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     LUMBAR DISC REPLACEMENT

Definition:

Replacement of the Lumbar disc is emerging as a new treatment option for some types of low back pain - discogenic back pain..

Spinal disc replacement is an experimental area of clinical investigation, which has the potential of revolutionizing the treatment of spinal degeneration. In Europe a growing amount of research is being performed on the efficacy of this new procedure. Lumbar disc replacement may soon be a standard treatment for some types of low back pain.

History:
Degenerative disc disease causes back pain by wearing away of the cushion that rests between the vertebrae of our spine. As the disc ages, it becomes more brittle and less flexible.

Spinal fusion has long been considered the best treatment for degenerative disc disease of the lumbar spine once conservative treatment measures have failed. The first treatment for degenerative disc disease is always with non-surgical options. These include anti-inflammatory medications, physical therapy, and epidural steroid injections. However, if patients try these treatments, and do not find satisfactory relief, then spine fusion surgery may be an option.

 However, there are several problems with spine fusion surgery. First, the rate of successful fusion is about 80%. While complete fusion of the segments is not always necessary for pain relief, it is concerning that we cannot always find a way for bone to grow across the damaged disc space. Second, fusing a spinal disc space decreases the motion of the back, and may lead to symptoms of stiffness. Finally, because of the stiffness when the fusion is performed, the segments of spine above and below the fusion are subjected to increased stresses. Patients who have a fusion at one level are more likely to develop problems at discs above or below (so-called adjacent levels) down the road.

 Prosthetic devices of replacement of the intervertebral disc may be broadly divided into devices that replace the nucleus only, leaving the annulus and cartilaginous portions of the endplate intact, and devices that replace the entire intervertebral disc.

                       DISC NUCLEUS REPLACEMENT DEVICES

           Raymedica PDN device                                   Newcleus device

                                          Newcleus device within the disc

                              TOTAL DISC REPLACEMENT DEVICES

              Pro-disc             Charité artificial disc.                      Maverick

Flexicore artificial disc  

COMPLICATIONS

Commonly associated post-operative complications associated with lumbar disc replacement procedures include: (1) abdominal wall hematomas, (2) vascular injury, (3) dural tears, (4) Nerve injury, (5) Retrograde ejaculation in males, (6) Migration of the prosthesis.

CONCLUSION:
Spinal disc replacement is not only possible but is an exciting area of clinical investigation, which has the potential of revolutionizing the treatment of spinal degeneration. The development of a prosthetic disc poses tremendous challenges, but the results from initial efforts have been promising.

Unfortunately, lumbar disc replacement is a new surgical procedure and as such is still considered experimental. While it is tempting to accept that this is a "better" treatment (pain reduction with less complications), we do not know if that is really the case and the next few years will prove whether this procedure will stand the test of time.

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Related Links

Lumbar Decompression

Lumbar Epidural

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