California Journal of Alternative Medicine - December, 1999

Feature Article :

Non-Linear Spinal Disc Traction

Medical sciences' ultimate answer
to one of humanities' oldest problems.

Alan Abrams, M.D.

 

Linear traction or traction whose force is applied in a straight line is as old as back pain itself.

Non-linear disc traction or traction applied in a smooth arc is brand new, has great therapeutic value and is made possible only thru computer technology and bio-robotic applications.

Linear traction can be applied in several ways and range from hanging upside down being suspended by the legs or feet to various "rack" typed devices that stretch the body and back. Over the years the "rack" type devices have taken on several new forms of bells and whistles. These range from alternating "pull and release" contraptions to linear traction applied at various angles. Whatever the fancy or crude application and regardless of how fancy with computer print-outs of the forces applied, linear traction is still force applied in a straight line.

Linear traction has known therapeutic benefits as well as known side effects. Linear traction applied with sufficient force to overcome the muscular and ligamenteous resistance to the spine being stretched apart in a straight line can effectively reduce disc bulge. Studies conducted by the Division of Neurosurgery, Health Sciences Center, University of Texas, San Antonio proved conclusively that decreased intradiscal pressures sufficient to literally "suck" the nucleus pulposus back into the torn annulus fibrosis were possible and repeatable. This reduces disc bulge, herniation and surgical intervention. This study consisted of placing a cannula into the spinal disc of the patient and applying traction while measuring the decreased intradiscal pressure with calibrated electronic transducers.

Negative pressures in the range of minus 160mm Hg were consistently recorded and was more than sufficient to "suck" the nucleus pulpous back into the annulus fibrosis. Other studies involving MRI have demonstrated graphic evidence of disc herniation reduction utilizing traction.

As beneficial as linear traction has proven itself there are still undesirable side effects. These side effects can best be addressed with a brief review of normal spinal shapes, structures and biomechanics.

The normal spinal column viewed from front to back should be straight. The normal spinal column when viewed from the side should have three distinct and very important spinal curvatures. These are the Cervical Lordotic (forward bending) curvature, the Thoracic Kyphotic (backward bending) curvature and the Lumbar Lordotic (forward bending) curvature. When any of these curvatures are disturbed disc deterioration is evidenced or is forth coming dependent upon the length of time since initiation of the disturbed curvature. Decreased, straightening or reversal of these curvatures are evidence of a biomechanical aberration and is part of the diagnostic evidence used to arrive at accurate clinical differential diagnosis.

The most mobile area of the spinal column is the cervical spine. Any disturbance of the cervical lordotic curvature will result in symptoms as far ranging as localized slight to severe pain to radicular pain from the neck into the shoulders, arms and hands, numbness, muscular weakness, even paralysis. Certain types of headaches have also been associated with cervical spinal biomechanical lesions.

The lumbar spine is the hardest working and bears the highest loads. Any disturbance of the normal lumbar lordotic curvature will result in symptoms ranging from slight to severe localized pain to radicular syndromes such as sciatica to numbness, muscular weakness, even paralysis.

Back pain, regardless of its location, can range from an annoyance to a life changing, job robbing, catastrophic, total incapacitation. Back pain is serious and back pain patients deserve every consideration.

Disturbance of the normal spinal curvatures set into motion several types of deteriorative processes that can be immediately pain producing or appearing as a late onset after the deteriorative process comes full bloom.

Many patients following a whiplash type injury have an immediate pain syndrome onset. Others develop pain syndromes days, even weeks later. The same is true of a low back pain syndrome. The patient can lift one object and develop pain or go on for years asymptomatic, then wake up one morning with annoying to agonizing pain.

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One of the deterorative processes set into motion by a disturbed spinal curvature is inflammatory reaction occurring on and around the spinal disc, facets, joints and nerves. The inflammatory process exudes toxins which are pain producing and hyper sensitizing to both motor and sensory nerves. Hyper sensitized motor nerves cause over reaction of the proprioceptor (stretch) fibers and result in muscle spasm. Muscle spasm causes increased intradiscal pressure and also depletes the intradiscal fluid reserves. Intradiscal pressure is the amount of pressure present in the central portion of the disc.

Intradiscal pressure rises with load bearing activities. Any time this value exceeds diastolic blood pressure infusion of nutrients and oxygen into the disc stops. Average intradiscal pressure in a non-load bearing condition is 70mm Hg. Could unexplained rises in diastolic blood pressure be the result of a reflexogenic response? This question warrants further scientific study and a correlation of patients suffering from degenerative disc disease and high diastolic blood pressure.

During non-load bearing activities the intradiscal pressure falls and fluid reserves accumulate inside the disc. This is referred to as the intradiscal fluid reserve ratio. Fluid reserves are diminished during load bearing activities and replenished during non-load bearing. Whenever this intradiscal fluid reserve ratio is disturbed whether by over work, muscle spasm or biomechanical lesion disc deterioration begins or accelerates.

The normal spinal disc is similar to an inflated automobile tire. The intradiscal fluid reserves maintain the proper "inflation", height, size, shape, flexibility and overall health of the spinal disc. Once the intradiscal reserves become depleted disc deterioration begins, disc height diminishes, and flexibility and range of motion is reduced.

A normal spine disc has annular fibers that criss cross one another at 120 degree angles. Once the disc height begins diminishing, the annular fiber criss cross-angle increase which weakens the wall of the disc. This weakened area becomes the tear site for nucleus pulposis migration.

As the disc deteriorates the flexibility of the disc and range of motion of the surrounding structures is reduced. Lack of movement in concert with the inflammatory reaction results in stagnation of toxins in and around the spinal disc, ligaments, joint capsules, facets and nerves. The toxicity results in both proprioceptors and nociceptors becoming hypersensitive. This results in increased pain but more importantly increased reflexogenic response and spasm. Increased muscle spasm results in higher intradiscal pressures even during non-load bearing activities which accelerates disc degeneration.

Linear traction of sufficient force to overcome muscle spasm, restricted range of motion, contracted ligaments and joint fixation can temporarily restore disc height. This traction force must also be high enough to overcome the natural muscular reaction when the mechanoreceptors are activated. This natural reflexive action is initiated when ligaments and muscles are stretched apart in a straight line, thereby reducing the normal lordotic curvatures.

Linear traction works but at the expense of increased pain during treatment and muscle spasm during and after treatment. Post traction application of therapies to reduce pain and muscle spasm is usually mandatory following linear traction. Linear traction is successful in vertebral segment separation and disc bulge and herniation reduction but to the detriment of normalizing lordotic curvatures, evacuating neurotoxins and infiltration of the disc with fresh nutrients and oxygen. Successful clinical outcomes for linear traction surpassed many other forms of therapy including most surgical interventions but with side effects and without long term favorable outcomes. Without lordotic curvature normalization and intradiscal fluid ratio normalization, disc deterioration resumes and the pain syndrome will return.

Linear traction is limited to only three variances. These are traction force, pull and relax time and angle at which the linear traction is applied to the patient.

Non-linear Disc Traction is the product of the multi-tasking capabilities of computers coupled with robotics. Non-linear Disc Traction has the capability of applying tractive force in a smooth arc and at constantly varying angles, forces and velocities. This requires the use of pressure, angle and velocity transducers sending a constant stream of information to a computer which has the capability of processing this information and responding within milliseconds.

Non-linear disc Traction has all the advantages of linear traction but without side effects.

There are several devices available today that provide linear traction. These include VAX-D, Lordex, D.R.S. as well as several inverted hang by your feet devices. There is only one non-linear traction devices available today and that is Vivatek. The manufacture of Vivatek holds U.S. and Foreign patents on this device so Vivatek will be the only non-linear traction device far into the future.

The advantages of non-linear disc traction are many. Non-linear disc traction normalizes the lordotic curvatures, which results in long range resolution of pain, restores intradiscal fluid reserve ratios and stops the degenerative disc disease process.

Another major advantage is reduced forces required for vertebral segment separation and disc bulge and herniation reduction. Linear traction requires large tractive pressures applied thru a harness attached to the patient's lower and upper torso. These large tractive forces are necessary to overcome reaction of large muscle groups being stretched and the reflexogenic reaction of mechanoreceptors and muscle contraction. Great force is also applied to areas of the patient other than the affected spinal disc. This results in some degree of risk to the patient but can also result in pain production in areas asymptomatic before linear traction application.

Non-linear disc traction with its computer-controlled applicator applies tractive forces directly to the area of affected spinal segment only. This maximizes treatment effectiveness, eliminates patient risk factors and post treatment pain, muscle spasm and other common linear traction side effects. By applying a traction force that normalizes the lordotic curvature rather than a linear force, which flattens or decreases the lordotic curvature, the proprioceptor neural fibers and nociceptor fibers are not activated and segment separation occurs without muscular resistance and to a greater distance of separation. Ligamenteous structures are not strained, entrapped nerves are released, facets are aligned and joint capsules are not irritated. The patient is treated without pain and without post linear traction side effects.

Linear traction is limited to pull/relaxation cycles of time varying from several seconds to minutes or more. Non-linear disc traction can apply pull/relaxation cycles of much shorter duration. The shorter pull/relaxation cycle acts as a pumping motion to the disc and surrounding structures increasing the infusion rate of oxygen and nutrients into the spinal disc and evacuation of toxins around the disc, facets, capsules, muscles and nerves. This results in a faster and more complete resolution of both the pain and degenerative disc disease process.

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Non-linear disc traction facilitates maximum separation of the vertebral segment resulting in higher negative pressure gradients inside the disc.

This higher negative pressure "sucks" migrated nucleus pulposus material to the center of the disc. Maximum separation also normalizes the annulus fibrosis annular fiber criss cross-angle which closes the annular tear site. Fibroblasts located on the interior of the disc become dormant due to decreased oxygen and nutrients. The fibroblasts lying dormant are activated by the infusion of oxygen and fresh nutrients and begin healing the torn annular fibers. Oxygen and fresh nutrients infused into the disc by the non-linear disc traction pumping action replenish the intradiscal fluid reserves. This action is similar to putting air into a low automobile tire. The tire resumes its shape, size, flexibility and the sidewall of the tire no longer bulges outward.

Linear traction is limited to lumbar spine applications in most instances.Non-linear disc traction is applicable to the cervical, thoracic and lumbar spine.

Linear traction requires the patient be placed in a harness while force is applied similar to pulling a string taunt between two points. Non-linear disc traction does not require a harness but rather the robotic feature of the computer controlled applicator automatically moves to the spinal segment to be treated and the non-linear tractive force is applied directly and in a smooth arch normalizing lordotic curvature. Patient pain and fear are eliminated and the patient can be treated in a relaxed state, which also promotes rapid and complete healing.

Contradictions to non-linear disc traction are few and are limited to open wounds, fractures, metastizing lesions on or around the spine, and metal spinal implants such as Harrington rods, etc. Non-linear disc traction is safe and can also be used for "failed back surgery" and patients suffering from osteoporosis.

Non-linear disc traction is normally billed under the Manual Traction physical medicine code and is universally accepted by third party payers. Insurance companies, especially work comp carriers, endorse this logical evolution of a tried and proven modality and are enthusiastic about its use due to quicker recover periods, lack of post treatment side effects and required extra treatment due to these side effects. Quicker return to work, reduced work restriction and reduced disability, rehabilitation and job retraining expenses are also a large motivating factor for non-linear traction applications and Insurance Company endorsement.

Non-linear disc traction is not experimental or investigational in any manner, has been in wide spread use and acceptance and holds FDA clearance K974626.

Of special interest is the very high clinical success rates demonstrated by non-linear disc traction treatment.

Pre and post x-rays and MRI finding demonstrated normalization of lordotic curvatures, increased disc spacing and disc herniation retraction. Non-linear disc traction treatment is fast becoming the most accepted and preferred treatment for neck and back pain patients in the United States today.

Before Non-linear disc traction

MRI

After Non-linear disc traction

MRI

X-RAY

X-RAY

  • Deceased Lordotic curvature
  • Facet Syndrome
  • Inflammatory Reaction
  • Degenerative Disc Disease in Progress
  • Patient Incapacitated with Sciatica
  • Lordotic Curvature, Facets and Disc spacing Normalized
  • Herniation Reduced
  • Patient Asymptomatic

Combined with low risk factors and very few contradictions, non-linear disc traction is the treatment of choice.

For more information call toll free 877-VIVATEK (877-848-2835)

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