides feedback of the tensions being applied to the
90 © TOUCH BRIEFINGS 2007
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