Fig. 2: Front view of implanted Charité Artificial Disc
(larger view)

Fig. 3: Side view of implanted Charité Artificial Disc
(larger view)

Patients who fit specific criteria may be good candidates for the Charité artificial disc replacement surgery. Other criteria to assess whether or not a patient is a good candidate for the procedure is more subjective and should be discussed with the patient's treating physician.

Indications for Artificial Disc Surgery

While the artificial disc technology holds great promise for many patients with ongoing low back pain, it is not a panacea for all patients. The indications for who is potentially a good candidate for the Charité artificial disc include the following:

  • The patient's diagnosis is lumbar degenerative disc disease, with the degenerated disc confirmed by the patient's medical history and an X-ray, MRI, and/or other diagnostic tests
  • The painful symptoms caused by the degenerated disc have not abated with at least six months of non-surgical treatment (such as pain medications, physical therapy, manipulation, ice and/or heat therapy, etc.)
  • The damaged disc is located in one of the two lower levels of the spine (either L4-L5 or L5-S1)
  • Patients whose vertebrae have not slipped or have slipped minimally (less than 3 mm)
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Contraindications for Artificial Disc Replacement

Individuals who may not be qualified to have the disc replacement surgery include those with the following conditions or factors. Generally, the artificial disc is not recommended to treat patients with back pain who have any of the following conditions or factors:

  • Multi-level disc degeneration
  • Instability in the spine (such as spondylolisthesis, fracture, or spinal tumor)
  • Anyone with poor bone quality (such as osteoporosis or osteopenia)
  • Some patients who have had prior spine surgery (Some patients who have had minor back surgery may still be candidates to have the artificial disc)
  • Patients who are pregnant
  • Patients with arthritis damage to the joints that connect the vertebrae (facet joint arthritis)
  • Anyone with a widespread infection or a spinal infection

Other factors may also apply in varying degrees (such as if the patient is morbidly obese or has specific allergies), so it is best for the patient to fully discuss their medical history and medical options thoroughly with the spine surgeon.

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The Charité Artificial Disc Replacement Surgery

The Charité disc replacement system is placed in the spine through a small incision just below the patient's belly button. Typically, two surgeons work together in performing the operation.

  • A general surgeon or vascular surgeon approaches the spine through an incision in the lower abdomen and carefully moves internal organs and blood vessels out of the way to provide access to the spine. The large blood vessels that continue to the legs (the aorta and the vena cave) lie on top of the spine, so it is important that a surgeon with the appropriate skills performs this manipulation of the major blood vessels.
  • A spine surgeon (either an orthopedic spine surgeon or a neurosurgeon) then uses specially designed instruments to remove the damaged disc, creates a space between two vertebrae for the implantation of the artificial disc, and fits the Charité disc in between the two vertebrae.

The disc replacement procedure is performed with the patient under general anesthesia and typically takes one to two hours to complete. During the FDA clinical trial, the average hospital stay for patients was about four days. Surgeons generally advise restriction of certain activities for a certain time period following the surgery, and some surgeons may prescribe a back brace.

    Figure 2: Front view of implanted Charité Artificial Disc

    Figure 3: Side view of implanted Charité Artificial Disc

While only 15 spine centers participated in the Charité artificial disc clinical trial, the number of spine centers and spine surgeons offering the artificial disc replacement surgery is expected to increase fairly rapidly as spine surgeons receive training in the procedure.