|The Artificial Disc Is Not A "New" Disc But A Metal Replacement|
The "Artificial Disc"
What is the artificial disc? How does it work? The artificial disc was developed in Germany in the 1960's and has been used in Europe since the 1990’s. It is not an artificial disc at all but is a stainless-steel mobile "fusion". The device is inserted through the side of the abdomen into the disc space once the disc is removed. The operation involves a 4 to 5 inch) abdominal incision, moving the abdominal contents and the major blood vessels to gain access to the anterior spine. This is not a minor operation and it usually involves two surgeons. Recovery appears to be similar to most abdominal or spinal surgeries. The concept of the artificial disc is simple. One, remove the real disc since it is causing pain, and two, allow mobility so that the remaining discs do not eventually fail as they do with most fusions. The artificial disc does allow this mobility but for some reason only has success rates similar to conventional fusions. Nonetheless, success rates are similar for fusions versus artificial discs in that success rates for U.S. studies reveal around 68% good to excellent1. European studies reveal higher success rates at 79%2. Contraindications for the procedure include: infection, spinal stenosis, spondylolisthesis, posterior facet joint disease, significant radiculopathy, osteoporosis and any prior spinal fusion. In this day and age, people want "replacement" parts that will make them "like new". Does the artificial disc give long term success? That is the big unknown. Artificial joints have been around for years and as time progressed it was found that they were only temporary replacements. They were temporary because they eventually loosened and the artificial joints had to be replaced with new artificial joints due to pain and dysfunction. This might sound easy, but in reality, it is not. To replace an artificial joint is very difficult and mortality and morbidity increase with each surgery. The answer to a failed artificial disc is to fuse the level and render the disc level immobile. In my conversations with European surgeons, some claim that they have moved away from the artificial disc and have returned to the fusion. Thus, even though the artificial disc has been around for many years, it is still not the answer to the problem. 1. A 1997 independent study, conducted by the Texas Back Institute and the Institutes for Spine and Biomedical Research, followed 67 patients who underwent intervertebral disc replacement with the SB Charité III device 2. A 1997 study conducted in France by Lemaire et al reviewed 105 cases undergoing SB Charité III prosthetic disc replacement.
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