BlueCross BlueShield of Tennessee Medical Policy Manual

Mechanized Axial Spinal Distraction Therapy Devices

DESCRIPTION

Mechanized axial spinal distraction therapy devices are generally marketed as a method for treating back pain. The basic mechanism of action involves a controlled distraction of vertebral bodies along the spinal axis for the purpose of reducing pressure along the spinal column (i.e., vertebral axial decompression). Generally, multiple treatments are administered over a period of time with the intent that the series of mechanized distractions will result in a considerable reduction in pain for a significant period of time. Mechanized, computer controlled tables are typically used to apply the distractive tension; the devices may also utilize other features such as harnesses, belts, and/or biofeedback. Mechanized axial spinal distraction therapy devices are used in the treatment of a number of conditions including, but not limited to, herniated discs, degenerative disc disease, sciatica, posterior facet syndrome, lumbosacral strain, radiculopathy, and a condition called internal disc disruption (IDD).

Examples of mechanized axial spinal distraction therapy devices include: VAX-D®, Decompression Reduction Stabilization [DRS]® System, DRX9000™, and Accu-Spina System™ IDD Therapy.

Note: This medical policy was previously entitled Vertebral Axial Decompression.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

There is insufficient published evidence demonstrating that the use of a mechanized axial spinal distraction therapy device renders a health benefit equal to, or greater than, other established alternatives (e.g., simple mechanical traction, flexion/distraction, inversion therapy). Many of the studies available are uncontrolled, or contain significant methodological flaws that undermine the validity of stated positive results. Well-conducted randomized, controlled trials are required in order to draw adequate conclusions as to the level of health benefit to be obtained by using these devices.

SOURCES

Agency for Healthcare Research and Quality. (2007, April). Decompression therapy for the treatment of lumbosacral pain. Retrieved February 9, 2011 from www.ahrq.gov.

BlueCross BlueShield Association. Medical Policy Reference Manual. (10:2012). Vertebral axial decompression (8.03.09). Retrieved October 10, 2013 from BlueWeb. (10 articles and/or guidelines reviewed)

Complete Guide to Medicare Coverage Issues [Computer software]. (2013, July). Vertebral axial decompression (VAX-D) (NCD 160.16, p. 2-81). OptumInsight, Inc.

Daniel D. M. (2007). Non-surgical spinal decompression therapy: Does the scientific literature support efficacy claims made in the advertising media? Chiropractic & Osteopathy, 15 (7).

Macario, A., Richmond, C., Auster, M., & Pergolizzi, J. (2008, January). Treatment of 94 outpatients with chronic discogenic low back pain with the DRX 9000: A retrospective chart review. Pain Practice, 8 (1), 11-17. (Level 4 Evidence - Industry sponsored)

Spinal decompression machines. (2008, June). The Medical Letter On Drugs and Therapeutics, 50 (Issue 1287), 41-42. (6 articles and/or guidelines reviewed)

Winifred S. Hayes. Medical Technology Directory. (2003, January; Update search 2008). Mechanized spinal distraction therapy for low back pain. Retrieved July 7, 2008 from www.Hayesinc.com/subscribers. (35 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  2/1/2001

MOST RECENT REVIEW DATE:  11/14/2013

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.