Artificial disc replacement: spare parts for your aching back

Your back is a complex piece of machinery. It is a collection of 33 vertebra, or small flat bones, that interlock together with springy, jelly discs between them.

When your back is hurt, these jelly discs can get deformed, broken, or otherwise injured. Even the normal wear and tear of aging can make the jelly in these discs ooze out of all the wrong places. This can cause pain as the vertebra slide against each other and encounter roughness. Any movement of your back causes exquisite pain when the vertebra cannot slide easily against each other. There are two primary ways to handle this situation. One is the gold standard surgery called spinal fusion, and the other is a revolutionary new device called an artificial disc replacement. Artificial disc replacement is all the rage in Europe, but it has not caught on as quickly in the United States. If you have trouble with the vertebra in your back, you may want to look into these two surgeries to decide which one is right for you.

Spinal fusion: lock and load

Spinal fusion is the surgery your doctor will likely recommend if you have a problem with your back. Essentially, the spinal surgeon attempts to make two vertebra fuse together into one big bone. This is done by taking bone from another part of your body, such as your pelvis, and using it to bridge the space where the disk used to be. It prevents the vertebra from moving and locks them in place so that you do not have the movement in your back that you once had before. The disc is removed and can, therefore, no longer impinge upon nerves and cause pain. A few problems exist with spinal fusion surgery. It doesn't always work. Sometimes the bones do not fuse together to create the larger bone and movement – and pain – still exists. Spinal fusion also decreases movement which means you will always have stiffness in that area of your back. Lastly, since that part of the spine is fused together, the vertebra directly above and below it are placed under undue stresses and can themselves become damaged.

Artificial disc replacement: more than a jelly doughnut

The newest type of surgery for a bad back is artificial disc replacement. Like artificial knees and artificial hips, an artificial disc is a plastic version of the jelly filled disc that exists between the vertebra of your back. This device consists of two metal plates with a plastic material between them that allows the discs slide over each other, and simulate the movement that a normal disk would give to the back. Disc replacement has been performed in both the cervical, or neck area, of the spine and the lumbar region, or lower back. Currently in the US, it is only approved for the lumbar region. Using this type of replacement would allow the spine to maintain its ability to move, reducing the stiffness that spinal fusion sometimes causes, and it will cut down on the amount of stresses that adjacent vertebra experience because the vertebra will still have movement. However, this type of surgery has not caught on with surgeons.

Artificial disc replacement bandwagon: why your doctor isn't jumping on

Since artificial disc replacement sounds so much better, you might be wondering why it hasn't caught on more. A few reasons exist for this. First, an artificial disc needs to be placed by a highly qualified physician to avoid deadly side effects. Not many of these exist in the US now because this surgery is so new. Second, if the disc slips, it can lead to serious side effects that can be debilitating for the patient. Third, although the rates of recovery from artificial disc placement are far quicker, many do not find that the long-term results of it are any better than from spinal fusion. Artificial discs also wear out and need further surgery to replace them. More research needs conducted to find out if artificial disc replacement actually improves the quality of life over those who get spinal fusion. Although spinal fusion has serious drawbacks, such as back stiffness and loss of range of motion, it is the gold standard and has a long track record of decreasing back pain. Artificial disc replacement is still very new, and has yet to prove its worth to orthopedic surgeons in the mainstream.

References:

• American Academy of Orthopedic Surgeons; Spinal Fusion; June 2010.
• American Academy of Orthopedic Surgeons; Aching Back Get Support from FDA, but Not Payors; Dennis P. McGowan, MSc, MD, and Vijay K. Goel, PhD; September 2007
• About.com; Lumbar Disc Replacement; Jonathan Cluett; February 2007

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