What is the effectiveness of spinal distraction for treating disc prolapse?

Spinal Distraction for Disc Prolapse: Limited Evidence of Effectiveness

Spinal distraction (traction) is not effective for disc prolapse and should not be used as a primary treatment modality. The highest quality evidence demonstrates no benefit over placebo or sham treatment for pain relief or functional outcomes.

Evidence Against Traction for Disc Prolapse

Systematic Review Findings

• A Cochrane review of 24 trials found traction no more effective than placebo, sham, or no treatment for any outcome in patients with low back pain with or without sciatica 1
• Two higher-quality trials specifically demonstrated no superiority of traction over placebo or sham interventions 1
• Multiple systematic reviews consistently concluded either no evidence of effectiveness or insufficient evidence to support traction use 1

Specific Findings by Clinical Presentation

• For sciatica of mixed duration: Autotraction showed benefit in two lower-quality trials, but continuous or intermittent traction was ineffective across 8 trials 1
• No clear evidence exists that various types of traction are superior to other conservative interventions 1

Safety Concerns

• Traction carries risks including aggravation of neurologic signs and symptoms, potentially leading to subsequent surgery 1
• Adverse events were poorly reported in the literature (not mentioned in 16 of 24 trials), raising concerns about incomplete safety data 1

Alternative Evidence-Based Approaches

Spinal Decompression Therapy (Modern Technique)

• A 2020 randomized controlled trial showed spinal decompression therapy combined with core stabilization exercises significantly reduced pain (NRS reduction: 4.75) and disability (Modified Oswestry: 45.13 point improvement) compared to exercises alone 2
• This represents a distinct, newer technique from traditional traction and warrants consideration as an alternative

Surgical Discectomy

• Surgical discectomy provides faster relief from acute sciatica than conservative management in carefully selected patients, though effects on lifetime natural history remain unclear 3, 4
• Microdiscectomy produces comparable results to standard open discectomy 4

Conservative Management

• Lumbar spinal decompression surgery shows similar effectiveness to intensive rehabilitation programs for patients who have failed 6 weeks of conservative therapy 1
• Both surgical and non-surgical approaches showed improvement with no significant differences in disability scores 1

Clinical Algorithm

For acute disc prolapse with radiculopathy:

1. Avoid traditional traction as primary treatment 1
2. Consider modern spinal decompression therapy (distinct from traction) combined with core stabilization exercises if conservative approach preferred 2
3. Reserve surgical discectomy for carefully selected patients requiring faster symptom relief 3, 4
4. Monitor for progressive neurological deficits requiring urgent surgical evaluation 5

Critical Pitfall

Do not confuse modern "spinal decompression therapy" (as studied in the 2020 trial) with traditional traction. While traditional traction lacks efficacy, newer decompression techniques combined with exercise show promise 2. However, the evidence base for traditional traction remains consistently negative across multiple high-quality systematic reviews 1.