Spine surgeons routinely perform "spinal fusion" procedures in an attempt to relieve pain caused by degenerating lumbar discs. Although in carefully selected cases, a spinal fusion can reduce or eliminate back pain, the procedure also reduces mobility of the spine. Furthermore, because of the increased stiffness of the fused section, the sections above and below a fusion are under increased stress, and thought to be prone to premature degeneration, which may lead to additional fusion surgery.

Artificial disc replacement is an alternative strategy for treating the pain of degenerative disc disease, while preserving the normal motion of the spine. Artificial discs have been in use in Europe for more than a decade. The first lumbar artificial disc was FDA approved for use in this country in October of 2004.

The device is known as the SB Charite. SB stands for Schellnack and Buttner, the names of the two original German designers. This is a metal and plastic prosthesis which has been in clinical use for more than 10 years in Europe. The prosthesis is currently in its third generation design, and is the most implanted artificial disc in the world. Although there are several other models currently in use around the world, the number of patients with significant follow-up is low.

The artificial disc is NOT indicated for all patients. There are specific criteria for its use. Currently it is approved only for patients with back pain due to degenerative disc disease at L4 through S1, who have failed non-surgical treatment for at least six months. There has been no side-by-side comparison of disc fusion vs. disc replacement, to see which is better. The disc replacement surgery requires a team of surgeons, with the general surgeon opening the abdomen for an anterior (front) approach to the spine.

Patients with simple disc hernation and leg pain are still candidates for the much simpler "micro-discectomy" procedure. Many patients who undergo spinal fusion in our practice have spondylolisthesis or slippage of one vertebrae on another. This unstable condition is a contraindication to disc replacement surgery.

The FDA and the company that markets the Charite device requires special surgeon training and certification to implant this device. Although The Neurosurgery Group was not involved in the lumbar disc replacement studies, our surgeons did participate in studies of the cervical artificial disc, which is awaiting FDA approval. Once our surgeons have completed the lumbar artificial disc training, we will make this exciting new technology available to our patients.