New advancements in spine surgery

Recent years have brought about many changes to the field of spine surgery, and the latest technologies, many still in development, are advancing spine care on multiple fronts-- particularly as alternatives to traditional fusion surgery. Traditional fusion surgery, the treatment of choice for certain patients with chronic back problems, has come under scrutiny as being invasive (looking at the amount of soft tissue trauma to the skin and muscles) and as limiting movement of the back (caused when two or more spinal segments are fused together in an attempt to stop the pain).

While the technologies for spine fusion alternatives cover a wide spectrum, they share common goals--namely, as compared to traditional spine fusion approaches, to be less invasive and to preserve more of the natural motion of the spine, while eliminating as much or more of the associated back pain and neck pain. This newsletter highlights several newer and developing technologies that address disc problems.

Artificial disc replacement

The traditional use of fusion surgery, which aims to eliminate chronic back pain by eliminating motion at a painful motion segment, is now being considered alongside newer surgical procedures aimed at motion preservation. The goal of motion preservation is to maintain as much of the natural motion of the spine as possible.

Total disc replacement. In the U.S., the initial approach for motion preservation is total disc replacement to address painful disc degeneration. The Charite artificial disc received FDA approval in October 2004. Other total disc replacements will likely soon receive approval and be available to patients as well, including both lumbar and cervical disks.

Artificial disk technologies may be considered for patients with mechanical pain syndrome (called "degenerative disc disease" on Spine-health.com), where the disc has been damaged--often by some trauma or repetitive motion--and the pain is ongoing and disabling to the individual's way of life. Learn more in Spinal disc replacement with the CHARITE Artificial Disc and Lumbar Artificial Disc Surgery for Chronic Back Pain.

Disc nucleus replacement. An alternative to artificial discs currently in development is called disc nucleus replacement. This approach replaces only the cushioning material within the disc nucleus, leaving the annulus (outer portion of the disc), cartilage, and related material intact. The goal of this alternative is to enable doctors to reestablish the original height of the disc and reestablish an even distribution of pressure across the vertebrae, without dismantling the vertebral structure. Compared to a total disc replacement surgery, nucleus replacement is less invasive and may keep other treatment options open to the patient. Nucleus replacement is intended to be an option for patients with degenerative disc disease or herniated discs. Learn more in Disc nucleus replacement as an alternative to artificial disc replacement.

Posterior dynamic stabilization

Artificial disc replacement does not address pain originating from the posterior elements (in the back of the spine), such as pain that originates from the facet joints, ligaments, tendons, or muscles. Disc replacement may not adequately address pain arising from spinal instability, such as spondylolisthesis, or stenosis (a narrowing of the passageway for the nerves). Posterior dynamic stabilization devices are in development with the intention of addressing these back problems. These devices use instrumentation that attaches to the back of the spine to help maintain motion but limit or eliminate the pain. A variety of posterior dynamic stabilization devices are in various stages of development and clinical investigation. Currently, the X-Stop device, which strives to keep the foramen open by limiting spinal extension (when bending backwards), is the only device approved for use in the U.S.

The technologies of these devices differ, but as a group they are generally designed to be minimally invasive (such as the interspinous process spacers, which can be implanted close to the skin) and salvageable (meaning revision surgery is an option if the device fails). Learn more in Posterior dynamic stabilization surgery.

IDET

Intradiscal Electrothermal Annuloplasty (IDET) is a minimally invasive treatment designed to treat chronic low back pain that results from certain types of painful degenerative disc disease or contained disc herniation. For patients who do find pain relief after IDET, it allows patients to experience pain relief without having to undergo major spinal surgery for disc removal (called a discectomy) and spinal fusion, or disc replacement. The procedure involves inserting a catheter into the disc(s) and heating it up. It takes about an hour and can be readily performed on an outpatient basis. See also IDET: an alternative to invasive surgery for chronic low back pain.

Final thoughts

Patients with chronic pain may want to consider these new procedures along with their other treatment options. It's important to keep in mind, however, that new doesn't necessarily mean better. New devices/procedures have quite a learning curve for treating physicians (e.g., learning which conditions/patients are best suited for each procedure), and longer term studies and follow-up may not yet be available to fully understand the potential risks and benefits of each procedure. There may also be wide variability in cost coverage across insurance companies. This information on www.spine-health.com is designed to help you better understand your condition and more effectively navigate your treatment options--without commercial bias--so you can enjoy your life to the fullest.

Best wishes,
Peter F. Ullrich, Jr., MD, Medical Director
Stephanie Burke, President

About the Spine-health.com Newsletter: Each issue of the Spine-health.com newsletter, SpineNews Update, is written by the founders of Spine-health.com - Peter F. Ullrich, Jr., M.D., Medical Director for Spine-health.com and Stephanie Burke, President of Spine-health.com.The content in the newsletters is not peer reviewed by Spine-health.com’s Medical Advisory Board.The articles to which the Spine-health.com newsletters link have been peer reviewed by members of the Medical Advisory Board.