Aetna considers vertebral axial decompression (e.g., by means of the VAX-D Table, the AxiomWorlWide DRX9000, the DRS System, the Alpha-Spina System, the Lordex Lumbar Spine System, the Saunder 3D ActiveTrac, NuChoice Medical Healthstar Elite Decompression Therapy, the Antalgic-Trak, the Cert Health Services SpineMED, or the Internal Disc Decompression (IDD) Therapy) experimental and investigational. Currently, there is no adequate scientific evidence that proves that vertebral axial decompression is an effective adjunct to conservative therapy for back pain. In addition, vertebral axial decompression devices have not been adequately studied as alternatives to back surgery.
VAX-D therapy for the management of low back pain uses a computer-driven table to control the level of disc decompression.
Although results from an early uncontrolled, retrospective study (Gose et al, 1998) regarding the benefits of the VAX-D table appeared to be encouraging, the findings need to be validated in prospective, randomized, controlled clinical trials because the study was poorly designed. In addition, there has been no follow-up publication indicating whether any reported improvements were temporary or permanent. Thus, there is still insufficient scientific evidence to support the effectiveness of the VAX-D table in treating patients with low back pain associated with herniated discs and degenerative disc problems. The Center for Medicare and Medicaid Services (CMS) Technology Advisory Committee did not recommend coverage of the VAX-D system because of the absence of scientific data on its effectiveness.
A subsequent randomized study (Sherry et al, 2001) compared VAX-D to transcutaneous electrical nerve stimulation (TENS) in the treatment of patients with chronic (> 3 months in duration) low back pain. Successful outcome was defined as a 50 % decrease in pain using the Visual Analog Pain Scale and an improvement in the level of functioning as measured by patient-nominated disability ratings. The TENS-treated group (n = 21) reported a success rate of 0%, while the group treated with VAX-D (n = 19) showed a success rate of 68.4 %. It is difficult to conclude from this study that VAX-D is effective in treating chronic back pain since detailed statistics regarding the outcomes for each group were not included in the analysis. Furthermore, patients were not blinded to the treatment received, thus, there may have been a negative placebo effect in the TENS-treated group.
The Australian Medical Services Advisory Committee (MSAC) (2001) performed an assessment of the literature on VAX-D therapy. The Committee concluded that “there is currently insufficient evidence pertaining to the effectiveness of vertebral axial decompression (VAX-D) therapy...”.
An evidence review by the Workers Compensation Board of British Columbia (Martin, et al., 2005) concluded: "To date there is no evidence that the VAX-D system is effective in treating chronic low back pain associated with herniated disc, degenerative disc, posterior facet syndrome, sciatica or radiculopathy."
The DRS System is marketed for the treatment of low back pain associated with herniated and degenerated discs. According to the manufacturer, the DRS System applies pressures on the disc in a graduated manner, which bypasses the inherent neurological mechanisms that lead to firing of stretch receptors in the paravertebral structures. This decreased resistance to the distractive forces allows a marked reduction in intradiscal pressures, which promotes retraction of herniated disc material and facilitates influx of oxygen, proline and other substrates.
Similar to the VAX-D table, there is little scientific evidence to support the effectiveness of the DRS System or the Internal Disc Decompression (IDD) Therapy in treating low back pain. Further investigation is needed to determine their value in the management of patients with low back pain.
An assessment by the Washington State Department of Labor and Industries Office of the Medical Director (Wang, 2004) concluded that "[p]ublished literature has not substantially shown whether powered traction devices are more effective than other forms of traction, other conservative treatments, or surgery".
The Agency for Healthcare Research and Quality's technology assessment on decompression therapy for the treatment of lumbosacral pain (Jurecki-Tiller et al, 2007) concluded that "[c]urrently available evidence is too limited in quality and quantity to allow for the formulation of evidence-based conclusions regarding the efficacy of decompression therapy as a therapy for chronic back pain when compared with other non-surgical treatment options. Of the studies examined for assessment of efficacy, neither included patients over 65 years of age. Adverse event reporting for decompression therapy is infrequent. There was one case report of an enlargement of an existing disc protrusion, and other studies reported worsening of pain in some patients".
CPT Codes / HCPCS Codes / ICD-9 Codes
Other CPT codes related to the CPB:
64722
97012
HCPCS codes not covered for indications listed in the CPB:
S9090
Vertebral axial decompression, per session
ICD-9 codes not covered for indications listed in the CPB (not all-inclusive):
720.0 - 724.9
Dorsopathies
The above policy is based on the following references:
U.S. Department of Health and Human Services, Health Care Financing Administration (HCFA). HCFA Technology Advisory Committee Minutes, August 6 - 7, 1996. Baltimore, MD: HCFA; 1996. Available at: http://www.hcfa.gov/events/tacminit.htm. Accessed July 13, 2001.
F-D-C Reports. FDA Recalls & Court Actions: Manuals for VAX-D Therapeutic Table. The Gray Sheet. 1996 Aug;22(34).
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.
Ramos G, Martin W. Effects of vertebral axial decompression on intradiscal pressure. J Neurosurg. 1994;81(3):350-353.
Shealy CN, Borgmeyer V. Decompression, reduction, and stabilization of the lumbar spine: A cost-effective treatment for lumbosacral pain. Am J Pain Mgmt. 1997;7(2):63-65.
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.
Medical Services Advisory Committee (MSAC). Vertebral axial decompression (VAX-D) therapy for low back pain. Assessment Report. MSAC application 1012. Canberra, ACT: MSAC; June 2001. Available at: http://www.health.gov.au/msac/pdfs/msac1012.pdf. Accessed April 2, 2004.
Tilaro F. An overview of vertebral axial decompression. Canadian J Clin Med. 1998;5(1):1-7.
Tilaro F, Miskovich D. The effects of vertebral axial decompression on sensory nerve dysfunction in patients with low back pain and radiculopathy. Canadian J Clin Med. 1999;6(1):2-7.
Washington State Department of Labor and Industries, Office of the Medical Director. Vertebral axial decompression (Vax-D). Technology Assessment. Olympia, WA: Washington State Department of Labor and Industries; 1999. Available at: http://www.lni.wa.gov/omd/TechAssessDocs.htm. Accessed August 7, 2003.
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.
Wang G. Powered traction devices for intervertebral decompression. Health Technology Assessment Update. Olympia, WA: Washington State Department of Labor and Industries, Office of the Medical Director; June 14, 2004. Available at: www.lni.wa.gov/ClaimsIns/Files/OMD/TractionTechAssessJun142004.pdf. Accessed February 28, 2005.
Martin CW; Workers Compensation Board of British Columbia (WCB) Evidence Based Practice Group. Vertebral axial decompression for low back pain. Report. Richmond, BC: Workers Compensation Board of British Columbia (WorkSafe BC); 2005.
Jurecki-Tiller M, Bruening W, Tregear S, et al. Decompression therapy for the treatment of lumbosacral pain. Prepared by the ECRI Institute Evidence-Based Practice Center for the Agency for Healthcare Research and Quality (AHRQ) (Contract No. 290-02-0019). Rockville, MD: AHRQ; April 26, 2007. Available at: http://www.cms.hhs.gov/determinationprocess/downloads/id47TA.pdf. Accessed February 6, 2008.
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
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