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.