When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
Beattie PF, Nelson RM, Michener LA, Cammarata J, Donley J. 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):264-274.
Centers for Medicare & Medicaid Services (CMS). National Coverage Determination (NCD). 160.16: Vertebral axial decompression (VAX-D). [CMS Web site]. 04/15/97. Available at: http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=124&ncdver=1&bc=AgAAgAAAAAAA&. Accessed February 4, 2013.
Daniel DM. Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media? Chiropr Osteopat. 2007;15:7.
Deen HG Jr, Rizzo TD, Fenton DS. Sudden progression of lumbar disk protrusion during vertebral axial decompression traction therapy. Mayo Clin Proc. 2003;78(12):1554-1556.
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.
Gay RE, Brault JS. Evidence-informed management of chronic low back pain with traction therapy. The Spine Journal. 2008;8(1):234-242.
Gose EE, Naguszewski WK, Naguszewski RK. Vertebral axial decompression therapy for pain associated with herniated or degenerated discs or facet syndrome: an outcome study. Neurol Res.1998;20(3):186-190.
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.
Macario A, Pergolizzi JV. Systematic literature review of spinal decompression via motorized traction for chronic discogenic low back pain. Pain Pract.2006;6(3):171-178.
Macario A, Richmond C, Auster M, Pergolizzi JV. Treatment of 94 outpatients with chronic discogenic low back pain with the DRX9000: a retrospective chart review. Pain Pract. 2008;8(1):11-7.
Ramos G. Efficacy of vertebral axial decompression on chronic back pain: study of dosage regimen. Neurol Res.2004;26(3):320-324.
Ramos G, Martin W. Effects of vertebral axial decompression on intradiscal pressure. J Neurosurg.1994;81(3):350-353.
Schimmel JJ, de Kleuver M, Horsting PP, et al. No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy. Eur Spine J. 2009;18(12):1843-50.
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;23(7):780-784.
Up-to-Date. Treatment of neck pain. 01/17/12. Available at: http://www.uptodate.com/contents/treatment-of-neck-pain?source=search_result&search=cervical+non-surgical+spinal+decompression&selectedTitle=8%7E150 [via subscription only]. Accessed February 4, 2013.
US Food and Drug Administration (FDA). Center for Devices and Radiological Health. SpineMed. 510(k) summary. [FDA Web site]. 04/27/05. Available at: http://www.accessdata.fda.gov/cdrh_docs/pdf5/K051013.pdf. Accessed February 4, 2013.
US Food and Drug Administration (FDA). Center for Devices and Radiological Health. DRX9000 True Non-Surgical Spinal Decompression System. 510(k) summary. [FDA Web site]. 05/26/06. Available at:http://www.accessdata.fda.gov/cdrh_docs/pdf6/K060735.pdf. Accessed February 4, 2013.
US Food and Drug Administration (FDA). Center for Devices and Radiological Health. VAX-D Genesis G2. 510(k) summary. [FDA Web site]. 10/05/07. Available at:http://www.accessdata.fda.gov/cdrh_docs/pdf7/K071347.pdf. Accessed February 4, 2013.
Policy: 12.01.01aa:Experimental/Investigational Services