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Artificial Disc Replacement:
Is It the Answer?


 

The latest advance in spinal surgery is called artificial disc replacement surgery. It's still considered experimental by the FDA. Most of the research behind it has been done in Europe. But it may be the Next Big Thing in surgically treating chronic back pain.

If you are considering surgery as a last resort—and that is the only time to consider an operation—is this new procedure right for you?

First, An Anatomy Lesson

Many of you already know this, but for those who don't, let me talk a bit about the anatomy of the spine. It's important to understand the basic anatomy so you can really appreciate treatment options like this.

The spine is made up of vertebrae, which are the blocks of bone that provide the support and structure of the spine. Between the bones are spinal discs, which act like cushions or "shock absorbers" between the vertebrae.

Spinal discs are made up of two parts. The outside of the disc is a strong, fibrous material called the annulus fibrosus. This hard outside part makes contact with nerve fibers or pain receptors in the spinal column.

Inside is a jelly-like substance called the nucleus pulposus. It is made up mostly of water and proteins. And that's where degenerative disc problems arise.

As you age, the amount of water in the disc naturally decreases. This can cause the disc to flatten out and even develop tears or cracks in the hard outer part, which can cause pain. The inner jelly material can bulge out and press against the outside, which can also stimulate the pain receptors.

Replacing the Disc

As with artificial knees and hips, artificial discs replace the degenerative disc. In theory, it should also preserving motion and flexibility better than traditional spinal fusion surgery.

The artificial disk most commonly used was approved in 2004. It's made of two metal plates with teeth to anchor the implant between the bones. Between the two plates is a polyethylene core. A metal ring surrounds the outside. To implant it, the surgeon makes an incision through the abdomen to remove the degenerative disc replace it.

Who Can Have the Surgery?

Only a small percentage of patients are candidates for artificial disc surgery:

  • There are only two clinical diagnoses that are appropriate for artificial disc replacement: symptomatic degenerative disc disease and post-discectomy syndrome. Post-discectomy syndrome is persistent back pain following previous surgery to remove a herniated disc.
  • You must have disc degeneration in only one disc, between L4 and L5, or L5 and S1 (the first sacral vertebra).
  • You must have undergone at least six months of treatment, such as physical therapy, pain medication or wearing a back brace, without showing improvement.
  • You must be in overall good health with no signs of infection, osteoporosis or arthritis.
  • If you have degeneration affecting more than one disc or significant leg pain, you are not a candidate for this surgery.
  • Patients whose bone may not be as strong due to aging or some other bone disorder are not considered candidates.

A Host of Complications

So, does it work? Because the procedure is so new, long-term results won't be known for some time. The FDA did conduct a small study of 120 patients and found that 70 percent of cases reported good-to-excellent results.

Other studies conducted in Europe found similar results, with success rates or patient satisfaction rates between 60 percent and 80 percent.

Sounds good, but as with all surgeries there are lots of potential land mines.

In addition to the usual complications associated with undergoing any surgery and general anesthesia, the complications associated with artificial disc replacement may include:

  • Breakage of the metal plate, dislocation of the implant, and infection.
  • Patients may not improve following the procedure and may require additional surgery.
  • The implant may fail over time due to wear and tear, material failures of loosening of the implants.

 

 

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All material herein is provided for information only and may not be construed as personal medical advice. No action should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being. The publisher is not a licensed medical care provider. The information is provided with the understanding that the publisher is not engaged in the practice of medicine or any other health-care profession and does not enter into a health-care practitioner/patient relationship with its readers. The publisher is not responsible for errors or omissions.

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