Inversion therapy in patients with pure single level lumbar discogenic
disease: a pilot randomized trial

K. S. Manjunath Prasad1, Barbara A. Gregson2, Gerard Hargreaves3, Tiernan Byrnes2, Philip Winburn2 &
A. David Mendelow2
1Department of Neurosurgery, James Cook University Hospital, Middlesbrough, United Kingdom, 2Department of Neurosurgery,
Regional Neurosciences Centre, Newcastle upon Tyne, United Kingdom, and 3Department of Physiotherapy, University of
Northumbria, Newcastle upon Tyne, United Kingdom



Implications for Rehabilitation

• Resolution of impairment and diasability due to radiculopathy is the aim of any intervention.
• Avoidance of surgery meant satisfactory resolution of impairment and disability due to radiculopathy. This happened more often in the inversion group to the
  extent of reaching statistical significance.
• The 12-point improvement in disability by the Oswestry Disability Index in the inversion group suggests a role for this intervention in disability reduction.
• Inversion may form part of the conservative rehabilitation of patients with single level unilateral lumbar disc
  protrusion alongside other forms of physiotherapy.
• There is a potential secondary impact in the reduction of rehabilitation following surgery.





Backache and sciatica due to protuberant disc disease

is a major cause of lost working days and health expenditure.

Surgery is a well-established option in the management

flowchart. There is no strong evidence proving that traction for

sciatica is effective. We report a pilot prospective randomized

controlled trial comparing inversion traction and physiotherapy

with standard physiotherapy alone in patients awaiting

lumbar disc surgery. This study sought to study the feasibility

of a randomized controlled trial on the effect of inversion

therapy in patients with single level lumbar discogenic disease,

who had been listed for surgery. Methods: This was a single

centre prospective randomized controlled trial undertaken

at the Regional Neurosciences Centre, Newcastle Upon Tyne,

UK. It was a prospective randomized controlled trial where

patients awaiting surgery for pure lumbar discogenic disease

within the ambit of the prestated inclusion/exclusion criteria

were allocated to either physiotherapy or physiotherapy

and intermittent traction with an inversion device. Posttreatment

assessment made by blinded observers at 6 weeks

for various outcome measures included the Roland Morris

Disability Questionnaire (RMDQ) Score, Short Form 36 (SF 36),

Oswestry Disability Index (ODI), Visual Analogue Pain Score

(VAS), magnetic resonance imaging (MRI) appearance and

the need for surgery. Avoidance of surgery was considered a

treatment success. Results: Twenty-six patients were enrolled

and 24 were randomized [13 to inversion + physiotherapy and

11 to physiotherapy alone (control)]. Surgery was avoided

in 10 patients (76.9%) in the inversion group, whereas it was

averted in only two patients (22.2%) in the control group.

Cancellation of the proposed operation was a clinical decision

based on the same criteria by which the patient was listed for

surgery initially. There were no significant differences in the

RMDQ, SF 36, ODI, VAS or MRI results between the two groups.





Intermittent traction with an inversion device resulted in a significant reduction in the need for surgery. A larger multicentre prospective randomized controlled trial is justified in patients with sciatica due to single level lumbar disc protrusions.

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