BlueCross BlueShield of Tennessee Medical Policy Manual

Cervical Traction Devices for Home Use

DESCRIPTION

Cervical traction devices for home use are noninvasive traction devices intended to stretch the soft tissues of the neck and to separate the spinal joint structures used to relieve neck pain.

A variety of cervical traction devices are available for use in the home:

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

Non powered traction devices are classified as Class I devices by the U.S. Food and Drug Administration (FDA). 510(k) clearance is not required, although registration with FDA is required. The Code of Federal Regulations describes non powered orthopedic devices as: “A non-powered orthopedic traction apparatus is a device that consists of a rigid frame with non-powered traction accessories, such as cords, pulleys, or weights, and that is intended to apply a therapeutic pulling force to the skeletal system.”

Randomized controlled studies continue to be deficient, and the poor quality of published articles also provides little evidence of the efficacy for the use of ambulatory cervical traction, inflatable cervical traction collars, or pneumatic cervical traction devices. In addition, there is a lack of documentation in published articles for specific duration and frequency of these devices that would aid in net health outcomes. Therefore, these devices are considered investigational.

SOURCES

American Association of Neurological Surgeons. (March, 2013). Treatment of subaxial cervical spinal injuries. In: Guidelines for the management of acute cervical spine and spinal cord injuries. Retrieved August 30, 2016 from https://www.guideline.gov/summaries/summary/44337/treatment-of-subaxial-cervical-spin.

Borman, P., Keskin, D., Ekici, B., & Bodur, H. (2008). The efficacy of intermittent cervical traction in patients with chronic neck pain. Clinical Rheumatology, 27 (10), 1249-1253. (Level 3 evidence - Independent study)

Cahaba Government Services Administrators, LLC. (2017, January) Local Coverage Determination (LCD): Cervical Traction Devices (L33823). Retrieved August 9, 2017 from https://www.cms.gov.

Cai, C., Ming, G., and Ng, L. (2010). Development of a clinical prediction rule to identify patients with neck pain who are likely to benefit from home-based mechanical cervical traction. European Spine Journal, 2011 (20), 912-922. (Level 4 evidence - Independent study)

Fritz, J., Thackeray, A., Brennan, G., and Childs, J. (2014, February) Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. Journal of Orthopedics, Sports & Physical Therapy, 44 (2), 45-47. Abstract retrieved August 9, 2017 from PubMed database.

Kang, J. H., & Park, T. S. (2015). Changes in cervical muscle activity according to the traction force of an air-inflatable neck traction device. Journal of Physical Therapy Science, 27 (9), 2723-2725. (Level 4 evidence - Independent study)

Misfud, M., Abela, M., & Wilson, N. I. (2016). The delayed presentation of atlantoaxial rotatory fixation in children: a review of the management. The Bone & Joint Journal, 98-B (5), 715-720. Retrieved abstract August 29, 2016 from PubMed database.

Raney, N. H., Petersen, E. J., Smith, T. A., Cowan, J. E., Rendeiro, D. G., Deyle, G. D., et al. (2009). Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. European Spine Journal, 18 (3), 382-391.

U. S. Code of Federal Regulations. (1987, current as of August 2017) Title 21, Volume 8. Section 888.5850. Orthopedic Devices, Surgical Devices. Nonpowered orthopedic traction apparatus and accessories. Retrieved August 8, 2017 from https://www.ecfr.gov.

Washington State of Labor and Industries. (2002, August). Technology Assessment. Pronex and HomeTrac cervical traction. Retrieved December 30, 2010 from http://www.lni.wa.gov.

Young, I. A., Michener, L. A., Cleland, J. A., Aguilera, A. J., & A. R. Snyder. (2009). Manual therapy, exercise, and traction for patients with cervical radiculopathy: A randomized clinical trial. Physical Therapy, 89 (7), 632-642. (Level 2 evidence - Industry sponsored)

ORIGINAL EFFECTIVE DATE:  6/11/2011

MOST RECENT REVIEW DATE:  9/14/2017

ID_BT

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.

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