Two Birmingham-area physicians say a relatively new, noninvasive therapy for lower back pain has surpassed their expectations and is allowing many patients to avoid surgery and reclaim a normal life. "I was tired of seeing so many people end up in surgery and come back not better," says Dr. David Wilhelm, a family care practitioner operating Greystone Back Pain Center in conjunction with Greystone Internal Medicine. "So we began to search around for a viable option to surgery." What Wilhelm and his physical therapist found was the Accu-SPINA™ device from North American Medical, the company that has developed Intervertebral Differential Dynamics Therapy® (IDD Therapy®). Accu-SPINA uses a computer to isolate and distract the vertebrae surrounding an injured disc by 5 to 7 millimeters. The 25- to 30-minute treatment provides static, intermittent, and cycling forces on structures that may be causing low back pain. During treatment, intradiscal pressure is dropped, promoting the diffusion of water, oxygen and nutrients into the vertebral disc area, rehydrating the degenerated disc. Repeated pressure differential promotes retraction of a herniated nucleus pulposus (the elastic core of the disc). According to North American Medical, IDD Therapy can provide relief for such conditions as herniated discs, degenerative disk disease, posterior facet syndrome, sciatica, and other acute or chronic back pain due to various conditions. "We were a little skeptical at first, but the results have been amazing," Wilhelm says. "We had 20 or 30 people scheduled for surgery, and we were able to keep them from having any procedure done." Wilhelm compares the Accu-SPINA to "a computerized, robotic physical therapy device. Once you get an MRI scan that shows which disc is a problem, you put this information into the machine. It changes the angle of the machine and the amount of weight, so you're delivering a consistent treatment each and every time." The number of treatments depends on the patient; it could be anywhere from 10 to 20, over a period of several weeks. "There's good data out there that shows about 85 to 90 percent of patients have a positive response," Wilhelm says. "Some of those people get well completely; some just have a more livable pain level. The amazing thing is to watch people almost stumble in here, stooped over in pain, having been told there was nothing that could be done short of surgery, and end up two to three weeks later pain free." In a study of the long-term effect of IDD Therapy, published in 2005 in the American Journal of Pain Management, researchers found patients reported a 76 percent decrease in pain one year after the last therapy session. The other physician offering IDD Therapy in Birmingham, Dr. Hisham Hakim, Greystone Neuroscience and Research Center, said the impressive research results published on IDD Therapy prompted him to add the Accu-SPINA to his options for treatments of back pain. "It was, to our surprise, better than we even expected," Hakim says. "I had a lot of patients who went back completely to normal life, and also a lot of patients avoid the need for surgery. It's really a very benign, noninvasive procedure that gives you a wonderful result." Hakim points out that the machine allows the therapist to target the force into the specific disc in question. Each patient, depending on factors such as their weight and their pathology, has an individualized treatment program, which is stored in the machine's computer. This technology differs significantly from a previous machine that used distraction for lumbar pain, the VAX-D®. The VAX-D transmitted a general force to the lumbar spine and could not individually select a vertebral level. The device also was dependent on the patient relaxing the lumbar paravertebral muscles and maintaining contraction of the shoulder girdles and cervical paraspinal muscles – not an easy task. The Accu-SPINA allows patients to relax in relative comfort during the treatment. Although this technology started emerging in the late 1990s, it is still not widely available. North American Medical says there are about a dozen locations offering IDD Therapy statewide, with two in Birmingham. Both Wilhelm and Hakim have been offering the technology for approximately two years. "The equipment is quite an expensive machine," Hakim notes. It takes a comprehensive treatment center, he says, "to absorb the cost and offer a comprehensive treatment protocol, with the IDD Therapy one part of it." Both Wilhelm and Hakim encourage area physicians to consider referring back pain patients for treatment. "I always recommend to give it a chance for the chronic back pain patient, and always for someone considering surgery for that," Hakim says. "You have nothing to lose, and a lot to gain." February 2007