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Decompression Therapy - Is It Worth It?
By Randy Southerland

On a recent weekday morning, Barbara Glass was in her chiropractor’s office laying facedown on a thickly padded table, a strap around her midsection, arms outstretched. The machine produces a gentle hum as the table slowly separates and contracts, producing a gentle pull that relieves pressure on the vertebra in her lower back. Standing up again, this 74-year-old Fayetteville, Ga., resident says the machine—known as VAX-D—has changed her life. She’s quick to tell anyone that it saved her from surgery, relieved her back pain and allowed her to resume a normal life again.

“I was at my row’s end,” she says. “Nothing was doing much good. I’ve got some herniated discs and I was in terrible shape. I just thought nothing would help but surgery.”

Glass is just one of a growing number of patients with various forms of degenerative spine disease, disc bulges and herniations, who are seeking relief on high tech computerized traction tables being promoted by DCs and MDs alike as a nonsurgical alternative. Doctors and patients say the tables are relieving and even curing these chronic ailments, while an equally vocal group warn that research on the tables effectiveness is sketchy and they aren’t the sort of tool chiropractors should be using.

The spinal decompression business was started by VAX-D’s inventor, Allan Dyer, a Canadian MD and former deputy minister of health in Ontario. In filings with the FDA, he told regulators that the device could decompress the intervertebral discs as measured by a lowering of intradiscal pressures. His company began marketing the device in the U.S. in the early ’90s, and since then other companies have sprang up selling similar devices.

Today, more than 1,000 of the vertebral axial decompression or spinal decompression tables are estimated to be in operation worldwide. Costing between $65,000 and $125,000, patients typically receive 16 to 30 treatments at an estimated cost of $185 to $300 per session. Medicare and most major insurance companies refuse to cover the procedure, meaning that patients must pay out of pocket, sometimes making it a hard sell for doctors.

“It’s just a matter of the patient,” says Linda Katz, D.C., Glass’ chiropractor. “It depends on how much pain they’ve been in. Patients who are not only in pain, but also highly motivated, tend to get the best results,” she adds. “The more they comply with treatment, the better the outcome,” says Katz. “So, if you really want to play tennis, or if you really want to go to work, you will get results.”

Many doctors like Katz can point to patients who came into their offices in debilitating pain, but after a series of spinal decompression treatments are able to resume a normal life—without surgery. Some doctors have also been able to make it a significant portion of their practice income—with some opening clinics putting several tables in use full time. That success helps account for the proliferation of companies marketing different versions of the tables.

“It’s not $2 million equipment like MRIs,” says Steve Brown, CEO of DVAD USA in Carlsbad, Calif., who got into the business after being cured of his own back pain by VAX-D. “It’s a lower cost item that they can get involved in, and I think there is just overwhelming clinical research. I mean thousands upon thousands upon thousands of people have been treated and you rarely if ever hear of anybody having a complication or a problem.”

In fact, table companies like to point to several studies—posted on their websites—that show as one study put it “reductions in low back pain and referred leg pain associated with a diagnosis of herniated disc, degenerative disc disease or facet syndrome.”

“Whenever you pull a muscle, the natural tendency for the muscle is to contract against it because they are not used to being stretched,” explains Dr. Bryan Hawley, an official with CERT Health Sciences, LLC, a Baltimore company that markets SpineMED Decompression Tables. “So you’ve got to overcome the guarding reflex. With the decompression tables they put computers on them now and it does it in a cycling format. And some of the higher-end models [sense] whenever the muscle starts to tighten up and the table will stop pulling. You create an ideal window of relaxed muscles, and you get away from the guarding reflex so you can actually get down deep to the disc.”

Patients get the best results when they not only complete the full complement of treatments, but also follow a regimen of exercise and diet, adds Brown.

Of course, the concept of spinal decompression is nothing new. Chiropractors have been doing it for years using manual tables such as the Cox Flexion Distraction. Proponents of more conventional chiropractic techniques say they often get better results at a fraction of the cost.

“All of those (decompression) units are capable of doing one thing only—long-Y-axis traction,” says James Cox, D.C., developer of the Cox Technic. “My table does not only long Y-axis decompression with the doctor in attendance, but when a patient has attained a 50 percent decrease of radicular pain in the leg, we can then do it unattended.” Cox asserts that manual techniques such as his gives the doctor the ability to treat problems at any level in the spine. “We also are capable in the lumbar spine of eliciting all facet joint ranges of motion—flexion, extension, lateral flexion and circumduction,” he explains. “Plus, we are able to do all these other adjustments to the low back.” Cox also contends that the research supporting the table’s effectiveness is thin at best. He, along with other critics, think use of the tables can distract chiropractors from using their own adjusting techniques to effectively deal with a patient’s problems.

“I find that embarrassing and detrimental to the image of my profession,” says Cox. “It sounds like they are saying that chiropractic comes up short or is not capable of handling stenosis cases like disc herniation and degenerative disc disease. These decompression tables seem to come on as if they’re going to be the savior of our inabilities as the chiropractic profession.”

Other DCs take a more moderate approach to the technology. “I know that some chiropractors that are more of a strictly chiropractic and nothing else type mindset are fearful that it’s going to pigeonhole chiropractic into [the idea] that the only thing we treat is low back pain,” says Shawn Ferguson, D.C., an Acworth, Ga.-based chiropractor who has referred patients to other doctors for treatment with the tables.

While he doesn’t use the tables in his own practice, Ferguson sees them as just another tool that’s appropriate for patients with certain spinal conditions.

With low back pain afflicting 80 percent of the population at some point in their lives, the potential cost of the therapy—rather than its effectiveness—has hindered coverage by insurance companies, says Brown. That means patients have to pay out-of-pocket or use credit plans such as GE’s CareCredit, which provides unsecured financing plans for procedures such as LASIK vision correction, cosmetic surgery and veterinarian care for pets.

Lack of coverage has gotten some doctors into trouble. Two Atlanta chiropractors were sentenced to 34 months in jail after pleading guilty to defrauding more than $1 million from Blue Cross Blue Shield of Georgia. Prosecutors contend the pair was “using inapplicable codes pertaining to different procedures, including surgical procedures” to gain reimbursement for VAX-D treatments.

An Indiana MD had to make more than $100,000 in repayments to Medicare, penalties, appeals and legal fees for similar inappropriate billing procedures. She sued the table manufacturer—North American Medical in Atlanta—contending a sales agent had assured her that the therapy was reimbursable. The case was dismissed.

Over the past few years other doctors have publicly contended they were told insurance companies would cover the procedure—usually in seminars sponsored by vendors. The companies themselves deny this contention and say they never tell doctors what codes to use in their practice.

“You can go to somewhere like Arizona and, if you have a workman’s compensation injury, it will be covered,” says Brown. “But if you have a non-workers compensation injury, even if it is the same carrier paying the bill, they won’t cover it”

Brown believes that eventually the insurance companies will come around—particularly as more research points to the efficacy of these tables.

“I think it’s very unfortunate, because what it boils down to is those who can afford it or can finance it get the care,” he contends. “Those who can’t may end up spending 10 times as much on surgery with a 50 percent failure rate, but that’s what they can get because that’s what the insurance company will cover.”

Despite the costs, doctors who offer the therapy can make money and recoup their investment. Documents provided by CERT Health Services on their SpineMED tables estimate that a doctor who brings in three new patients a month can gross $89,700 annually. More patients can generate even more profit. “You can definitely turn a $20,000-a-month clinic into a $120,000-a-month clinic,” says Hawley.

Success is usually determined by how well the doctor can market to patients, and in particular how good he or she is at building a referral network with other DCs and medical doctors.

“In order to serve all kinds of patients it’s important to network with all types of doctors,” Katz says. “We send a written report of progress to the doctor to keep them informed. I’ve recently written a letter to local chiropractors informing them that I’m not interested in taking their patients and will not adjust them. This allows them to offer a solution other than surgery for their patients [without fear of losing them as chiropractic patients].”