Lumbar Disc Disease and Artificial Disc Replacement
The United States' Food and Drug Administration's approval of the Charité Artificial Disc (DePuy Spine, Inc.) has prompted a great deal of interest from patients with severe low back pain. SpineUniverse recently received an update from Dr. Harry Herkowitz who provided insight into this new technology that holds great promise.
SpU: The Food and Drug Administration's approval of the CHARITÃ™ Artificial Disc has prompted a lot of interest from visitors to SpineUniverse.com. What is your opinion about the significance of artificial discs in the treatment of lumbar disc disease?
Dr. Herkowitz: I feel that the artificial disc will have a significant role in the armamentarium of the spinal surgeon. Again, it should be noted that the indications for operative treatment of disc degeneration is limited and only a select number of individuals would qualify for this surgical procedure.
SpU: Dr. Herkowitz, are there benefits to these devices?
Dr. Herkowitz: Yes. In the setting of an individual who has continued to have significant mechanical low back pain despite all reasonable non-operative means and whose quality of life has been significantly lessened because of the continual pain, the artificial disc does provide a surgical option that I feel is beneficial over that of fusion procedures.
SpU: What is a primary advantage of artificial disc use and is it proven?
Dr. Herkowitz: The concept of preserving motion from a physiologic perspective makes good sense. It is also important to note that to date, the long-term advantages of the artificial disc over more traditional fusion procedures has not been proven.
SpU: What are some of your concerns about artificial discs?
Dr. Herkowitz: Again, from a physiologic perspective, preservation of motion is the ideal goal for its use. There are concerns, however. The two major concerns are:
1) For an implant which would become dislodged, the salvage options are quite limited at this time, and
2) The effect on the posterior elements of the spine.
Certainly, with degenerative changes noted in the spinal motion segment, preservation of spinal motion in a situation where degeneration of the posterior elements (e.g. facet joints) has occurred or may occur, may be another cause of low back pain. This will have to be carefully monitored as we gain longer follow-up. In addition, the concerns of metal debris or polyethylene wear and its effect on the endplates also has not been elucidated at this time.
SpU: Despite these concerns, overall what is your opinion?
Dr. Herkowitz: Again, these are issues that must be monitored as we gain more experience with the artificial disc technology. But, overall, I feel that this is a significant advance in the treatment of disc degeneration and will provide an alternative surgical option in the spine armamentarium.
SpU: Thank you Dr. Herkowitz.