| Medicine Section - Vertebral Axial Decompression
| Topic: Vertebral Axial Decompression |
Date of Origin: 04/1998
|
| Section: Medicine |
Policy No: 45 |
| Approved Date: 11/11/2008 |
Effective Date: 12/01/2008 |
| Next Review Date:
12/2010 |
IMPORTANT REMINDER
This Medical Policy has been developed through consideration of medical necessity,
generally accepted standards of medical practice, and review of medical literature
and government approval status.
Benefit determinations should be based in all cases on
the applicable contract language. To the extent there are any conflicts
between these guidelines and the contract language, the contract language will
control.
The purpose of medical policy is to provide a guide to coverage. Medical Policy
is not intended to dictate to providers how to practice medicine. Providers
are expected to exercise their medical judgment in providing the most appropriate
care.
Description
Vertebral axial decompression is a type of lumbar
traction that has been investigated as a technique
to reduce intradiscal pressure and relieve low back
pain associated with herniated lumbar discs or degenerative
lumbar disc disease.
A pelvic harness is worn by the patient. The specially
equipped table on which the patient lies is slowly
extended, and a distraction force is applied via the
pelvic harness until the desired tension is reached.
This is followed by a gradual decrease of the tension,
and the cycle is repeated. The cyclic nature of the
treatment allows the patient to withstand stronger
distraction forces compared to static lumbar traction
techniques. The level of tension is individually calibrated
and recorded. An individual session typically includes
15 cycles of tension, lasting approximately 30 minutes,
and 10 to 15 daily treatments may be administered.
Several devices used for vertebral axial decompression
have received 510(k) marketing clearance from the US
Food and Drug Administration (FDA). According
to the FDA labeled indications, vertebral axial decompression
may be used as a treatment modality for patients with
incapacitating low back pain and for decompression
of the intervertebral discs and facet joints.
Policy/Criteria
Vertebral axial decompression is considered investigational.
Scientific Background
Randomized Clinical Trials
A placebo effect may be expected with any treatment
whose principal outcome is pain relief. Therefore,
randomized trials are required to evaluate the magnitude
of the expected placebo effect and to determine if
there is an independent effect of active treatment.
Two small randomized studies (n=27 and 64) reported
little to no difference between patients treated with
or without mechanical traction. (6,7)
Sherry and colleagues conducted a randomized trial
comparing vertebral axial decompression (using theVAX-D
device) with transcutaneous electrical nerve stimulation
(TENS). (4) While a 68% success rate was associated
with VAX-D compared to a 0% success rate associated
with TENS therapy, without a true placebo control,
the results are difficult to interpret scientifically.
Non-randomized Studies
A number of non-randomized studies have been published
(2,3,5, 8,9); however data from these studies is unreliable
due to limitations associated with observational studies
of chronic pain, most importantly, lack of control
for placebo or treatment effect. Other flaws
in the case series include failure to use a validated
outcome measures and failure to report: methods of
patient identification or collection of data, duration
of treatment benefit, and follow-up time.
Summary
In summary, there continues to be a lack of rigorous
clinical evidence supporting the efficacy of vertebral
axial decompression. Current evidence is insufficient
to permit conclusions regarding the effect of vertebral
axial decompression on net health outcomes.
References
- BlueCross BlueShield Medical Policy Reference Manual,
Policy No. 8.03.09
- Ramos G, Martin W. Effects of vertebral axial decompression
on intradiscal pressure. J Neurosurg 1994;81:350-53
- Gose EE, Naguszewski WK, Naguszewski RK. Vertebral
axial decompression therapy for pain associated with
herniated or degenerated discs or facet syndrome:
An outcome study. Neurolog Res;20:186-90
- Sherry E, Kitchener P, Smart R. A prospective randomized
controlled study of VAX-D and TENS for the treatment
of chronic low back pain. Neurol Res 2001 Oct;23(7):780-4
- Ramos G, Efficacy of vertebral axial decompression
on chronic low back pain: study of dosage regimen. Neurol
Res 2004;26(3):320-4
- Harte AA, Baxter GD, Gracey JH. The effectiveness
of motorised lumbar traction in the management of
LBP with lumbo sacral nerve root involvement: a feasibility
study. BMC Musculoskelet Disord 2007; 8:118
- Fritz JM, Lindsay W, Matheson JW et al. Is there
a subgroup of patients with low back pain likely
to benefit from mechanical traction? Results of a
randomized clinical trial and subgrouping analysis. Spine 2007;
32(26):E793-800
- Macario A, Richmond C, Auster M et al. Treatment
of 94 outpatients with chronic discogenic low back
pain with the DRX9000: a retrospective chart review. Pain
Pract 2008; 8(1):11-7
- Beattie PF, Nelson RM, Michener LA et al. Outcomes
after a prone lumbar traction protocol for patients
with activity-limiting low back pain: a prospective
case series study. Arch Phys Med Rehabil 2008;
89(2):269-74
Cross References
None
| Codes |
Number |
Description |
| CPT |
None |
|
| HCPCS |
S9090 |
Vertebral axial decompression, per session |
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