» » Artificial Disc
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 over 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 over 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.
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