In the July issue 2003 of Views Magazine we described the different treatment options for chronic low back pain. You can find this and all the earlier chapters of our spinal surgery library in the archives of the magazine on www.viewsonline.net.
Total Disc Prosthesis - These implants aim to replace the entire disc while maintaining motion.
Artificial joints are now well-known and reliable treatment for osteo-arthritis in the hip and knee. Fusion surgery was considered the gold standard for spine problems a decade ago. For more pronounced disk degeneration a total disk replacement can now be recommended as an alternative to fusion. A few different models are frequently used all over the world and is suitable for most patients with chronic back pain as a result of a degenerated disc, as long as they are not older than 55-60 and do not suffer from osteoporosis. Patients generally experience an immediate relief of their chronic pain and can resume everyday activities that they could not do for years. Having said this, in some cases a fusion can still be necessary and this decision can only be made in the light of the MRI, X-rays and the consultation with an experienced spinal surgeon.
Nuclear Prosthesis - These implants aim to replace a damaged or herniated nucleus pulposus.
For people with shorter history of pain and less degeneration however there has not been anything else but wait and see. Sometimes conservative treatment can make things better, but often the only way is to reduce the function of living, giving up sports and family life. I have heard the story many times, about people only capable of working, returning home for the bed and resting for the whole weekend to be able to go to work again next week.
In those cases where physical therapy, manipulation and training no longer gives any relief a surgical intervention may be indicated. Standard treatment modes for this condition typically include enucleation, which may further destabilize the disc, or use of permanent fixation devices that immobilize the problem area but may result in degeneration of adjacent segments. As a treatment alternative, a PDN prosthetic disc nucleus is designed to restore disc height and relieve pain while preserving segmental motion. It consists of a hydrophilic copolymer absorbing 80% of its weight in water when fully hydrated. It is truly an artificial shock absorber! The PDN device can be implanted either through a posterior technique similar to that used for removal of a disc herniation, or through a retroperitoneal approach where the disc is accessed from the side. This technique is truly minimal invasive and permits early recovery and activity. Since 1996 over 2000 patients have been implanted with PDN devices, and the vast majority of these have experienced significant relief from the symptoms of degenerative disc disease. It is essential however that a treatment decision is based on a thorough preoperative examination by an experienced spinal surgeon where all the advantages and disadvantages of different treatment modalities are discussed.