Intervertebral Differential Dynamics Therapy

Original Editor - Ezinne Chika Ekediegwu

Top Contributors - Naomi O'Reilly  

Introduction[edit | edit source]

In healthcare, many treatment approaches for spine-related musculoskeletal conditions (neck or low back pain) have evolved. This has been in correspondence with the rapid increase in the burden of back-related disabilities [1]. Among the numerous approaches available for the management of these conditions, pharmacology, surgery and physiotherapy have remained the most popular practices in the whole world [2] [3]. At first, the best and only acceptable means of addressing such conditions in patients is the administration of a wide range of opioids and steroids [4]. In more severe cases, surgery becomes the next line of treatment irrespective of its obvious complication and economic cost [5]. It is on this note that adjunct treatments and physiotherapy became the limelight in the management of spine-related musculoskeletal conditions [6][7]. Opioids and surgeries may still be effective, nevertheless, the advent of non-surgical spinal decompression such as Intervertebral Differential Dynamics (IDD) has provided a safer and cost-effective breakthrough for patients presenting with spinal-related conditions [8] [9][10][11]. The main reasons for IDD therapy advocacy are ;

  1. chronic neck and back pain are the major causes of disability,
  2. there is an ongoing opioid pain medication epidemic in the United States, and other countries of the world
  3. majority of patients prefer to avoid the risks of surgery or suffer from spine-related musculoskeletal conditions contraindicated to surgical intervention, 4
  4. IDD is cheaper and safer when compared with surgical procedures and
  5. the computerized system of IDD seems to produce consistent, reproducible, and measurable non-surgical decompression, demonstrated by radiology [12][13]

Definition[edit | edit source]

Simply put, Intervertebral Differential Dynamics (IDD) means decompression of intervertebral segments, aimed at varying  spinal levels with dynamic distraction and longitudinal mobilisation. By way of definition, it is a precise and powered advanced form of spinal decompression treatment used to open the disc space between targeted vertebrae to alleviate pain caused by disc compression and degeneration [14] [15]. Intervertebral Decompression Dynamics Therapy (IDDT) is the latest incarnation of traction therapy which involves spinal stretching on a traction table or similar motorized device aimed at relieving neck or back pain [16][17]. It is a non-invasive spinal rehabilitation treatment developed by Norman Shealy, designed by a group of medical practitioners (consisting of neurosurgeons, physiotherapists, orthopaedic surgeons and other healthcare practitioners) and is delivered by the Accu-SPINA® spinal care device in an attempt to improve the efficacy of spinal pain management [18]. It is Food and Drug Administration (FDA) approved, class II medical device [9]. Individuals with neck or back pain, which has deferred other treatment options at least for three months are usually the best candidates for this kind of therapy [19]. For now, it has remained the biggest advancement in the treatment of neck or back deformities associated with persistent pain.

IDD therapy consists of a set of computer-directed physiotherapeutic treatment regiments to heal or rehabilitate damaged structures in the cervical and lumbar intervertebral discs as well as facet joints, with a course of treatment consisting of 20 sessions of 25 to 30 minutes, spread over a six-week period [18].  The IDD device offers an electrically-generated static, intermittent, and cycling pulley forces delivered accurately to gently distract the targeted injured spinal segments, thereby creating a negative intra-discal pressure to promote retraction or re-positioning of the bulging or herniated disc material and a lower pressure in the intervertebral disc for the influx of healing nutrients into the disc using intermittent motorized traction [16] (Gay, 2013). With this, pressure is taken off from specific injured intervertebral discs and nerves whilst at the same time, tight muscles and stiff ligaments are  gently stretched with resultant reduction in disc herniation size and improvement in pain, depression, straight leg raise (SLR) and disability [12][14][18].  Clinicians  can correctly and properly review and modify every  single treatment on the IDD device because every aspect of the therapy is recorded and adjustable [16].

Figure.1 IDD Therapy Machine by Accu-Spina (Steadfast Corporation Limited, Essex, United Kingdom) in Astella Physiotherapy Clinics, Enugu, South-East Nigeria.

Therapeutic Effects[edit | edit source]

  1. Comfortably re-educate (stretch and work) supporting soft tissues to increase joint range of motion
  2. Distract and mobilise the facet joints
  3. Open the disc space to create pressure differentials for fluid exchange (promoting diffusion of oxygen, water and nutrients into the vertebral disc area for rehydration of degenerated disc, stimulation of metabolism and promotion of disc healing)
  4. Create negative pressure to promote retraction of disc bulge and remove pressure on nerves
  5. Re-align spinal structures and rehabilitate damaged discs
  6. Release endorphins for pain relief  and stress reduction, thereby making the therapy session so comfortable and sedative
  7. Deliver passive exercise element to reduce muscle spasm
  8. Provide an environment for the body to heal itself. [16][18][17]

Indications[edit | edit source]

In accordance with the IDD device manufacturer’s protocol/recommendation; [12]

  1. Herniated or bulging discs
  2. Degenerative disc disease
  3. Sciatica
  4. Facet syndrome
  5. Cervical radiculopathy
  6. Chronic low back and neck pain

Contraindications[edit | edit source]

In accordance with the IDD device manufacturer’s protocol/recommendation; [12]

  1. Cauda Equina Syndrome
  2. Spondylolithesis (Grade II or higher)
  3. Spondylolysis
  4. Osteoporosis (T-score greater than -2.5)
  5. Spinal surgery (less than six months)
  6. Surgical hardware in the spine
  7. Vertebral fracture(s) (less than six months)
  8. Patients less than 18 years
  9. Pregnancy
  10. Postpartum (less than six months)
  11. Metastases
  12. Congenital spinal abnormalities
  13. Rotatory or severe scoliosis
  14. Pacemaker

Treatment Protocol[edit | edit source]

IDD therapy comprises of varying treatment sessions specifically designed for each patient lasting for 25 to 30 minutes [16]. Its protocols allow for the controlled distraction of targeted vertebrae to mobilize the joint and to create a negative pressure inside the intervertebral disc [18]. A session of IDD therapy is usually preceded by targeted exercises or manual therapy or 10 minutes of FAR infrared on the affected segment (neck or back) to increase blood circulation. After the session, 10 minutes of cold therapy to reduce soreness is usually recommended. For optimal benefit, the manufacturer of the IDD device recommends 20 sessions of IDD therapy 3 to 5 times a week for 6 to 8 weeks for patients with neck or back pain.  

Outcome Measures[edit | edit source]

Treatment progress can be monitored using the inbuilt Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) outcome measures on the IDD device.

Previous Studies on IDD Therapy[edit | edit source]

Documented findings about the therapeutic goals achieved through the IDD device exist. Shealy [20] reported an average of 65% and 76% pain reduction at completion of IDD therapy and at one year post-IDD therapy respectively. McClure & Farris [18] examined 415 patients treated with IDD therapy programmes with treatment success measured as 50%+ decrease in average pain scores taken at 2 months and 2 years. A double blinded randomized controlled trial carried out by Demirel et al. [21] answered one of the most rampant question about IDD, in this light as to whether non-surgical spinal decompression therapy makes a difference in management of spinal dysfunction. According to Demirel et al [21], following a 15 sessions of IDD therapy administered to the study group coupled with electrotherapy, stabilization exercises and frictional massage with the control group exposed to all modalities except IDD, a decrease in pain level, functional restoration and reduction in the thickness of the herniation was reported [21].

Schaufele and Newsome [22] concluded in their study on patients with symptomatic lumbar degenerative disc disease that IDD therapy when compared with exercise-based physiotherapy offers similar clinical improvement. The first study on IDD therapy carried out by Ekediegwu and colleagues [23] in Africa, revealed that IDD therapy in conjunction with physiotherapeutic modalities offer statistically significant improvement in low back pain. In addition to this, the efficacy of IDD therapy in conjunction with conventional conservative treatment has been proven and highly recommended [12][24][25][26].

References[edit | edit source]

  1. Buchbinder, R., Van Tulder, M., Öberg, B., Costa, L. M., Woolf, A., Schoene, M., Croft, P., Buchbinder, R., Hartvigsen, J., Cherkin, D., Foster, N. E., Maher, C. G., Underwood, M., Van Tulder, M., Anema, J. R., Chou, R., Cohen, S. P., Menezes Costa, L., Croft, P., … Woolf, A. (2018). Low back pain: A call for action. The Lancet, 391(10137), 2384-2388. https://doi.org/10.1016/s0140-6736(18)30488-4
  2. Meroni, R., Piscitelli, D., Ravasio, C., Vanti, C., Bertozzi, L., De Vito, G., Perin, C., Guccione, A. A., Cerri, C. G., & Pillastrini, P. (2019). Evidence for managing chronic low back pain in primary care: A review of recommendations from high-quality clinical practice guidelines. Disability and Rehabilitation, 43(7), 1029-1043. https://doi.org/10.1080/09638288.2019.1645888
  3. Pillastrini, P., Gardenghi, I., Bonetti, F., Capra, F., Guccione, A., Mugnai, R., & Violante, F. S. (2012). An updated overview of clinical guidelines for chronic low back pain management in primary care. Joint Bone Spine, 79(2), 176-185. https://doi.org/10.1016/j.jbspin.2011.03.019
  4. Curatolo, M., & Bogduk, N. (2001). Pharmacologic pain treatment of musculoskeletal disorders: Current perspectives and future prospects. The Clinical Journal of Pain, 17(1), 25-32. https://doi.org/10.1097/00002508-200103000-00005
  5. Smith, J. S., Klineberg, E., Lafage, V., Shaffrey, C. I., Schwab, F., Lafage, R., Hostin, R., Mundis, G. M., Errico, T. J., Kim, H. J., Protopsaltis, T. S., Hamilton, D. K., Scheer, J. K., Soroceanu, A., Kelly, M. P., Line, B., Gupta, M., Deviren, V., Hart, R., … _, _. (2016). Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. Journal of Neurosurgery: Spine, 25(1), 1-14. https://doi.org/10.3171/2015.11.spine151036
  6. Romero-Morales, C., Bravo-Aguilar, M., Abuín-Porras, V., Almazán-Polo, J., Calvo-Lobo, C., Martínez-Jiménez, E. M., López-López, D., & Navarro-Flores, E. (2021). Current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Disease-a-Month, 67(10), 101210. https://doi.org/10.1016/j.disamonth.2021.101210
  7. Manchikanti, L., Singh, V., Kaye, A. D., & Hirsch, J. A. (2020). Lessons for better pain management in the future: Learning from the past. Pain and Therapy, 9(2), 373-391. https://doi.org/10.1007/s40122-020-00170-8
  8. Jadon, D. A. (2017). Non-operative management of Discogenic back pain by Intradiscal interventions: An evidence based review. SDRP Journal of Anesthesia & Surgery, 1(1). https://doi.org/10.25177/jas.1.1.2
  9. 9.0 9.1 Schimmel, J. J., De Kleuver, M., Horsting, P. P., Spruit, M., Jacobs, W. C., & Van Limbeek, J. (2009). No effect of traction in patients with low back pain: A single centre, single blind, randomized controlled trial of Intervertebral differential dynamics therapy®. European Spine Journal, 18(12), 1843-1850. https://doi.org/10.1007/s00586-009-1044-3
  10. Gay, R. E., & Brault, J. S. (2008). Evidence-informed management of chronic low back pain with traction therapy. The Spine Journal, 8(1), 234-242. https://doi.org/10.1016/j.spinee.2007.10.025
  11. Van Tulder, M. W., Koes, B. W., & Bouter, L. M. (1997). Conservative treatment of acute and chronic Nonspecific low back pain. Spine, 22(18), 2128-2156. https://doi.org/10.1097/00007632-199709150-00012
  12. 12.0 12.1 12.2 12.3 12.4 Henry, L. (2017). Non-surgical spinal decompression an effective physiotherapy modality for neck and back pain. Journal of Novel Physiotherapy and Physical Rehabilitation, 4(3), 062-065. https://doi.org/10.17352/2455-5487.000049
  13. Shealy, C. N., & Borgmeyer, V. (2003). Decompression, reduction, and stabilization of the lumbar spine: a cost-effective treatment for lumbosacral pain. Technology Review, 6(5).
  14. 14.0 14.1 Choi, J., Lee, S., & Hwangbo, G. (2015). Influences of spinal decompression therapy and general traction therapy on the pain, disability, and straight leg raising of patients with intervertebral disc herniation. Journal of Physical Therapy Science, 27(2), 481-483. https://doi.org/10.1589/jpts.27.481
  15. Ramos, G., & Martin, W. (1994). Effects of vertebral axial decompression on intradiscal pressure. Journal of Neurosurgery, 81(3), 350-353. https://doi.org/10.3171/jns.1994.81.3.0350
  16. 16.0 16.1 16.2 16.3 16.4 Patnaik, G. (2018) Role of IDD therapy in the back and neck pain. Journal of Medical  Student Research 1:002
  17. 17.0 17.1 Gay R (2013) All About Spinal Decompression Therapy. SPINE-health. Available from: https://www.spine-health.com/treatment/chiropractic/all-about-spinal-decompression-therapy (accessed 1 Sep 2022).
  18. 18.0 18.1 18.2 18.3 18.4 18.5 McClure, D. & Farris, B. (2006). Intervertebral Differential Dynamics Therapy – A New Direction for the Initial Treatment of Low Back Pain. European Musculoskeletal Review. 45-48.
  19. Awad, J. N., & Moskovich, R. (2006). Lumbar disc Herniations. Clinical Orthopaedics & Related Research, 443, 183-197. https://doi.org/10.1097/01.blo.0000198724.54891.3a
  20. Shealy, C. N. (2005). Intervertebral differential dynamics therapy. Practical Pain Management, 5(3), 64-65.
  21. 21.0 21.1 21.2 Demirel, A., Yorubulut, M., & Ergun, N. (2017). Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? double-blind randomized controlled trial. Journal of Back and Musculoskeletal Rehabilitation, 30(5), 1015-1022. https://doi.org/10.3233/bmr-169581
  22. Schaufele, M. K., & Newsome, M. (2011). Intervertebral Differential Dynamics (IDD) Therapy vs. Exercise Based Physical Therapy–Results from a Randomized Controlled Trial. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, 21(01), 34-40.
  23. Ekediegwu, E., Chuka, C., Nwosu, I., Ogbueche, C., Ekechukwu, E., Uchenwoke, C., & Odole, A. (2021). Reduction in Chronic Low Back Pain Using Intervertebral Differential Dynamics Therapy (IDDT) and Routine Physiotherapy: A Retrospective Pre-Post Study. Journal of Musculoskeletal Disorders and Treatment, 7(2) :098
  24. Kang, J.I., Jeong, D.K., Choi, H. (2016). Effect of spinal decompression on the lumbar muscle activity and disk height in patients with herniated intervertebral disk. Journal of Physical Therapy Science 28: 3125-3130.
  25. Henry, L. (2015). Non-surgical spinal decompression of lumbar disc herniation: a case report and proposed multimodal chiropractic treatment approach. The Internet Journal of Chiropractic. 4:1
  26. Macario, A., Richmond, C., Auster, M., Pergolizzi, J.V. (2008).  Treatment of 94 outpatients with chronic discogenic low back pain with the DRX9000: a retrospective chart review. Pain Practical. 8(1):11-17. Doi: 10.1111/j.1533-2500.2007.00167.x. PMID: 18211590.