lumbar traction

Hello, does anyone have some expierience in complications due to lumbar traction ? f.ex.:like an acute cauda equina syndrom resulting from disc fragment migration at the L3-L4 level after traction therapy. :eek

[arkesh_physio]

hi,
some patients do complaint of increased symptoms after traction mainly because of increased disc volume.
but cauda equina syndrome seems to be rare.
regards,
ark.

[sdkashif]

Complications can only occur if all the necessary contraindications and precautions are not ruled out. These are as under:

(1) ligamentous instability

(2) Any spinal condition in which structural integrity is compromised, such as osteomyelitis, diskitis, primary or metastatic tumor, spinal cord tumor, severe osteoporosis

(3) Stretch Forces to areas of Spinal Hypermobility

(4) Acute Sprain, Strains, and inflammation or any painful symptoms aggravated by initial traction procedures.

(5) Any Spinal condition or disease process in which movement is contraindicated.

(6) Severe Haemorrhoids

(7) clinical signs of myelopathy

(8) severe anxiety

(9) untreated hypertension & Cardiovascular disease

(10) midline herniated nucleus pulposus

(12) restrictive lung disease

(13) active peptic ulcer

(14) hernia

(15) aortic aneurysm

(16) pregnancy

(17) Patients with respiratory problems or who develop claustrophobia when placed in the traction apparatus.

[Physiobase]

Interesting thought. Was the any investigations suggesting that this was NOT the case prior to the traction? I would suggest traction mainly assists muscles to relax/release and has verry little affect on the movement of disc material. I could propose that, like lying down, the reduced pressure on the discs could lead to some further increase in fluid volume albeit is small.

My first thought is that this type of patient already had the cauda equina issue (it this was actually a patient and not a hypothesis). Furthermore that traction aggravated the symptoms and that this lead to further investigation which demonstrated the cauda equine issue.

On a traction note: it can be a useful treatment and patients that have benefited from it in the past tend to come in asking for it. It is however poorly applied and is an acquired skill. I remember in Australia there were an excellent set of traction videos you could get you hands on that really looked into how, why, when, how long etc to use traction. These were excellent teaching aids, much more than the undergraduate degree.

Anyone heard of the DRS traction machine?

I've heard it is very effective.

Here is also a study about it's efficiency

www.certhealthsciences.com/research.html

[Kinetix]

I have not heard about it, sorry, but we use a Chatanooga Group Triton system in our hospital and it has a verry cute traction unit (large color touch screen) and a quite adaptible table. Anyway, I think the thoracic belt is not verry good (a bit slippy, can't hold the pacient fixed). The position is lying supine or prone.
I have used another device (made by myself) prior to this, a Vaquette type. The position was prone, hips and knees bent at 90 degrees. Also, used forces between 25 and 45 kgf.
Comparing the too systems, I would say that the older, "hand made" one, has a better efficiency cause of the better position (despite of the pulleys and ropes ).
What is your opinions?
Which position is better: prone or supine, knees and hips flexed or straight?
What forces do you use?
Thanks a lot!
P.S. For admin. If my post is not correctly localised, please move it where is better.