SNSI Home  News Releases Artificial Disc offers relief. New surgery may become common within 5 years. |
Monday, December 01, 2008 |
| Artificial Disc offers relief. New surgery may become common within 5 years. |
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| Sunday, January 09, 2005 | |
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Kathleen O'Dell, News-Leader Suffering from lower back pain? A new implantable, artificial spinal disc may bring relief for some Ozarks sufferers. Some surgeons call it the most significant leap in treatment of disabling, chronic low back pain and degenerative disc disease in 40 years.
Joplin nurse Kelsa Brown is just happy she was a perfect candidate and first in line to get one in Springfield. Brown, 38, struggled with lower back pain for two years while exhausting all possible tests, medicines and therapies. Her next option was spinal fusion surgery, even though it would have limited mobility in her lower back. Then Springfield neurosurgeon Dr. Wade Ceola suggested a new treatment -- an artificial disc implant for use in the lumbar, or lower back. Clinical trials leading to approval in October show that patients with the artificial discs have greater flexibility and pain relief sooner than those who undergo traditional spinal fusion, Ceola explained. And the more motion, the less wear on bones above and below the artificial disc, and less likelihood of more surgery later. Eager to offer the new option, Ceola (pronounced CHO-luh) became the first in Springfield to be trained to do it. Others in Springfield have followed. Brown underwent the surgery Dec. 8 at Cox South. In place of the old disc, she has a metal and plastic device that moves when she moves, and stays in place under the normal pressure of her body weight. A scar will eventually form to provide more stability. Gone are sleepless nights with nagging backaches and radiating, debilitating pain. She hopes to return to work soon. "I have no leg pain, no tingling, numbness -- nothing. They were completely gone and has been gone since I woke up from surgery," Brown said. "It's wonderful," she added. "I am walking and I feel like I'm finally getting my life back." Demand growing Brown is one of many people benefiting from the race to develop better treatments for degenerative spine diseases. In 20 years, experts predict it will be the largest disease class because people are living longer, said Ceola's colleague and neurosurgeon Dr. Mark Crabtree. By 2025, some 83.4 million Americans will be over age 60, experts say, and more than 2 million of them will suffer from a degenerative disease related to the spine. Researchers are working on multiple versions of artificial discs for the neck and lower back. They've been evolving since the first lumbar implant in 1984. The CharitØ Artificial Disc by DePuy Spine, used in Brown's lower back surgery, is the latest design. Surgeons are perfecting methods to do minimally invasive back surgery using a pencil-thin instrument, the endoscope. Others are experimenting with lasers to shrink discs and reduce pressure; and using nucleoplasty -- inserting a needle into the problem disc and sending an electrical impulse to shrink the disc and reduce pressure on nerves. Researchers are working on screws that would re-absorb and bone would fill the space. A new option The spine contains 24 small bones, or vertebrae, to protect and support the spinal cord, with its many critical nerves. Soft discs between each vertebra absorb shock and allow the back to move. If the discs get injured or wear out with age, the result can be pain, lack of motion or a condition called degenerative disc disease. The most common treatment is spinal fusion surgery. It joins together vertebrae using bone grafts and metal screws so that motion no longer occurs in the treated area. It can relieve the pain, but over time the lack of motion causes the area just above and below the fused level to wear out faster, which may require surgery, Ceola said. About 600 to 800 people undergo spinal fusion in Springfield hospitals every year, he said. About 10 percent of patients eligible for spinal fusion will be candidates for the artificial disc, Ceola said. The device consists of a sliding plastic core sandwiched between two metal endplates made from cobalt chromium alloy. The materials are like those used in other implants such as total knee replacements. It is mainly for patients with only one diseased disc in the lowest part of the back, but with an otherwise healthy spine, blood vessels and weight status. That combination often rules out older adults, who usually have multiple disc problems, Crabtree said. Average age of likely candidates is about 35 to 55. "I think it will become a pretty common procedure in the long run -- in the next five years," Crabtree said. "At first it will be sort of slowly applied, and of course depending on the results and how patients do, we'll expand that." Ceola already has several disc-implant candidates waiting for approval from their insurance companies. It's so new here that hospitals are still developing charges, but the disc alone costs area hospitals about $8,000. Precise fit A team of surgeons operates on the lumbar area of the spine through a 4-inch incision in the patient's abdomen, about an inch left of the navel. While Brown was under general anesthesia, vascular surgeon Dr. Randy Mullins made the incision and moved the internal organs and blood vessels aside to allow access to the spine. Ceola, assisted by Crabtree, used fine cutting and grasping instruments to remove the bad disc. Then Ceola measured the space for a new disc, placed it and took multiple X-rays to make sure it fit properly. "Making sure it's sized correctly is one of the most important parts of the device," Ceola said. A bad fit can cause more pain or allow the disc to slip out of place. After the two-hour surgery, Mullins closed the incision. Ceola described the surgery as "technically perfect." That same day Brown was able to sit upright, and the next day took her first pain-free steps. She went home two days later with limited pain at the incision and temporary lifting restrictions. Complications are similar to major surgery. Rarely, an implant may cause pain or slip out if it's not seated properly. Kelsa Brown only had success. "I can't tell there's anything back there," she said. "It feels like I felt before I ever started having pain."
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