One of the most common causes of chronic back pain is degenerative disc disease. In this condition, the cartilaginous disc that serves as a cushioned shock absorber between the vertebrae in your back becomes arthritic and slips out of place. For those with this advanced disease, the pain not only feels like a knife in the back, but it often travels down along the nerves into one, or less commonly, both of the legs.
Traditionally, patients who have not found relief with conservative therapy such as medications, exercises and acupuncture have been taken to the operating room, where they have undergone a lumbar spinal fusion. In this major surgery, rods are literally screwed into the back to stabilize the spinal column and help fuse the bones. This procedure has been effective for many patients-though it fails in up to 15 percent of cases. Some patients require additional surgery in segments of the spine adjacent to that area.
For years, doctors have experimented with several minimally invasive procedures that could repair the diseased area of the spine without the trauma of extensive surgery. Europeans have studied an operation for the past ten years that’s dramatically different than anything else tried in the United States. They’ve been performing “disc replacement surgery,” in which an old disc is removed and an artificial one made of a cobalt-chromium alloy and polyethylene (metal and hard plastic) is inserted between the two vertebrae.
Over the past year, various medical centers across the country have been studying disc replacement surgery’s potential benefits. Two types of disc implants are being used, both of which seek to accomplish the same goals-relieve the patient’s pain, maintain flexibility and motion in the spine and prevent the need for further surgery. Doctors will spend the next couple of years implanting these devices, but only under the guidelines of a clinical trial.
It’s still too early to tell if this technology will stand the test of time, but experts believe it’s promising and are excited about its prospects. Why? If it proves successful, patients will have several important advantages. Disc replacement is a shorter surgery, with less blood lost and faster recovery time (plus it’s potentially less costly). And unlike with lumbar fusions-where the spinal column is rigidly fixed in place-the artificial disc technology allows patients to maintain the motion in their back. Some doctors are calling this the first surgery of its kind to potentially restore some of movement in the back.
The evolution of back surgery is very similar to that of knee and hip operations over the last generation. Thirty years ago, doctors would fuse arthritic knees and hips, costing patients a great loss of function. Then doctors began using replacement technology and, after several generations and modifications, it became the surgery of choice for these diseased joints. The hope is that disc replacement will become the norm for certain back conditions. The technology that now exists may not be the ultimate product, but these early clinical trials are telling us that the days of long, invasive surgeries for some types of disc disease could well be on their way to extinction.
