There are a couple of alternatives to spine fusion surgery that may be considered for patients with low back pain from lumbar degenerative disc disease. Currently, the main fusion alternatives include:
- IDET. or Intradiscal electrothermal coagulation (or annuloplasty). This procedure involves inserting a needle into the lumbar disc space, passing a catheter through the needle, and heating up the annulus (the outer core of the disc space). The exact mechanism by which the procedure relieves pain has not been clearly established, but it is theorized that the heat contracts and thickens collagen fibers in the disc wall, which in turn seals up painful tears and cracks and reduces pain. The procedure also cauterizes nerve endings which is thought to make them less sensitive. Not all patients benefit from IDET, and the treatment is more likely to help people with less severe degenerative disc disease than people with significant disc degeneration. IDET is minimally invasive and usually done on an outpatient basis (no overnight hospital stay) under mild sedation and a local anesthetic. Although the procedure is minimally invasive it has largely fallen out of favor in the spine world as it has marginal clinical efficacy. Most insurance companies no longer cover the procedure.
In This Article:
- Artificial discs. Disc replacement surgery involves replacing the painful disc in the spine with an artificial disc. As of August 2006, two brands of lumbar artificial disc are available for use in patients in the U.S.: the Charite lumbar artificial disc and the PRODISC-L lumbar artificial disc. A number of other artificial disc brands are in the clinical trial testing phase. The goal of artificial disc replacement surgery is to preserve the normal motion of the spine (unlike fusion, which eliminates motion at the painful spinal segment). Artificial disc surgery has two primary theoretical advantages over spinal fusion; 1) it is thought that preserving spinal motion reduces the risk that other segments of the lumbar spine will wear down prematurely; 2) it is believed that artificial disc surgery may achieve better pain reduction than fusion. However, these potential benefits come at the expense of greater risk with the surgery. Any motion preservation device can fail by extrusion or wearing out with time. Revision surgeries are expensive and extremely dangerous. The risk/benefit ratio of artificial disc vs fusion is still largely unknown, and currently many insurance companies are not covering the procedure.