Scot Miller, DO, FACS
Orthopaedic Surgeon
Akron General Medical Center
For patients suffering severe low back pain from degenerative spinal disc disease, artificial disc replacement surgery may offer several improvements over spinal fusion surgery, the current standard of treatment for the condition.
The FDA granted approval last October for the implantation of the Charité Artificial Disc, the first artificial disc on the market in the U.S. In the FDA clinical trials comparing Charité disc replacement with spinal fusion surgery, disc replacement patients experienced an increase in flexion and range of motion at two years of follow-up. Spinal fusion patients lose range of motion since that procedure relieves pain by limiting mobility. Disc replacement patients in the clinical trial also had superior pain relief, left the hospital sooner, returned to work sooner and were more satisfied with the procedure than the spinal fusion patients.
Perhaps most important for patients, disc replacement helps prevent additional wear and tear on the spine at levels above and below the site of the replacement; spinal fusion puts pressure on discs at other levels, often causing degeneration within a few years after the procedure.
Disc replacement surgery may be suitable for more than half of the 200,000 patients undergoing spinal fusion each year. It is an option for those patients who have only one diseased disc, located between L4 and L5 or between L5 and S1. Patients are candidates if they are between ages 30 and 60, have experienced unrelenting back pain for at least three months for which all other treatment – such as pain medication, a back brace or physical therapy – has failed, and have a diagnosis that has been confirmed by an MRI. Artificial disc replacement surgery is not suitable for patients who have disc deterioration or instability at more than one spinal level or who have poor bone quality.
The Charité artificial disc consists of a high-density plastic core between two chromium alloy endplates. The endplates have teeth that sink into the spinal bone for stability. The design aligns the spine and allows the plastic center to rotate and bend, which provides the freedom of movement. Developed in Germany in the 1980's, the Charité disc has been available for over 17 years in more than 30 countries.
To perform the procedure, a vascular surgeon works in conjunction with a spine surgeon. The vascular surgeon approaches the spine through an incision in the abdomen, cutting through the retroperitoneum and moving aside the organs. The spine surgeon then removes the damaged disc and creates a space between two vertebrae for implantation of the artificial disc. The procedure takes about one and a half hours and is performed under general anesthesia. Patients usually can go home within forty-eight hours. As with any surgery there are possible complications, which include wound infection, blood clots or abnormal bleeding, but the risk is in the .1% to 1% range.
Spine surgeon Scot Miller, DO, and vascular surgeon Robert Netzley, MD, performed Summit County's first artificial disc replacement surgery in March. Dr. Miller also participated in the clinical trials for the Charité Artificial Disc and has been specially trained and certified in the procedure. To refer a patient for artificial disc surgery or to discuss the suitability of a candidate, please call 1-800-DOC-AGMC.
