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.
Looking beyond disc replacement, there are other emerging treatments and technologies on the horizon for those suffering from back and spinal problems. These include biological disc regeneration and computer-assisted and image- guidance technology such as surgical navigation, where a surgeon uses an intraoperative CT scan to assist in the placement of screws and other devices when performing spinal fusion.
"Spinal fusion is still the best option for some patients, but studies show that in some cases, the screws are not ideally placed," said Courtney W. Brown, MD, assistant clinical professor of orthopaedic surgery at the University of Colorado and an orthopaedic surgeon at Panorama Orthopedics in Golden, Colo. "The interoperative CT scan can help with placement of spinal screws when the anatomy is difficult. The only major drawbacks are that it is technically demanding and expensive."
While some of the research on these emerging technologies is preliminary, these innovations do show great promise, said Jeffrey C. Wang, MD, chief of orthopaedic spine service and associate professor of orthopaedic and neurosurgery at UCLA Comprehensive Spine Center at the UCLA School of Medicine. "Back injuries can be debilitating, so it's great to know that there may be even better ways for us to help those patients," said Dr. Wang. "However, we have to ensure that we don't circumvent the research process because everyone's excited about these new treatments. We can introduce them only once their efficacy and safety can be scientifically proven."