For Back Pain: The Lumbar Artificial Disc Replacement Is Approved, But Is It Ready?
There has been much public hype about this latest innovation. A poll by Spine -Health.com showed that 49% of people, who are candidates for lumbar fusion, are postponing their surgery, hoping to receive the artificial disc. All of the excitement is because; this new device appears to solve two of the major problems that occur with fusion of the lumbar spine.
Well, at least in theory, it appears to solve it.
Historically, two of the major problems with lumbar fusion are limitations caused by the lack of motion, and accelerated degeneration at the adjacent levels. Increased wear and tear at the neighboring disc levels, often leads to additional surgeries over the next several years.
The new artificial disc seems to solve that problem. It allows normal, or near normal motion, while still replacing the painful or diseased disc. But, this new device presents some problems of its own, and some surgeons think that there may still be some questions that are unanswered.
The two major concerns about the artificial discs are durability, and problems with replacement. Because this appliance is new, data from long term studies is limited, and what information is available, is not great. Some studies show high failure rates, and some manufacturers are telling patients that their artificial disc may have to be replaced within 10 years.
This is really the point that some surgeons are concerned about. Replacing a worn out or failed device, is a very complex operation with many risks, and some of the risks are life threatening.
The artificial disc is implanted through an anterior approach to the spine. Surgeons make an abdominal incision, and the abdominal organs are moved aside. Then the great vessels must be mobilized, the aorta and the iliac arteries are most often affected. This involves ligating and severing the small feeder arteries that tether them in place, then gently retracting the vessels to expose the anterior lumbar spine.
This exposure is a difficult and complex procedure, in a young healthy patient, under the best of conditions. Repeat surgeries would be complicated by scar tissue, adhesions, and the age of the patient. This would make handling the great vessels increasingly dangerous with each surgery. For a patient in their 30s, this may mean four or more operations by the time they reach their 70s.
When considering any surgical procedure, you must always consider the risks and benefits. The potential benefits, of increased function and normal range of motion of the artificial disc are noteworthy, and certainly worth investigating. As time passes, surgeons will gain more experience, newer techniques will be developed, and the risks will become more manageable. But, with the current technology the critics appear to raise valid points.
David L. Stevens PA-C
If you are living with back pain, you can learn more about the causes of, and the treatment options for back pain at my website.