Case Report: 50-Year-Old Male Treated with PRODISC®

Kevin T. Foley, MD
Professor of Neurosurgery
University of Tennessee
Memphis, TN
The Food and Drug Administration (FDA) has approved the PRODISC®-L Total Disc Replacement (Synthes Spine, Inc. of West Chester, PA). This artificial disc is indicated for use in patients who are skeletally mature, have degenerative disc disease (DDD) at one level in the lumbar spine (from L3-S1), have no more than Grade 1 spondylolisthesis at the involved level, and have had no relief from pain after at least six months of nonsurgical treatment.
Case History

The patient is a 50-year-old farmer with a seven-year history of low back pain. The patient described his pain as severe when standing or sitting and less severe when lying. He reported significant pain during work-related activities. He was no longer able to lift heavy objects (e.g., bags of soil and seed). Further, he had to brace himself while shaving, etc.

Diagnosis

Work-up revealed that the patient had Degenerative Disc Disease (DDD) at the L5-S1 level. See Figures 1 and 2.

Figure 1: Lateral X-Ray - DDD at L5-S1
Figure 1: Lateral X-Ray - DDD at L5-S1
Figure 2: Lateral MRI - DDD at L5-S1
Figure 2: Lateral MRI - DDD at L5-S1

Non-Surgical Treatment

Non-surgical treatments included non-steroidal and anti-inflammatory medications, epidural steroid injections, and physical therapy. Conservative measures failed to alleviate the pain.

Surgical Options

The patient was given two options: 1) lumbar fusion surgery; or 2) disc replacement surgery as a participant in the nonrandomized portion of the PRODISC® disc replacement trial. He elected to have disc replacement surgery because he was interested in preserving motion in his lower lumbar region.

Surgical Outcome

The patient’s surgery and hospital course were uncomplicated. Six weeks following surgery he reported a significant reduction in pain. He stated that any residual pain was probably associated with decreased muscle tone due to long-term deconditioning. The patient felt confident that this would resolve as he gradually resumed his normal activities. Figures 3 through 5 illustrate placement of the PRODISC®.

Figure 3: Anterior X-Ray - PRODISC®
Figure 3: Anterior X-Ray - PRODISC®
Figure 4: Lateral X-Ray - PRODISC®
Figure 4: Lateral X-Ray - PRODISC®
Figure 5: Lateral X-Ray Spine Bent Forward - PRODISC®
Figure 5: Lateral X-Ray Spine Bent Forward - PRODISC®
Last Updated: 08/16/2006
Continue Reading: Artificial Discs and Degenerative Disc Disease
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Peer Review by Leading Specialists

    Stephen E. Heim, M.D., F.A.C.S.

    This is a particularly well-written and educational article in terms of both degenerative disc disease of the lumbosacral spine and the option of disc replacement surgery. Several points mentioned by Dr. Foley are especially worthy of emphasis. Firstly, the majority of patients with radiographic degenerative disc disease can be treated successfully non-operatively. Secondly, fusion of a lumbosacral motion segment will increase stresses upon the adjacent levels of the low back; however fusion surgery can be very successful in the treatment of functionally limiting degenerative disc disease. Thirdly, disc replacement surgery is fairly new technology and under study to more completely determine its efficacy both short and long term. With the motion preservation offered by disc replacement surgery, stresses upon adjacent motion segments will be minimized. Fusion surgery will remain the "final alternative" if motion preserving disc replacement surgery were to be unsuccessful.
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