New technologies may offer new treatment options for some patients with degenerative back problems, according to research presented at the 72nd Annual Meeting of the American Academy of Orthopaedic Surgeons. These latest innovations in spinal surgery could provide promise for hundreds of thousands of U.S. patients who undergo spinal surgery each year.
While the initial and often adequate standard treatment for degenerative spinal disorders -- such as slipped discs or compression fractures of the vertebrae -- is non-operative care, certain patients may require surgery ranging from spinal fusion, injection of cement into the weakened vertebrae (percutaneous vertebroplasty or kyphoplasty), or the placement of screws and metal plates to stabilize the spine. In recent years, however, new treatments have been developed that may offer some patients less post-operative pain, fewer complications and a faster, more complete recovery.
One of these treatments is disc replacement, in which the injured disc is removed and replaced with an artificial device. Paul C. McAfee, MD, an orthopaedic surgeon at the Scoliosis and Spine Center in Towson, Md., led two studies on disc replacements: one on replacements in the lumbar (lower back) region using recently FDA-approved Charite disc, and one on those in the cervical (neck) region.
"The great thing about disc replacements is that they allow us to preserve the motion in the patient's spine," Dr. McAfee said. "Treatments like spinal fusion immobilize part of the spine, which causes stress on the adjacent levels of motion. Also, if you need to fuse multiple vertebrae, recovery time and the chance of complications increase. But with disc replacement, you don't have those problems. It's not right for every patient, but if you follow the clinical indications, it can be an excellent option."
Dr. McAfee's study on the Charite disc found that patients who received that type of disc replacement had an 82.5 percent increase in their flexion and range of motion two years after surgery, compared to a decreased range of motion for all patients who received spinal fusions; the Charite patients also had significantly better restoration of disc height. From his study on porous coated motion discs used in the cervical region, Dr. McAfee learned that not only is this procedure less invasive than fusion procedures, but the recovery time is much shorter. Some patients were able to have the surgery on an outpatient basis, and 87 percent of working patients were able to return to their jobs within six weeks after surgery.
While initial indications of the Charite disc appear promising, the device was just recently granted FDA approval in October 2004. Hence, further long- term study and data are required for orthopaedic surgeons to definitively determine patient results from this new procedure compared to traditional bone fusion.