January 1, 2006

Mischa Clay is like most people suffering back pain. Even the simplest daily tasks can be difficult to perform. Getting dressed, carrying small items, bending and even sneezing can make you wince. About 65 million Americans suffer from low back pain every year, according to the American Association of Neurological Surgeons (AANS). Americans spend about $50 billion each year on low back pain, the most common cause of job-related disability and lost workdays. More than 12 million people are reported to have degenerative disc disease. The 38-year-old woman from Chapmanville said she’d tried several things including physical therapy, injections and pain medication. “Nothing was helping, I knew something had to be done,” Clay said. “I was just trying to get back to normal.” She had been experiencing pain in the middle of her back for about two years and it was getting worse. Spinal fusion surgery, a common treatment for chronic low back pain caused by degenerative disc disease, joins vertebrae together using bone grafts so that motion no longer occurs between them. While most patients report relief from pain after spinal fusion surgery, the surgery often robs them of flexibility and range of motion. Instead of fusion, a team of doctors in Charleston is removing the damaged disc and replacing it with the new CHARITÉ Artificial Disc, a high-tech device made of two metallic endplates and a movable high-density plastic center that, once implanted, is designed to help align the spine and preserve its ability to move. Spinal discs maintain the position of the spine and allow for the flexibility to bend and twist. This is the option Clay chose. In clinical trials comparing artificial disc replacement to spinal fusion surgery, CHARITÉ Artificial Disc patients maintained or improved their range of motion and experienced improvements in pain. There were no significant differences in complications. In use in Europe since 1987, the U.S. Food and Drug Administration (FDA) approved the CHARITÉ™ Artificial Disc in October 2004, making it the first artificial disc on the U.S. market. The procedure The procedure begins with general surgeon John DeLuca, MD taking several minutes to move major organs aside and move vital veins and arteries out of the way. “Those beginning steps are some of the most important,” said Matthew Walker, MD, an orthopedic surgeon. “I can’t stress enough, the importance of getting good exposure. We can’t do the procedure without having good access to the spine.” Specialists, neurosurgeon and/or an orthopedic spine surgeon, then remove the damaged disc and create a space between two vertebrae for the implantation of the artificial disc. A tiny jack is placed between the bones to separate them enough to carefully place the endplates and then the plastic center. The jack is released and removed. “Placement of the plates and center is key. If you get it just a little off, you run the risk of having the disc slip,” said John Schmidt, MD, a neurosurgeon. “This part of the procedure takes the longest because we have to be so precise.” The recovery The length of stay is on average two to three days, about the same as fusion patients. “I try to get the patient out of bed and walking as soon as possible, sometimes within the same day as the surgery,” said John Deluca, MD. “Patients are not big pain medication users during recovery. All things considered they are pretty comfortable afterwards.” Clay says she’s taking her recovery one day at a time and walks every day. “Everything’s getting better. I’d do it all over again,” Clay said. In spinal fusion surgery a damaged spinal disc is removed and vertebrae are joined together using bone grafts and metal screws and/or cages so that motion can no longer occur in this area of the spine. Patients usually have to wear a brace for about three months after surgery. “Unlike the recovery from spinal fusion, we encourage patients with a new disc to be active right away. The artificial disc allows for motion. The more the motion the patient can perform, the better in securing the metallic endplates in the vertebrae,” Schmidt said. Candidates Artificial disc replacement is not for everyone. As with any major surgery, there are possible complications that can occur including unresolved pain, allergic reactions, general intestinal problems and/or infection. Patients should ask their doctors to see if artificial disc replacement is appropriate for them. Generally candidates for disc replacement are younger people with degenerative disc disease. Strong bones are a must and the patient cannot use tobacco products following the surgery.

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