This is a big question these days! Everywhere me and my patients look (or listen) we hear about “Spinal Decompression” and it’s 85% to 95% (the number varies from commercial to commercial) success rate. I thought I knew what it was all about, but decided to do some research over the past couple of days.Spinal Decompression mostly refers to a type of spinal traction device called the DRX 9000, but can refer to other devices such as the Vax-D, DRS, and even the Chattanooga Triton Spinal Traction machine.
What I Found
I started off with a google search that led me (if you clicked on “research” above, you’ll see similar search results) that led me to pages of information from the manufacture of the device, to bloggers telling their experiences, to news articles about investigations and fraud, and to the websites of chiropractors and spine centers that promote and use these machines. Here are the highlights: I found that the makers of these machines (DRX 9000) have been under investigation for fraudulent advertising.
There are also billing problems that end up leaving patients holding the bag for a HUGE bill. Look at this bulletin for details. It’s a little difficult to follow, but it basically is warning those in the medical coding profession (those who bill and do some accounting for medical services) that these treatments are not reimbursable under most insurance plans. Patients receive the final bill from the practitioner stating that their insurance did not pay, and are left to pay the entire bill. Most of these treatments, according to the providers who are providing them, go for between $2500 and $5500 for a full course consisting of 30-40 visits over a six-week period.
They also detail how many practitioners with these machines bill under alternate codes to fool the insurance company into paying for the procedure These codes are called Common Procedural Terminology (CPT) codes, and are accounting codes to describe medical and dental services provided to a patient. Providers sign insurance contracts agreeing to always bill the code that most closely describes the service provided, but many go back on their word if the money doesn’t add up to what they believe they are entitled to. Additionally, I’ve found that some of these models are labeled as “spinal decompression therapy” when they are simply a computer-controlled traction unit. When I say “computer controlled” I don’t mean that the basic controls are any different from a traction unit produced 10 or even 20 years ago – they have the same options and adjustments – just the newer ones have fancy touch screens!
I’ve checked into all of the settings that I was able to find online about the Triton DTS system (as advertised by many local chiropractors) and found that all of the controls it offers are the same controls offered on my machine (by the same manufacturer) that is about 15 years old. Triton has a nice-looking touch screen, mine has a fake wood-grain panel with control knobs and switches. The metal frame is also kind of a pasty brown, instead of gleaming white, and the harnesses are slightly different.
This article really sums most of my findings up – I’ve added this sentence after publishing this about an hour ago.
What’s are the Differences and Similarities Between Traction and Spinal Decompression?
- Traction is covered under most insurance policies, while spinal decompression is not.
- Spinal decompression units can cost the provider up to $150,000 to purchase, while a good used traction unit and table can be had for around $3,000.
- Many providers of spinal decompression require patients to sign a contract, obligating them to pay for a set number of treatments (whether beneficial or needed), while traction is provided on an as-needed basis, and continued only if improvement in the patient’s condition can be linked to it’s use.
- Spinal decompression is mostly used as a stand-alone treatment, while traction is used as part of a comprehensive rehabilitation plan.
- Neither has been proven to be beneficial as a stand-alone treatment.
- Spinal decompression is usually prescribed for 25 or more visits for all patients, while most of our spine patients do not receive traction (less than 10% – there are usually many more effective treatments that we can utilize) and those that do generally receive fewer than 6 treatments of spinal traction.
- The amount and timing of the force applied can be altered at will by the treating provider for both decompression and traction.
- Spinal traction units can easily change the direction of pull, and can allow a patient to lie prone (face down) if that position is more beneficial, while most spinal decompression units do not allow prone positioning or substantial changes to the angle of pull.
- Spinal traction units can be issued for home use, and are covered by most insurance plans, while spinal decompression cannot be delivered at home.
What About the “86% Success Rate”?
There is one study that I was able to find from a journal that I’ve never heard of before, and that I cannot find in the National Library of Medicine database of medical journals. Assuming all of the facts in the article are true (I was not able to find the article this evening, but read it a few evenings ago) there are at least two inherent flaws in their research that I noticed in a cursory reading:
- It is very tough to say conclusively that any particular patient’s back pain is due to any particular cause. Many people will have abnormalities on MRI or x-ray that have nothing to do with their pain, and many people will have pain without any abnormality. In this study, patients were classified based on their MRI findings, and treatment settings were different for some than others.
- Most people with back pain and sciatica are significantly better after 6 weeks, regardless of intervention. Any therapeutic intervention needs to beat this timeline, or achieve success in patients who have had pain much longer than 6 weeks. In this case there was no “control group” who matched the demographics (age, sex, type and duration of pain, etc) that received no treatment or a sham (placebo) treatment, so placebo effect and the natural course of their problems could not be compared.
What Should I Take Away From This?
First, a properly qualified therapist (board certified in orthopedic PT) should perform a thorough evaluation of your problem, and select specific interventions that have scientifically been proven to provide benefit for a patient in your condition. If yours is a case (and some are) where your problem does not respond to the most researched form of treatment, other alternatives can be explored that may assist you in your recovery.
Secondly, a properly trained therapist will be able to demonstrate improvement in your condition quickly, or will be able to notify you quickly (usually within two weeks) that he or she will not be able to significantly affect your problem with therapy.
Thirdly, no ethical healthcare provider should obligate you to sign a contract for treatments that you may or may not need, or may or may not respond well to. If you try 3 visits of spinal decompression, and see no result, there is no ethical reason that you should have to pay for another 30 ineffective treatments.