Cervical Artificial Discs: Valuable New Technology or Fashion?
Spine surgery, like many other areas of medicine that are experiencing rapid technological growth, is often subject to fashion trends. At this period in time, the fashion is tilted towards motion preservation technology – both in the lumbar spine (low back) and cervical spine (neck). The first artificial disc was approved for the lumbar spine in November of 2004 (Charite, Depuy Spine Inc.) to much fanfare, but for a variety of reasons it has largely not lived up to its expected dominance in the spine industry.
In this author’s opinion, cervical artificial disc replacement should enjoy better overall acceptance and success than lumbar artificial disc replacement by insurance companies, physicians and patients for several reasons:
Preserving motion in the neck will work, because motion is not causing the pain
By its very nature, treating a cervical disc herniation with a motion preservation device (cervical artificial disc) is very different than treating chronic low back pain with a motion device. This is because motion is not the cause of pain for neck surgery, so using artificial disc replacement to preserve the motion (instead of fusion, which limits motion) is practical.
Neck surgery is done to relieve pressure on the nerve root. After removing the cervical disc something needs to replace the disc space or it will collapse (kyphosis). Traditionally, what has been left in the disc space is a bone graft to create a fusion and prevent disc space collapse. However, the motion in the disc space is usually not in and of itself a pain generator, and therefore preserving the motion in this space with a cervical artificial disc is reasonable.
Chronic low back pain because of a painful disc is entirely different from neck surgery. With low back pain, the disc itself may be the pain generator, or something else with the motion at the disc space may be generating the pain. Spine fusions for chronic low back pain work by limiting the motion at the painful level; but preserving the motion in this area by using a lumbar artificial disc may preserve the source of the pain.
Neck surgery to relieve arm pain is a more reliable procedure
When neck surgery is done to relieve arm pain (or back surgery is done to relieve leg pain, or sciatica) due to a pinched nerve the surgery is very reliable. However, neck surgery for either chronic neck pain (vs. arm pain), or low back surgery for chronic back pain (vs. leg pain) is not nearly as reliable. Artificial disc replacement surgery in the neck is indicated for arm pain, whereas the artificial disc replacement in the lumbar spine is not for leg pain (herniated discs). Lumbar artificial disc replacement is designed to treat chronic low back pain due to a painful disc (degenerative disc disease). Lumbar disc herniations resulting in leg pain, if they are treated surgically, are treated with a microdiscectomy, not a fusion or artificial disc.
Indications for cervical artificial disc surgery are more clear-cut
Besides being a more reliable surgery than lumbar artificial disc replacement, cervical artificial disc replacement will also have the advantage in that a new disease entity will not need to be considered. In lumbar artificial disc replacement the disease entity it was intended to treat - lumbar artificial disc disease - is not clearly defined and there is still quite a bit of controversy concerning proper surgical indications for degenerative disc disease, whereas cervical disc herniation resulting in arm pain (radiculopathy) is very well defined and the indications are not at all controversial. For this reason, insurance companies will not be as reluctant to cover any added expense for a new procedure.
When the Food and Drug Administration approved the first lumbar artificial disc many felt that insurance companies would automatically cover the procedure. This did not happen and many have still not approved it as an alternative to fusion surgery. This was unprecedented in medicine as approval usually meant coverage. With the new realities of cost containment in medicine, new technologies with not only have to be proven safe and efficacious, they will also have to be cost conscious.
Subject: The Prestige disc is the
September 13th, 2007
Subject: I would seriously consider
September 14th, 2007
Subject: Facing a third cervical surgery
I've had 2 cervical fusions and am facing a third. In 1998 I was diagnosed with a herniated disc and large osteophytes at c5-6 and had a laminectomy with bovine graft.
18 months later I had a second surgery to remove the bovine graft which hadn't fused properly. This was replaced with a piece of my hip along with some screws/plating to hold it together. During this time I was diagnosed with rheumatoid arthritis.
Within the last yearI developed some serious neck pain and numbness along my left side. The MRI revealed a large osteophyte at c5-6 behind one of the screws that is pressing on the nerve and causing a bulge or possible leak of the spinal fluid. I am almost 50 and dread the thought of another surgery.
April 6th, 2008
Subject: Also facing 3rd c-spine surgery.
I am 46 and hyper active. I was racing dirt bikes, ski, wieght lift, hike, snow shoe, Mt bike, you get the picture,
I have two kids that need me to remain active.
I had a c-spine fusion in 2000 for c-4,5,and 6. They removed some bad bone spurs that were pressing on nerves and it relieved the pain.
Less than a year later I fell skiing and snapped my neck in a whip lash type motion busting the screws out and breaking the bone graph out.
A second operation in the front to remove the old plates, screws and bone, ream out some new bone spurs that had already grown back in and then harverst some more bone from my hip. Cut into the back of my neck and put in a graph and two plates fusing c-4-7.
2003 I came down with the resistant staph infection in my spinal cord, osteomylytis and an epidural absyis. this almost killed me and after my spine turned to jelly and back I feel brittle. I have some paralisis from my rt chest down my bicept to my hand. antibiotics IV for 6 months. All better! What can't kill you right!
All was well until I fell on my head in a spectacular dirt bike racing crash. Things started down hill fast after that. I have lost the sensation in both fingers and hands, my arms and shoulders are losing strenth, size and feelings. The pain is unbearable.I get Taser like electrical shocks that shoot down my hands and some my whole body, it takes my breath away and makes me grunt.
I had MRIs and I saw the pain Dr who performs my every 6 month nerve RFA. he referred me to a surgon and told me what I could plainly see from the MRI. My spinal cord was again getting squished, no fluid present where pinched, He said I need at least one or more discs fused.
I am ready to get this over with, but if any one has any advise I welcome it. I get some relief from meds, hanging upside down and sleeping on ice packs.
I work as a cop more than full time and am scared I can't defend my self. I have quickly lost my muscles, size and strenth along with dextarity.
Help!
Out tumped
April 7th, 2008
Subject: Spinal Surgery Options
To: Out Thumped
My husband is recently diagnosed with herniated discs, spinal stenosis and degenerative discs (the latter is not new) in the neck, rather than lumbar, region. He has not been able to work since the last week of January. His job as a scuba diver and boat pilot requires dexterity.
His primary care doctor is talking about a laminectomy and, if necessary, fusion. Given his situation, fusion is out of the question. Just today, we were advised of a German clinic, Alpha Klinic, that appears to have options worth considering before the traditional laminectomy/fusion. We have begun to check out this option. The web site is alphaklinik.com. You may want to look at this.
While artificial disc replacement surgery is relatively new in the USA, there is a doctor on staff at this clinic who has been doing the procedure since 1989! If the situation weren't so serious, you'd have to laugh really.
Anyway, check out the Alpha Klinik. It may or may not be an option for you.
Living with a Partner in Severe Pain
April 8th, 2008