As with any new surgical procedure, there are a number of factors that should be considered prior to undergoing an artificial disc surgery. A number of factors that may be helpful for patients to consider when considering whether or not to have artificial disc replacement surgery are outlined below.
Surgeon training. Historically, the extent of training for spine surgeons to use a new technology has varied greatly. Some surgeons have pursued a level of training similar to that employed for the device's FDA trial, but unfortunately, this has not always been the case. There are currently no well defined, accepted standards for the training of surgeons wanting to employ the use of new technology.
The manufacturer of the Charité artificial disc, DePuy Spine, has stated that prior to doing any surgery with the Charité disc surgeons must undergo extensive training sponsored by DePuy Spine. This mandatory training includes a combination of participating in artificial disc surgery procedures with other trained surgeons, consultation and visitation with spine surgeons, and lectures and educational materials.
In addition, the Spinal Arthroplasty Society has set a goal of establishing standardized training programs for physicians prior to their using any new artificial disc replacement technology. It is intended that the training be similar to that required for participation in the FDA clinical trials. While such training is expensive and time consuming for both the surgeons and faculty, there are many important benefits for patients, surgeons, hospitals, and manufacturers of the artificial disc.
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Surgeon skills. As with any type of spine surgery, the skill and experience of the surgeon performing the surgery is an important consideration. Unfortunately, this is usually difficult for patients to assess and there is no central source that reports on a surgeon’s outcomes. In general, it is a good idea to research a spine surgeon through some combination or asking a referring physician what their opinion is and asking other patients who have had the same procedure done with that surgeon.
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- Patient selection. As with a spine fusion surgery, making sure that the individual patient is a good candidate for the procedure is essential to success. Here are a just couple of examples of how inappropriate patient selection can have serious consequences:
- If a patient receives an artificial disc, but the disc that was replaced was not actually the cause of the patient's pain, then the patient will have undergone an extensive, invasive, and costly procedure but still have the same level of pain. This may seem like an incredibly obvious point, but with back pain it is often difficult to pinpoint the precise cause of a patient's pain. Accurate and careful diagnosis of the patient's pain generator is crucial and cannot be overemphasized.
- If the patient does have a painful disc, but other factors (such as significant degenerative changes in the facet joint) are present, then the patient may have to undergo a revision surgery after the initial surgery to either correct the placement of the disc or fuse the spine - a situation that is definitely best avoided by correctly assessing all the risk factors prior to the first surgery.