Artificial Disc
An
Alternative to Fusion Surgery | Why
It's Big News | Additional Discs | Benefits | Drawbacks | Lumbar vs. Cervical Artificial Disc | Where to Go For Artificial Disc Surgery
 Perhaps the most anticipated advance in spine surgery
over the past 20 years is the arrival of the artificial disc, which
first received formal approval by the Food and Drug Administration (FDA)
for widespread use in the United States on October 26, 2004. The Charité disc for the low back (lumbar) area was the first to be approved. Since then, additional artificial discs have also been approved by the FDA.
The artificial disc is projected to
have a dramatic impact on the field of spine, just as the
introduction of the artificial joint had for those with damaged knee
or hip joints. Before the introduction of the artificial knee or
artificial hip, these joints often had to be fused. However, thanks
to artificial joint implants, thousands of people each year regain
the ability to walk. Finally, this new technology is being brought
to the field of spine.
The artificial disc represents the best alternative to date for spinal
fusion surgery. Each year in the U.S., more than 200,000 spinal fusion
surgeries are performed to relieve excruciating pain caused by damaged
discs in the low back and neck areas.
During a fusion procedure, the damaged disc is typically
replaced with bone from a patient’s hip or from a bone bank.
Fusion surgery causes two vertebrae to become locked in place, putting
additional stress on discs above and below the fusion site, which restricts
movement and can lead to further disc herniation. An artificial disc
replacement, however, is designed to duplicate the function level of
a normal, healthy disc and retain motion in the spine.
Some experts estimate that over the next 10 years, more
than half of patients who would otherwise receive a fusion will receive
an artificial disc instead. Educated consumers nationwide are expected
to migrate towards regional spine centers of excellence for access
to this latest technological advance in spine care.
The arrival of the artificial disc is tremendous news because of the
widespread incidence of degenerative disc disease. A natural byproduct
of aging occurs through the loss of resiliency in spinal discs and
a greater tendency to herniate, especially when placed under a heavy
load, like when we lift heavy objects. Additionally, some people have
a family history of degenerative disc disease, which increases their
risk of developing the disease.
When a natural disc herniates or becomes badly degenerated,
it loses its shock-absorbing ability, which can narrow the space between
vertebrae. In fusion surgery, the damaged disc isn’t repaired
but rather is removed and replaced with bone that restores the space
between the vertebrae. However, this bone locks the vertebrae into
place, which can then damage other discs above and below.
A common aspect of all artificial discs is that they
are designed to retain the natural movement in the spine by duplicating
the shock-absorbing and rotational function of the discs Mother Nature
gave us at birth. Most artificial disc designs have plates that attach
to the vertebrae and a rotational component that fits between these
fixation plates. These components are typically designed to withstand
stress and rotational forces over long periods of time. Still, like
any manmade material, they can be affected by wear and tear.
Since the first lumbar disc was approved in 2004, new discs have been introduced for low back surgery and neck surgery. For example, following the Charité disc to market is a variety of
alternatives, some specifically designed for use only in the cervical (neck) area. The PRESTIGE® Cervical Disc by Medtronic is the first artificial disc to be approved by the U.S. Food and Drug Administration for use in the cervical spine. The PRESTIGE® disc is composed of two pieces of stainless steel in a ball-and-trough design that maintains natural motion. Once the diseased or damaged disc has been removed, the device is inserted into the remaining intervertebral disc space. The images to the right show the artificial disc in action, as it appears in an x-ray. The Prestige® cervical disc by Medtronic, shown below, includes screws that attach to the vertebral body, and a center plate that retains the movement of the spine.
In addition to the Prestige artificial disc for the neck are the Prodisc-L (for lumbar, low back disc replacement) and Prodisc-C (for cervical disc replacement). Other artificial discs are completing clinical study and are pending FDA approval. Manufacturers of artificial discs aim to design discs
that are not only resistant to wearing out but that are easily replaced
if revision surgery is needed. While artificial disc surgery is still
relatively new, the potential benefits are very encouraging for those
with degenerative disc disease.
Generally speaking, those who receive artificial disc replacements
return to activity sooner than traditional fusion patients. Because
there is no need to harvest bone from the patient’s hip, there
is no discomfort or recovery associated with a second incision site.
Some of the overall benefits of artificial disc surgery include:
- Retains movement and stability of the spine
- Prevents degeneration of surrounding segments
- No bone graft required
- Quicker recovery and return to work
- Less invasive and painful than a fusion
- Reduces pain associated with disc disease
When treating knee and hip replacement patients, orthopedic surgeons
try to postpone the implantation of an artificial joint until a patient
is at least 50 years old so that they do not outlive their artificial
joint, which typically lasts anywhere from 15 to 20 years. Revision
surgery, which may be necessary to replace a worn-out artificial
joint, can be complex.
This is also a concern with the artificial disc. Unlike
knee and hip replacement patients who are typically in their 50s or
60s, many patients can benefit from artificial disc technology at a
much younger age — in their 20s or 30s. Therefore, the implantation
of an artificial disc in younger patients can raise a surgeon’s
concern about the potential life span of the artificial disc in the
spine and the need for revision surgery to replace a worn-out artificial
disc, which can be complex.
Because of the weight of the body and the rotational stress that the trunk places on discs in the low back (lumbar) area, more stress is placed on artificial discs in the lumbar area than in the neck (cervical) area, which only supports the weight of the head.
Due to the fact that the surgeon must access the front of the spine, an incision is made in the abdomen for lumbar discs and in the front of the neck for cervical discs. Typically, access to the cervical discs can be easier than the lumbar discs.
Are you a candidate for artificial disc surgery? This can be a complicated assessment based on the type of disc problem you have. Keep in mind that the physician you choose for spine surgery will have great impact on your outcome from spine surgery - especially artificial disc surgery. The more experienced and trained the surgeon is in spine, the more options you have to explore.
For example, the spine surgeons at Ann Arbor Spine Center have multiple spine fellowships (the highest level of medical training available), including training at the Mayo Clinic.
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