The Real Time Geometric Effect of a Lordotic Curve-Controlled Spinal Traction Device: A Randomized Cross Over Study

Abstract

Background: A standard spinal traction (ST) device was designed to straighten the spine without considering physiological lumbar lordosis. Using lordotic curve-controlled traction (LCCT), which maintains the lordotic curve during traction, the traction force would be applied to the posterior spinal structure effectively. Thus, the purpose of our study was to evaluate real-time biomechanical changes while applying the LCCT and ST. Methods: In this study, 40 subjects with mild non-radicular low back pain (LBP) were included. The participants underwent LCCT and ST in random order. Anterior and posterior intervertebral distance, ratios of anterior/posterior intervertebral distance (A/P ratio), and lordotic angles of intervertebral bodies (L2~L5) were measured by radiography. Results: Mean intervertebral distances were greater during LCCT than those measured prior to applying traction (p < 0.05). Mean A/P ratio was also significantly greater during LCCT than during ST or initially (p < 0.05). In particular, for the L4/5 intervertebral segment, which is responsible for most of the lordotic curve, mean LCCT angle was similar to mean lordotic angle in the standing position (10.9°). Conclusions: Based on measurements of radiologic geometrical changes with real-time clinical setting, the newly developed LCCT appears to be a useful traction device for increasing intervertebral disc spaces by maintaining lordotic curves.

Mechanical Changes of the Lumbar Intervertebral Space and Lordotic Angle Caused by Posterior-to-Anterior Traction Using a Spinal Thermal Massage Device in Healthy People

“…As a result, insignificant posterior height of the intervertebral space indicates that posterior spinal structures, including posterior ligaments, receive little tension due to maintaining the lordotic curve as compared to the baseline condition. Our results are consistent with the research findings from the study conducted by Lee and colleagues who demonstrated that the anterior/posterior intervertebral distance ratio was significantly greater during lordotic curve-controlled traction (LCCT) compared to axial traction treatment in the L3–4 and L4–5 sections [ 20 ]. These findings suggest that posterior-to-anterior vertical traction might contribute to symptom improvement of the disc herniation.…”

“…Furthermore, the central canal area of the lumbar spine was found to be wider as compared to baseline. These results are supported by the comparative study between LCCT and traditional traction conducted by Lee and colleagues [ 20 ]. Their findings demonstrated that LCCT traction therapy resulted in greater improvements in pain, function, and morphology of the central canal area of the spine compared to the traditional axial traction technique in patients with lumbar intervertebral disc disease.…”

“…Worldwide, this technique is recommended by many physicians for conditions such as protruded IVDs to treat spinal muscle spasm, pain, and stiffness [ 26 , 27 ]. To date, different types of traction methods such as skeletal traction, spinal decompression, and mechanical traction are commonly used, with devices such as manual, mechanical, inversion, positional, and motorized instruments; however, despite its long history of use and academic results, the clinical usefulness of traction method in lumbar disc problems has been poorly recorded until now [ 20 , 21 , 23 ]. When traditional axial traction is applied to the patient in the supine position, the posterior spinal structures including the facet joints and posterior longitudinal and interspinous ligaments are stretched more than the anterior spinal structures due to decreased lordotic curve, consequently causing pain [ 21 , 24 ]; therefore, to complement this shortcoming of axial traction, new traction techniques and guidelines are required to achieve optimal therapeutic outcomes.…”

“…Until now, the spinal traction devices used for patient treatment have mostly adopted the axial traction approach; however, this approach has technical limitations due to the changes of the natural lordotic curve [ 20 , 21 ]. When axial traction force is applied in the supine position, the straightened spinal structures decrease the lumbar lordotic angle, which may cause negative effects such as muscle pain or spasms, as well as structural damage to the posterior facet joint, posterior longitudinal, interspinous ligament, and soft tissue, rather than decompressing IVD [ 20 , 21 ]. To address this limitation, posterior-to-anterior vertical traction and combination traction (axial and vertical traction) are good solutions due to maintaining the lumbar lordosis curve in supine posture [ 22 , 23 ].…”

“…Despite the many benefits of spinal traction treatment, clinical studies on existing axial traction therapy for lumbar disc disease patients are insufficient. Moreover, the limitations of horizontal traction therapy have been shown in the clinical research outcomes, especially in terms of reduced lordotic curvature [ 20 , 21 ]. Recently, vertical traction in supine posture has received attention as a vulnerability complement to traditional traction therapy, although scientific data and evidence are scarce; therefore, we conducted this pilot study to obtain objective data for real-time vertical traction applications.…”