There is significant excitement among surgeons as well as among patients following the recent FDA, or Food and Drug Administration, release of the Charit� Artificial Disc (DePuy Spine, Inc.). The delight among patients with degenerative disc disease comes from the perception that there’s now a safe way to eliminate pain from degenerative discs while also maintaining normal movement. Several patients have developed advanced stages of disc degeneration requiring an additional fusion process or have heard about others with similar difficulties getting fusion processes before, who still continue with constant pain or had more than one effort at fusion. They’ve also discovered the successful results following disc arthroplasty in Europe which has been highly publicized by the media in America.
That is certainly an exciting new addition to the variety of therapies and methods for treating degenerative disc disease. An almost amazing quantity of progress has been made when looking at the way in which the evaluation and treatment for degenerative disc disease has developed over recent years. Many healthcare professionals are now able to recognize disc disorder with MRI and pain generators with discography and facet blocks. Now they could be performed through incisions that are barely observable either anteriorly through the abdomen or through the back where only a decade past, lumbar fusions were being performed through substantial posterior incisions. With the usage of instrumentation that is presently available, achievement rates for one amount fusions approach 90 to 95 percent. Regrettably, not every patient who has degenerative disc disease and contains a successful fusion has a successful clinical result. There’s still a number of patients for whom fusion will not effectively relieve pain.
Disc replacement arthroplasty has the prospect of the treatment of most of the spinal motion segment illnesses which are currently being treated both successfully and not by one of the numerous fusion techniques. At this comparatively early phase of disc replacement development, many healthcare specialists don’t know all of the issues which will be encountered following these procedures. Because the surgical strategy is via the abdomen either retroperitoneal or transperitoneal, in other words, around or through the gut, there are several foreseeable complications including vascular injury, thrombophlebitis, or vein inflammation accompanied by blood clot formation, nerve root injuries, injury to the ureter, and retrograde ejaculation in men.
It’s also known that several disc replacements have failed and have been converted to some fusion with varying clinical consequences. Removing artificial discs, especially at the L4-5 level, poses a substantial risk of vascular injury due to scarring round the prosthesis. Surely, it’s known that artificial joints produce wear debris where that is obviously not an issue with fusion and an inflammatory reaction which could escalate over time.
Spine specialists and other healthcare professionals in general are very positive and excited about total disc arthroplasty, and suitably so. Appropriate training via cadaveric labs and courses will help minimize the learning curve of the procedure, to avoid other possible complications. There will without a doubt be many improvements and modifications in the prosthetic layouts.
Early results are surely encouraging in the hands of the investigational surgeons but are fraught with the numerous problems common to the creation of a procedure that is new. Total disc arthroplasty is likely to be an option that is better than fusion for several degenerative disorders of the lumbar spine as layout advancements continue being made and as further encounter defines the indicators because of its use.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
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