Lumbar and Cervical Disc Replacement
Another new technology has recently become available for the treatment of cervical and lumbar spine degenerative changes: cervical and lumbar disc replacement. The idea behind total disc replacement is to preserve the inherent motion of the spine, restore its height and restore its natural function. Over the last few years there have been numerous clinical studies performed both in lumbar and cervical spine to evaluate the treatment, effectiveness and results of lumbar and cervical disc replacements, and there are now a variety of FDA-approved devices available for treatment.
The lumbar spine disc replacement has had FDA approval for the last few years. The challenge in lumbar disc replacement surgery is with the surgeon's approach, which is through the abdomen. There are some technical issues that make it a little more challenging to perform surgery from the front, rather than using the standard posterior approach to the lumbar spine. The other issue we have confronted in both the literature and clinical studies is that when there is a failure of the disc replacement the approach is much more difficult and involved to correct. For this reason, disc replacement of the lumbar spine is limited to a very select group of patients who have very specific indications for that design.
The cervical disc replacement, however, has some technical advantages. Those advantages include most importantly the approach. The approach to the cervical spine for a herniated disc or degenerative changes and bone spurs is probably 80% of the time done through an anterior approach in the front of the neck. That approach is technically reasonably safe and very effective. The standard approach is an anterior cervical discectomy, removing the disc and the spur that is impinging upon the nerve and replacing it with a bone graft and very often a plate and screws. The surgical approach to the cervical spine for a disc replacement is the exact same incision, exact same placement, exact same surgery. The only difference is instead of placing a bone graft and a plate in the disc space you would put a disc replacement in its place.
There are a number of clinical studies ongoing to evaluate the effectiveness of the cervical disc replacement for which Drs. Gratch, Lee, and Hsu have been involved. There are at the present two cervical disc replacement devices that are approved by the FDA. They have gone through the appropriate clinical studies and the results have shown them to be equal to the anterior cervical disc replacement and the anterior cervical discectomy and fusion. Both approaches have seemed to be very effective and the results at this point seem to be very good.
Many advances continue in the field of Spinal Surgery. We continue to strive for technology that allows a quicker recovery and better overall clinical outcomes. Dr. Gratch, Dr. Lee and Dr. Hsu continue to be on the leading edge of not only the clinical studies but the newer approaches and technologies available.