Title:Vertebralaxialdecompression(VAX-D)therapyforchroniclowbackpain- April2001
Agency:MedicareServicesAdvisoryCommittee(MSAC) CommonwealthDepartmentofHealthandAgeing GPOBox9848CanberraACT2601Australia
Reference:MSACApplicationnumber1012. AssessmentreportISSN1443-7120
Aim:
Toassessthesafetyandeffectivenessofvertebralaxialdecompression(VAX-D)therapyandunderwhat
circumstancespublicfundingshouldbesupportedforthisservice.
Conclusionsandresults:
Safety:DetailedevidenceonthesafetyandcomplicationratesoftheVAX-Dtableislacking.
Effectiveness:Forpatientswithradiculopathyorradicularpainassociatedwithaherniated
intervertebraldisc,thereissomeevidencetosuggestthatsurgicaldiscectomyismore effectivethanVAX-Dtherapyatrelievingpainintheshorttomediumterm.No comparisonscanbemadebetweenthesetwotherapiesinthispatientgroupoverthelong term(ie,10years).Forotherpatientgroups(ie,patientswithradiculopathyorradicular painassociatedwithdegeneratedintervertebraldiscs,andpatientswithnon-specificlow backpain)thereisinsufficientevidencetomakeanyconclusionsregardingtherelative effectivenessofVAX-Dtherapy.
Cost-effectiveness:Noevidence-basedconclusionscanbedrawnregardingthecost-effectivenessof VAX-Dtherapyinanypatientgroup.However,itislikelythatdiscectomyismorecost- effectivethanVAX-Dtherapyforthetreatmentofpatientswithradiculopathyor radicular painassociatedwithherniatedintervertebraldiscs.
Recommendations:
AsthereiscurrentlyinsufficientevidencepertainingtotheeffectivenessofVAX-Dtherapy,MSAC
recommendedthatpublicfundingshouldnotbesupportedatthistimeforthisprocedure.
Method:
TheapplicantrequestedthatVAX-Dtherapybesubsidisedforthetreatmentofchroniclowbackpain
resistanttoconservativetreatment.Accordingly,areviewofthemedicalliteraturewaslimitedtoevidenceofsecond-linetreatmentadministeredtopatientswithlowbackpainofatleastthreemonthsduration.Threedistinctpatientgroupswereidentified(seetablebelow),andeachofthesegroupswasassociatedwithaparticulartreatment.Inthisreviewthemostcommonconservativetreatmentfornon-specificlowbackpainwasdefinedasoralanalgesicsornon-steroidalanti-inflammatorydrugs(NSAIDs),withorwithoutphysiotherapy.InadditiontoevaluatingtheevidencepertainingtoVAX-Dtherapyin
eachofthethreepatientgroups,theevaluationincludedareviewofevidencerelatedtoeachofthethree comparatortreatments.
PatientgroupPatientdescriptionMostcommontreatment(Comparator)
1Radiculopathyorradicularpaincausedbyherniatedintervertebraldisc,unresponsivetoconservativetherapy
2Radiculopathyorradicularpaincausedbydegeneratedintervertebraldisc,unresponsivetoconservativetherapy
3Chronicnon-specificlowbackpain,unresponsiveto conservativetherapy
Discectomyormicrodiscectomy
Laminectomy,withorwithoutfusion,orlaminotomy
Ongoingconservativetreatment
Oneprospective,controlledclinicaltrialofVAX-Dtherapywasidentified,whichwasconductedin patientscorrespondingtoPatientGroup1.Thisstudysuffersfromseveralsignificantdesignproblems andwasconductedinarelativelysmallnumberofpatients.Theremainingevidenceisfromquasi- experimentalnon-randomisedstudies,andcase–series,conductedpredominantlyinmixedpatient populations.
ProducedbyDrSarahNorris,M-TagPtyLtd.,Australia