Spinal Fusion or Artificial Disc Replacement? Spine Experts Speak Out
Artificial Discs: Spine Experts Speak Out - Part 3
The approval in 2004 of an artificial disc to treat degenerative disc disease has had lots of people talking. It is a cure for back pain or just another high-tech, high priced gadget? The answer probably lies somewhere between. SpineUniverse spoke to several renowned and respected spine specialists about their opinions of this new technology. Read on to find out what these experts think.
CHARITÃ Artificial Disc
DePuy Spine, Inc.
|Gerard Malanga, MD
Director, Pain Management
The approval of artificial discs for the treatment of low back pain from disc disease represents a potentially helpful treatment to patients who suffer from disc-related spine pain. The successful track record of joint replacement has been well established in the knee and hip joint and this is the hope for disc replacement in the spine. Certainly, the current surgical solution of spinal fusion has been less than desirable since it results in loss of motion and altered biomechanics of the spine. A disc replacement would hopefully allow for more normal biomechanics and better long-term success.
The main concern with this procedure is that the spine is a complex structure and the cause of low back pain can be very elusive. As with any surgical procedure, the best results occur when patients are properly selected. If there is an overzealous use of this procedure and if patients are not properly selected, the results will decline. In addition, as with any new procedure, there is a learning curve in performing the procedure. It should therefore be performed by spine surgeons with appropriate training and experience in this type of surgery. Keep in mind that although this procedure can restore the motion of the disc, it is the muscular control of the spine that allows us to support and function in day-to-day activities. An appropriate post-operative treatment should be developed to enhance the muscular components of the spine, which will hopefully enhance the results of disc replacement surgery. Ultimately, gathering outcome data over time will be the best way to determine the benefits of this newly approved procedure.
|Vincent Traynelis, MD
University of Iowa Hospitals
Iowa City, IA
Recently, a total disc replacement device for the lumbar spine was approved by the FDA for use in the United States. Total disc replacement may be an option for those patients with degenerative disc disease, who do not have significant instability. When such individuals fail to respond appropriately to non-operative treatments, they become candidates for surgical fusion. Replacing the disc, rather than fusing the spine, will allow these patients to retain normal spinal motion. Preserved spinal motion may be beneficial in decreasing the risk of further degeneration of the remaining discs.
Although this technology holds great promise, it should be embraced slowly and cautiously. Only properly selected patients will benefit from such procedures. Many individuals will still require fusion. Artificial discs are placed in the anterior, or front portion of the spine. To do the operation properly requires tremendous surgical expertise and specialized training. It is anticipated that complications arising from improperly placed artificial discs or those that have migrated out of position will be difficult to treat.
Despite these concerns, I do believe that disc replacement will ultimately represent a significant advance in our ability to treat many patients.
|Jeffery Wang, MD
Chief, Spine Service
Department of Orthopaedic Surgery
Los Angeles, CA
With the FDA approval of the CHARITÃ Artificial Disc, we begin a new era in the treatment of degenerative disc disease. While this is a very exciting time for both patients and physicians, I do think we need to be very careful and cautious in our approach to this new technology. We must understand that while it may possibly provide a better method for us to treat our patients, we still need to make sure we do not overuse or implement this inappropriately in our patients. We also need to continue to observe our patients and carefully watch this new technology to determine whether or not it is safe and effective. Although the initial results of the studies are very promising, we need to understand the long-term benefits, effects, and safety of these artificial discs. While we may see short-term improvement, we may run into significant problems as the product wears out in the future.
It is also important to understand how this technology fits in with our current technology of fusion. Certainly if you compare the outcomes of disc replacement with the outcomes of lumbar spinal fusion, the results are very comparable and there is no definitive evidence that lumbar disc replacement will prevent the development of further degeneration or result in long-term motion preservation as compared to spinal fusion. In summary, we need to be very careful and very selective with the implementation of this new technology.
One concern that I do have is that patient interest will drive this area and allow this technology to be used inappropriately. As physicians, it is our responsibility to carefully select our patients, assure them that we are properly trained in this procedure and carefully follow our patients to determine the long-term safety. I believe the training process for the physicians needs to be very carefully monitored and implemented, and patients should understand that this is a new technology and may not be the magical cure for all of their problems.
|Mark R. McLaughlin, MD
Princeton Brain and Spine Care
The lumbar disc prosthesis, when perfected, and indications for arthroplasty, when refined, will make a solid impact in combating degenerative disease of the lumbar spine. Over the last decade we have succeeded in identifying a patient population that may benefit, however we are still in the infancy of lumbar disc prosthesis technology. I have no doubt this device will help some patients. My concern is that some patients will not be helped and perhaps may be hurt by the overzealous incorporation of this technology. This advance must be adopted slowly and carefully with continued vigilant outcomes research. Doctors owe this to their patients -- else we slip toward the precipice of over-daring.
There is a precipice on either side of you -- a precipice of caution and a precipice of over-daring.
- Winston Churchill