ARTIFICIAL INTERVERTEBRAL DISCS AND BEYOND

Abstract

Introduction: This is a prospective study to determine the effectiveness of artificial disc replacements in the treatment of discogenic low back pain. There has been increasing interest in the possibility of preserving the motion of a diseased vertebral motion segment by various biomechanical designs. Preserving the motion of the segment, rather than opting for arthrodesis seems intuitively to be a more favourable treatment for several spine disorders.

Up until now most spine surgery has been salvage (correcting the effects of trauma, stabilising correcting deformity, fusing degenerative segments) not restoration of normal function. As new alternatives to fusion come to fruition, we now have the ability to truly restore the spine to normal function. Spinal arthroplasty is a new concept and includes total disc replacement, nuclear replacement and there are efforts by investigators looking at posterior element reconstruction or facet replacement.

Methods: The data have been collected from the surgical experience of one surgeon since commencement of this procedure in 1996. Data were collected from pre-operative, post-operative clinical and patient questionnaires (both pre- and post-operative) and radiological assessment.Patient questionnaires include Roland-Morris Questionnaire, Oswestry Questionnaire, Visual Analogue Scores, and SF36 Data.

Results: 86 Patients have had implantation of the Charite artificial disc prosthesis “Link”; 113 levels have been instrumented; 42 males, 44 females; follow-up two months to five years, average follow-up 20 months.

The results so far indicate good to excellent in 84% of cases. Complications have the potential to be catastrophic but attention to surgical detail results in minimal complications which will be discussed in the body of the presentation.

Discussion: This paper is a prospective study. It also represents a personal surgical evolution and understanding of the role disc replacement plays in the treatment of discogenic low back pain. Disc replacement should be used as part of the armamentarium a spine surgeon can utilise in his practice. There are strict guidelines and criteria that need to be adhered to if optimal results are to be obtained. The artificial disc which has been most extensively used in the world is the Link SB Intervertebral Prosthesis. To date, over 2000 cases have been performed worldwide. The study is not intended to suggest that routine or indiscriminate use of the artificial disc replacement is warranted, but rather serves to provide a framework for further investigation to the utility of spinal arthroplasty with function intervertebral replacements.