Computed tomographic evaluation of lumbar spinal structures during traction

Abstract

In the previous studies, it is reported that traction diminishes the compressive load on intervertebral discs, reduces herniation, stretches lumbar spinal muscle and ligaments, decreases muscle spasm, and widens intervertebral foramina. The aim of this study was to evaluate the effects of horizontal motorized static traction on spinal anatomic structures (herniated area, spinal canal area, intervertebral disc heights, neural foraminal diameter, and m.psoas diameter) by quantitative measures in patients with lumbar disc herniation (LDH). At the same time the effect of traction in different localizations (median and posterolateral herniation) and at different levels (L4-L5 and L5-S1) was assessed. Thirty two patients with acute LDH participated in the study. A special traction system was used to apply horizontally-motorized static lumbar traction. Before and during traction a CT- scan was made to observe the changes in the area of spinal canal and herniated disc material, in the width of neural foramina, intervertebral disc heights, and in the thickness of psoas muscle. During traction, the area of protruded disc area, and the thickness of psoas muscle decreased 24.5% (p = 0.0001), and 5.7% (p = 0.0001), respectively. The area of the spinal canal and the width of the neural foramen increased 21.6% (p = 0.0001) and 26.7% (p = 0.0001), respectively. The anterior intervertebral disc height remained unchanged with traction however the posterior intervertebral disc height was significantly expanded. This study is the first to evaluated in detail and quantitatively the effect of motorized horizontal lumbar spinal traction on spinal structures and herniated area. According to detailed measures it was concluded that during traction of individuals with acute LDH there was a reduction of the size of the herniation, increased space within the spinal canal, widening of the neural foramina, and decreased thickness of the psoas muscle.

Real-Time Monitoring of Stresses and Displacements in Cervical Nuclei Pulposi During Cervical Spine Manipulation: A Finite Element Model Analysis

“…If we, therefore, rotate toward the healthy side of the cervical spine, space emerges between the prolapsed nucleus pulposus and the nerve root, which minimizes pain caused by nerve root compression. [34][35][36] In contrast, rotating toward the affected or prolapsed side will worsen the symptoms. Biomechanically, it is more safe and rational to rotate toward the healthy side than the prolapsed side of the IV disk during CSM.…”

“…33 Application of a distraction force can also cause a decrease in the area of the protruded disk and an expansion of the posterior disk space. 34 This study, therefore, can provide new information to prove that there is a small displacement between the prolapsed disk and the nerve root in CSM.…”

p38 mitogen-activated protein kinase inhibition modulates nucleus pulposus cell apoptosis in spontaneous resorption of herniated intervertebral discs: An experimental study in rats

“…One hypothesis is that, in disc bulges and protrusions, the herniation may retract back into the parent disc (15,16). A second is that dehydration promotes disc regression due to a higher MRI T2 signal intensity, as higher regression rates have previously been reported (17,18).…”

Reduction in Disk and Fiber Stresses by Axial Distraction is Higher in Cervical Disk With Fibers Oriented Toward the Vertical Rather Than Horizontal Plane: A Finite Element Model Analysis

“…[16][17][18][19][20] Past research indicates that the application of distraction forces causes a decrease in the area of the protruded disk and an expansion of the posterior disk space. 13 However, there still is not a clear understanding as to how these 2 different vector forces in the axial direction (distraction and compression) change the load-sharing mechanics between disk fibers and the surrounding disk matrix-these poorly explained mechanisms in the literature form the basis for the current study hypothesis. There is also a lack of data suggesting a long-term benefit of distraction forces on the disk.…”

“…These interventions relieve pressure in the disk and are thought to minimize pain caused by nerve root compression. [13][14][15] Radiculopathy and herniated or prolapsed disks have been effectively treated with distraction therapies. [16][17][18][19][20] Past research indicates that the application of distraction forces causes a decrease in the area of the protruded disk and an expansion of the posterior disk space.…”