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Jefferson Surgeons Perform Their First Lower Back Pain Procedure Using Artificial Disk
FDA-approved disk offers relief, mobility and improved recovery to those with progressive back pain who have not been aided
by medication or braces
Dr. Vaccaro
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About three-quarters of all adults suffer from back pain during their lifetime. In fact, back pain is one of the most common
reasons adults visit the doctor. For some of these sufferers, back problems are constant and cause significant impairment,
keeping them from their daily activities and from doing the things they love.
Traditionally, spinal fusion is used to treat this ailment, but orthopedic surgeons at Thomas Jefferson University Hospital
and neurosurgeons at Jefferson Hospital for Neuroscience, Philadelphia, have found that a new artificial disk composed of
metal and plastic, recently approved by the U.S. Food and Drug Administration (FDA,) is proving to be an effective additional
choice for patients who might otherwise consider fusion. Jefferson performed its first procedure using the artificial disk
in February and is among the first centers in the Philadelphia region to perform this procedure.
Charité™ Artificial Disc
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The Charité™ Artificial Disc, made by Johnson & Johnson's DePuy Spine, Inc., has been used in Europe for more than 17 years
and has been used in treating thousands of patients worldwide with good results. It is currently the only FDA-approved device
of its kind. Treatment with the disk appears to allow for faster recovery than fusion, with the potential benefit of retaining
stable motion. Long-term studies show about the same amount of pain relief with the artificial disk as with fusion. Total
disk replacement with the artificial disk involves removing the deteriorated disk from between the vertebrae and implanting
an artificial disk made of metal and plastic.
According to Alexander R. Vaccaro, MD, Co-director of Reconstruction Spine Services at the Rothman Institute at Jefferson,
follow up studies from pre-approval testing of the artificial disk produced very favorable results.
“This device allows the spine to move, something you don’t get with fusion. In studies, patients were observed to have motion
between zero and 21 degrees while bending forward and backward,” says Dr. Vaccaro, who is also Professor of Orthopedic Surgery,
Jefferson Medical College of Thomas Jefferson University.
Degenerative Disk Disease
Many of the problems of the spine are caused by degenerative disk disease. This condition affects the cartilaginous cushions
called intervertebral disks that can be found between the vertebrae (bones) of the back. These disks act as shock absorbers
between adjacent vertebrae and also work to hold the spine together. When injured through aging and injury, disks cannot repair
themselves, and this wear can lead to degenerative disk disease – and, often, pain for its sufferers. The diagnosis of degenerative
disk disease can be confirmed by history, X-rays and MRI.
One treatment for degenerative disk disease is surgery – including spinal fusion – to reduce further degeneration and control
pain. Spinal fusion involves the “welding” of two or more of the small bones (vertebrae) that make up the spinal column and
fusing them together with bone grafts and internal devices such as metal rods. The end product is a solid, stiff area of the
affected vertebrae.
With the new procedure, the surgeon chips away the damaged disk, creating room for the new one to be placed, while checking
with X-rays to ensure proper alignment. The surgeon chooses the specific artificial disk size that will restore the particular
patient’s original disk height and function and match his or her anatomy.
Jefferson’s First Artificial Disk Recipient
The first patient to receive the disk replacement at Jefferson, David Lodi, was a good example of the type of patient who
can benefit from the new device.
Mr. Lodi, 42, a postal worker from Audubon, NJ, had a “bad back” and degenerative disk disease for years, but he didn’t know
that he essentially had a “time bomb” ready to go off in his aching spine. His life was changed when a car struck him in February
2004 as he was he was crossing a crosswalk. After his accident, Mr. Lodi’s back pain was suddenly nearly unbearable. “I had
trouble walking. I couldn’t sleep. I couldn’t do everyday things without a lot of pain. My whole life was turned upside down,”
he says. He found himself constantly making accommodations to his daily routine so as to avoid pain. At work at the U.S. Post
Office in Bellmawr, NJ, Mr. Lodi was reassigned to light desk duty.
Mr. Lodi’s physician prescribed various approaches to treat his pain including medications, braces and epidural steroids (an
injected combination of cortisone and a local anesthetic). When these approaches didn’t cut the pain, Lodi’s doctor suggested
that he look into spinal surgery at Jefferson. While Mr. Lodi may have been an appropriate fusion patient, Dr. Vaccaro suggested
surgery with the new Charité Artificial Disc, which, according to its makers, is an alternative to spinal fusion for patients
who have one diseased disk between the L4 and L5 levels or between the L5 and S1 levels. Those with degenerative disk disease
whose spine has moved less than 3 mm. may receive the disk if treatment, such as medication or physical therapy, has failed
to relieve their pain for at least six months. Patients who have had some minor lower back surgery may also be candidates
for the disk.
The artificial disk is not appropriate for those who have an infection throughout the body or spine, disk degeneration or
instability at more than one spinal level or who have poor bone quality, notes Dr. Vaccaro.
Encouraging Post-op Studies
In two-year post-op studies by DePuy Spine, Inc., patients also reported greater pain relief and levels of restored function
that were no worse than those experienced by patients who had fusion surgery.
There is a limited risk of complications with the artificial disk surgery, including potential injury to the surrounding vessels
on insertion and for wear over time because of it’s the artificial disk’s nature as an articulation moving device, says Dr.
Vaccaro. The rates of complications were about the same between the artificial disk patients and fusion patients.
“We are very excited to be able to offer this technology at Jefferson,” concludes Dr. Vaccaro. “We’ve had artificial knee
and hip replacements for years, and now we have this option for the spine that we expect to be very successful.”
