University of Maryland spine surgeons say procedure helps to preserve motion, hasten recovery
Replacing a damaged disc in the lumbar spine with a new artificial one may be a better treatment option for some patients than spinal fusion because the procedure preserves motion and provides for a faster recovery, University of Maryland spine surgeons say.
“The CHARITÉ artificial disc emulates a normal disc. It has many degrees of range of motion, allowing for flexibility and extension as well as for side-to-side bending and rotation,” says Steven C. Ludwig, M.D., an orthopaedic surgeon at the University of Maryland Medical Center and an associate professor of orthopaedics at the University of Maryland School of Medicine.
“This type of disc replacement is the first alternative to lumbar spinal fusion surgery to alleviate pain from a damaged disc while preserving a patient’s full range of motion,” Daniel E. Gelb, M.D., an orthopaedic surgeon at the medical center and an associate professor of orthopaedics at the School of Medicine, says.
But Drs. Gelb and Ludwig, who are co-directors of the University of Maryland Spine Center, note that some patients with lower back pain caused by degenerative disc disease may not be eligible for the new procedure. The U.S. Food and Drug Administration (FDA) has approved the CHARITÉ artificial disc to treat patients with disease at one level of the lumbar spine – either L4-5 or L5-S1, two common problem areas in the lower back. Patients who have several damaged discs, instability in their spine, severe arthritis or who have had multiple previous back surgeries are not candidates.
“The ideal person for this treatment is a relatively thin person, with a single level of degeneration in the spine and normal facets, or joints, in the back of the spine,” Dr. Ludwig explains. Patients should also have tried more conservative treatments, such as physical therapy and anti-inflammatory medication, for at least six months before opting for surgery.
The CHARITÉ artificial disc, which is manufactured by DePuy Spine, Inc., is made of plastic with two metal end plates that attach to the vertebrae. The device was developed and used in Europe before being approved by the FDA last year.
About 65 million people in the United States experience lower back pain, many from degenerative disc disease in which the discs, or cushions between the vertebrae, start to deteriorate. More than 200,000 people undergo spinal fusion surgery each year to alleviate the pain. Surgeons use rods or cages, plus bone grafts, to fuse two vertebrae, immobilizing a segment of the spine. They typically harvest the bone grafts from the person’s hip, which can add to the patient’s pain after the surgery.
While the fusion surgery often helps to eliminate pain, it can reduce the patient’s range of motion and put stress on the vertebrae and discs above the fused segment. “By fusing the vertebrae, you are essentially putting a segment of the spine to rest permanently. So you are exchanging some motion for pain relief,” Dr. Ludwig says. He notes that more patients may be candidates for spinal fusion surgery because of the strict eligibility requirements for the CHARITÉ artificial disc.
In the new procedure, orthopaedic surgeons remove the damaged disc before implanting the artificial disc. They work with a vascular surgeon to access the spine from a small incision in the belly, rather than cutting into the patient’s back. By operating from the front of the body, surgeons avoid having to cut through muscle or possibly damaging nerves in the back.
Dr. Ludwig says that patients are able to leave the hospital a day after surgery, compared to an average of three days after the spinal fusion procedure. They can begin range of motion exercises sooner than after spinal fusion surgery and often regain mobility in six to 12 weeks, compared to more than three months for fusion patients.
University of Maryland Orthopaedics offers a full range of treatment options for patients with back pain, including medication, exercise, physical therapy and spinal injections as well as surgery. Teams of specialists also provide state-of-the-art care for patients with other orthopaedic problems, such as injuries of the shoulder, elbow, knee, hip, ankle, wrist and hand.
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