New Study Suggests Artificial Disc Replacement is a Better Treatment Option for Degenerative Disc Disease Pain
A new study published in the ANZ Journal of Surgery
suggests that artificial disc replacement is more effective in the short term for degenerative disc disease (DDD). Other traditional treatment options for DDD, which typically occurs with age, include simple pain-relief drug therapy, physical therapy, and in some cases surgical removal of the damaged disc. In certain cases, the bone is then permanently fused to protect the spinal cord. Lumbar fusion surgery is currently the “gold standard,” for treating low back pain, according to the American Academy of Orthopaedic Surgeons (AAOS). Artificial disc replacement is rarely performed for patients who suffer from DDD.
The surgical implantation procedure of an artificial disc is performed through an incision in the abdomen (similar to an anterior lumbar interbody fusion). With this approach, the organs and blood vessels must be moved to the side. This allows your surgeon to access the spine without moving the nerves. Usually, a vascular surgeon assists the orthopedic surgeon with opening and exposing the disk space. Most surgeries take about 2 to 3 hours.
Researchers Prema Thavaneswaran and Meegan Vandepeer set out to assess the safety and effectiveness of lumbar artificial intervertebral disc replacement (AIDR) for patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed non-operative treatment. They conducted a systematic search of several electronic databases between January 2005 and April 2012 to identify relevant randomized controlled trials and non-randomized comparative studies. Which studies were included was determined by a predetermined protocol set by two independent reviewers.
Six randomized controlled trials (comprising nine studies) and one non-randomized comparative study comparing lumbar AIDR with lumbar fusion were included in the review. According to Thavaneswaran and Vandepeer’s findings, for the majority of adverse events reported, there were no obvious differences in incidence rates between the two treatment groups, and serious adverse events were rare in both groups. Following lumbar AIDR, effectiveness outcomes including Oswestry Disability Index (a standard questionnaire that determines level of low back pain) scores, procedural success rates, pain scores, narcotic medication use and patient satisfaction were generally significantly better than, or equivalent to, outcomes achieved following lumbar fusion.
The researcher concluded that in the short to medium term, the safety and effectiveness of lumbar AIDR appears to be comparable to that of lumbar fusion.
According to information from the AAOS, artificial disk replacement is a newer surgical procedure for relieving low back pain. Similar to hip or knee joint replacements, a disk replacement substitutes a mechanical device for an intervertebral disk in the spine. The device is meant to restore motion to the spine by replacing the worn, degenerated disk. This technology has been available in Europe for over a decade. Artificial disk replacement initially gained U.S. Food and Drug Administration approval for use in the United States in 2004. Over the past several years, numerous other disk replacement designs have been developed and are currently being tested.
Pictured: DePuy Spine Inc.'s Charité artificial disc. Image courtesy of DePuy Spine.