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 . 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  . 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 . In more severe cases, surgery becomes the next line of treatment irrespective of its obvious complication and economic cost . It is on this note that adjunct treatments and physiotherapy became the limelight in the management of spine-related musculoskeletal conditions . 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  . The main reasons for IDD therapy advocacy are ;
- chronic neck and back pain are the major causes of disability,
- there is an ongoing opioid pain medication epidemic in the United States, and other countries of the world
- majority of patients prefer to avoid the risks of surgery or suffer from spine-related musculoskeletal conditions contraindicated to surgical intervention, 4
- IDD is cheaper and safer when compared with surgical procedures and
- the computerized system of IDD seems to produce consistent, reproducible, and measurable non-surgical decompression, demonstrated by radiology 
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  . 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 . 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 . It is Food and Drug Administration (FDA) approved, class II medical device . 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 . 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 . 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  (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 . 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 .
Therapeutic Effects[edit | edit source]
- Comfortably re-educate (stretch and work) supporting soft tissues to increase joint range of motion
- Distract and mobilise the facet joints
- 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)
- Create negative pressure to promote retraction of disc bulge and remove pressure on nerves
- Re-align spinal structures and rehabilitate damaged discs
- Release endorphins for pain relief and stress reduction, thereby making the therapy session so comfortable and sedative
- Deliver passive exercise element to reduce muscle spasm
- Provide an environment for the body to heal itself. 
Indications[edit | edit source]
In accordance with the IDD device manufacturer’s protocol/recommendation; 
- Herniated or bulging discs
- Degenerative disc disease
- Facet syndrome
- Cervical radiculopathy
- Chronic low back and neck pain
Contraindications[edit | edit source]
In accordance with the IDD device manufacturer’s protocol/recommendation; 
- Cauda Equina Syndrome
- Spondylolithesis (Grade II or higher)
- Osteoporosis (T-score greater than -2.5)
- Spinal surgery (less than six months)
- Surgical hardware in the spine
- Vertebral fracture(s) (less than six months)
- Patients less than 18 years
- Postpartum (less than six months)
- Congenital spinal abnormalities
- Rotatory or severe scoliosis
Treatment Protocol[edit | edit source]
IDD therapy comprises of varying treatment sessions specifically designed for each patient lasting for 25 to 30 minutes . Its protocols allow for the controlled distraction of targeted vertebrae to mobilize the joint and to create a negative pressure inside the intervertebral disc . 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  reported an average of 65% and 76% pain reduction at completion of IDD therapy and at one year post-IDD therapy respectively. McClure & Farris  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.  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 , 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 .
Schaufele and Newsome  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  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 .
References[edit | edit source]
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