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Disk
Replacment |
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Disk replacement
(called “anthroplasty”) is becoming available
in the United States with the potential of significantly
expanding the options available to sufferers of severe
back pain. Following more than a decade of use in Europe,
several artificial disks are in FDA trial (one has been
approved at the time of this writing.)
Disk anthroplasty is generally considered in patients
with a condition called “Mechanical Low Back Pain”
when the pain is not related to the spinal nerve and there
is degeneration of intervertebral disk. The traditional
approach to this condition is to remove motion at the
degenerated disk in the hope of removing or reducing pain.
Called a “fusion” operation, the results for
long-term pain elimination have been mixed. A common problem
with fusion operations is the potential for creating new
problems at disks adjacent to the treated disk called
“Adjacent Level Disease.”
One way of thinking of this is considering that the spine
provides flexibility similar to a green twig. When you
move your hands up a twig, effectively shortening it,
greater stress is placed on the remaining length of twig,
and the risk of it breaking increases. Similarly, a fusion
operation concentrates stresses on the remaining disks
that were not fused. This has been a recognized problem
with fusion operations for a long time and therefore has
been considered a last option for most patients.
Disk replacement is an exciting new option. The goal of
the disk anthroplasty procedure is to maintain motion
at the treated level by replacing rather than fusing the
disk. Intuitively, this would provide pain relief and
reduce the occurrence of “Adjacent Level Disease.”
(Research is underway to document this expected outcome.)
The idea of disk replacement is exciting to both the surgeon
and the patient. But, caution is the best position to
take. Only a properly educated and trained spinal surgeon
can make appropriate recommendations whether a disk replacement
is in the patient’s best interest. The National
Spine Foundation’s goal is to participate in and
support continued research on the outcomes of disk arthroplasty
and the development of new devices and techniques.
It is also important to note that disk anthroplasty is
a technically demanding procedure that involves changes
to many surgeons’ operative practices. A goal of
the National Spine Foundation is to become a center for
training surgeons on disk anthroplasty. |
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