Medical Minute 4-8: Relieving Back Pain Without Spinal Fusion

By: Vanessa Welch Email
By: Vanessa Welch Email

Margaret Wee was one of those hit hard by years of abusing her young body and back.

"I have had pain and numbness in my left leg for the past four years to the point where I could not feel my left foot," she said.

A car accident in high school followed by the rigors of collegiate soccer, a couple of bad snowboarding accidents, and degenerating disc disease has left this 28-year-old with two herniated discs in her lumbar spine.

One option: Spinal fusion, but that comes with severe implications

"The results are never great. It takes something that's terrible and makes it bearable," said Kenneth Light, M.D., Spine Surgeon.

Instead of a spinal fusion that would make part of Margaret's spine immobile and could contribute to arthritis later on, spine surgeon Doctor Kenneth Light instead opted for a new pro-disc implant.

"He pulls the spine apart, cuts a little joint and slips this little joint into the spine. The spine springs together and captures this joint."

Compare the numbers: For spinal fusion surgery, patients will stay in the hospital for five days. For a lumbar disc replacement, two days. If you use the implant for a cervical disc replacement, one day.
Recovery with the implants is cut from 12 weeks to 10 days.

Six months after surgery, Margaret has some numbness in her foot, a little pain, but nothing like before. Nothing's holding her back. She's ready to ride even after the sun goes down.

For more information on other series produced by Ivanhoe Broadcast News contact John Cherry at (407) 691-1500, jcherry@ivanhoe.com.

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MEDICAL BREAKTHROUGHS - RESEARCH SUMMARY:

BACKGROUND: Disc replacement surgery is becoming increasingly popular in treating patients with degenerative discs in their lower back. This surgery is necessary for people who do not benefit from taking anti-inflammatory medications, doing physical therapy, and receiving injections. One of the main reasons why disc replacement surgery is needed is because the discs become damaged. When damaged, the jelly-like cushions between the vertebrae and the spine begin to bulge, pressing against the main nerve, and cause sharp shooting pains. A disc replacement is implanted into the spine to imitate the functions of a normal disc. (SOURCE: www.mayoclinic.com)

TREATMENT: Artificial discs are usually made of metal or plastic-like (biopolymer) materials, or a combination of the two, and have been used in the body for many years. There is also a newer type of surgery for replacement discs consisting of a scaffold seeded with living cells. These implants are grown from living cells, and could provide more comfort and flexibility. This new surgery could also relieve back pain without many of the side effects caused by the current artificial disc replacement surgery. When Compared to the metal and plastic implants used today, an artificial scaffold swathed in living tissue could repair itself, and the constant access to blood supply would reduce the risk of infection after surgery. (SOURCE: http://www.technologyreview.com)

OPTIONS: Artificial discs are usually made of metal or plastic-like (biopolymer) materials, or a combination of the two, and have been used in the body for years. However, there is a newer type of surgery for disc replacement that uses living cells inserted into a scaffold. This artificial disc was engineered to closely imitate the natural form, so it would perform the same functions as an actual disc. Engineers at the Medical University of South Carolina modeled the complex structure of a disc on a computer, and then began constructing a scaffold made from dissolved polyurethane. Bovine cells were seeded onto the scaffold to test if the structure would support cell growth. After 19 days, the cells grew, and arranged themselves as they would in a natural disc. (SOURCE: http://www.technologyreview.com)

BENEFITS: Since the new discs are grown from living cells, they would provide more comfort and flexibility. The new disc replacement surgery could also relieve back pain without many of the side effects caused by the current artificial discs. When compared to the metal and plastic implants used today, an artificial scaffold containing the living cells and tissue could repair itself, and with constant access to the blood supply, chances of infection after surgery would be reduced. Like a natural disc, the artificial disc would act as a shock absorber, creating a cushion for spinal impacts. This new disc is still in development, but they will be nearing clinical trials over the next few months. Researchers will begin testing the disc in rats to further understand how complicated the discs need to be to restore function. (SOURCE: http://www.technologyreview.com)

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IN-DEPTH INTERVIEW WITH THE DOCTOR FROM THE STORY ABOVE:

Kenneth Light, M.D., a spine surgeon in San Francisco discusses advancements in spinal fusion, and how a new disc replacement is the greatest advancement in spinal surgery in years.

I read in the press release that 80 percent of people will have back pain sometime in their life?

Kenneth Light: Most people have back pain at some point, yes.

How do you know when it goes from normal to something that needs to be fixed?

Kenneth Light: Two things: One is you have shooting pain down your leg, associated also with numbness and weakness, and you can't walk; so that would be one reason why you would have to get it fixed. The other reason is you could have very bad pain shooting down your leg, and you can't sit in a chair, and most people have to sit in a chair to go to work every day. And the third time you know that you have to go to the doctor is when your pain in your back is so bad; you can't get out of the bed in the morning. There's no question; you have to go to work, and if can't go to work, most people have to get it fixed.

Now, before it was all spinal fusion, which has its downsides?

Kenneth Light: A spinal fusion is the way that the doctor took unstable vertebrae, or spine; spines that were slipping in various directions, or spines that were crooked, such as scoliosis, and could straighten them and put them back into alignment. We still have to use the spinal fusion for those conditions. The downside of a spinal fusion is, number one: it makes the back abnormally stiff. When the back gets very stiff, it doesn’t function normally. The discs allow the spine to have some kind of recoil, so when you walk there's some cushioning of the rest of the joints in your body. When you lose that cushioning, it puts a lot of stress on the joints adjacent to the spine. Those joints would be the sacroiliac joints, which are the joints that attach the pelvis to the sacrum, which is part of the spine. It also puts a lot of stress on the hip joints, and patients who have very long spinal fusion, develop arthritis of the sacroiliac joints, then they develop arthritis of the hip joints. On the level of the spine that’s attached to the fusion, the discs seem to disintegrate at a rapid rate. Then the fusion is extended another level, and another level, and another level, and pretty soon, the whole spine is fused.

So you're kind of trading in one problem for another?

Kenneth Light: You are. You're trying to put off a very bad problem into the future, but what happens is eventually you have to pay the piper. And eventually you have to either add on to the fusion, or you develop trouble at the adjacent level.

Total disc replacement can stop this progression?

Kenneth Light: So what happened was there was a woman who won the 1972 Olympics on the uneven parallel bars in Munich; wound up becoming an orthopedic surgeon. In the early 1980s, she thought to herself "well, maybe we can avoid doing the spinal fusions" cause we all know they're bad, and the results are never great, the results are okay. The results take something that’s terrible, and make them bearable. So, they starting doing disc replacements in Europe in the 1980s, and they caught on, and the results were actually pretty good. But it wasn't until about six or seven years ago that they were permitted to be done here. They are the single greatest advancement in spinal surgery in the last 50 years.

Once you get a total disc replacement, is your injury going to progress like it did with spinal fusion?

Kenneth Light: Well, we think not. We don’t have enough information in this country to be able to say for sure that it's going to prevent the progression of the disease. Because, if you took a normal person, and you followed them throughout their lives, we know that little by little as everyone gets older all of our discs have a tendency to degenerate. So, it won't be for a long time before we can say "well, If we do the disc replacement, it's going to slow the degenerative process down" because we would have to compare that to a number of people who had solid fusions. I could tell you a few things about disc replacements that are definitely true. The first thing is that the pain after a disc replacement is substantially less than that of a spinal fusion. The amount of days the patient spends at the hospital is substantially less than that of a spinal fusion.

How much less?

Kenneth Light: The average spinal fusion would be in the hospital for a combined anterior/posterior operation would be in the hospital about five days. It's roughly two or three days for the lumbar disc replacement. For a cervical disc replacement the average time in the hospital is one or two days. We've had patients where they wake up the next day and say "can I go home", and a spinal fusion is usually two or three days. The improvement in the function is much faster than that of a spinal fusion. The average spinal fusion takes six to 12 months to heal. The average disc replacement for a cervical disc replacement for a one or two level disc replacement, the patient can go back to work in 10 days to 2 weeks, for a spinal fusion its often six weeks, 12 weeks. So, the recovery is much faster, the pain is much less, and the function of the spine approximates that of a normal spine. It doesn’t make the spine abnormally stiff, and so the patient has much more movement, they have much more mobility.

END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

If you would like more information, please contact:

Gary Grasso
Public Relations Rep. for Dr. Kenneth Light
garygrassopr@yahoo.com


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