GMDH 9: Spinal Decompression

21 September 2008

Morning Dr. Hollander

I keep seeing these commercials for spinal decompression, I was wondering what that is all about and how that works. What does it help with and what your professional opinion is on it?

-Dave

Good Morning! Good question.

Spinal decompression as a treatment for neck and low back pain has recently become very popular and also very controversial. Some chiropractors and also other physicians have been charging very high fees for this "miracle" therapy. Some even tried billing insurances the thousands of dollars; however they were doing so under coding for surgical decompression. Not too honest there. They were brought up on charges for fraud. Incredible.

There is some truth however, to the ability of spinal decompression to help heal disc injuries and thereby alleviate neck and back pain. To address this it is necessary to discuss the physiology of the disc.

Imbibition

The human spine contains 23 cartilaginous discs. These discs provide mobility to the spinal column while allowing it to protect the spinal cord. The intervertebral disc (IVD) is largely an avascular structure in the adult. It has a very poor blood supply to begin with and as we age this blood supply lessens.

There are however, still cells that reside in the IVD, Chondrocytes that require nutrients to survive and carry out their function (secreting cartilage). They, like any other cell require the intake of glucose and oxygen, and the removal of waste products like carbon dioxide. In the absence of blood vessels, the disc uses a "pumping" action with the movement of the spine to diffuse the nutrients and waste products across the disc's tissues. This process is commonly referred to as "imbibition."

Subluxation

In the event of vertebral subluxation, the movement of the spine is compromised and thereby the process of imbibition cannot occur. The chondrocyte cannot take in oxygen and glucose. It literately begins to "suffocate" and "starve." You thereby have the mechanism for "Degenerative Disc Disease (DDD)."

You also then also have a mechanism to prevent and reverse this process. If you restore proper motion to the spine (i.e. the chiropractic adjustment), you also restore the disc's ability to imbibe itself.

Curiously, the "standard of care" for discal injuries, medication and bed rest, does nothing to help promote imbibition and thereby does very little to promote healing within the disc itself.

Spinal Decompression

Imbibition can be promoted in the IVD in a variety of ways. Spinal decompression promotes imbibition by simulating a "pump" in the body, often by a series of neck and low back traction followed by relaxation.

There are many other ways to promote imbibition in the IVD. Exercises as simple as sit-ups, leg raises, upper body extensions, even running all help to promote global imbibition. Obviously these exercises are not appropriate in cases of acute low back pain. There are some rehabilitative chiropractic exercises that can target imbibition at specific disc levels. And there are other modalities used in the chiropractic office that can produce a similar effect like Flexion-Distraction.

Money

Some chiropractors and other physicians have decompression therapies that they will charge somewhere between $5,000 and $10,000 for a series of treatments, usually 12-14. These costs usually correlate to the cost of their decompression table, which is often in the vicinity of 100-150k.

It is my opinion that the fancy decompression table doesn't do all the much more than the not-as-fancy decompression table. They usually have flat-screen monitors that play videos and music while you're in therapy.

Decompression is decompression. In our office we offer spinal decompression as one of our services. Our table cost about 14k, and we charge about $1400 for a series of treatments. It is very reasonable and produces the same effect of any other spinal decompression.

Conclusion

The IVD is an avascular structure that requires a process called imbibition to live. Chiropractic adjustments and movement/exercise helps maintain and promote imbibition. Spinal decompression helps promote and heal disc injuries also, but does not have to be astronomically expensive.

Hope that helps,

Mad Chiro Luv,

-Darren, DC

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