New Advancement in Back Care

We recently got back from the North American Spine Society conference—the largest annual conference of spine medicine specialists in the US—and this year the talk seemed to be all about new surgical advancements designed to reduce the patient’s back pain while preserving some or all of the motion in the spine. This newsletter reviews some of the new technologies available as well as the current standard treatments for back care.

The first artificial disc is now available in the US

The Charité artificial disc, made by DePuy Spine (a Johnson and Johnson company), has just been approved by the FDA for commercial use in the U.S. This comes after a two-year long clinical trial, in which patients who had the Charité artificial disc implanted in their spine were found to do no worse than those with anterior lumbar interbody fusion surgery. Only patients with back pain from degenerative disc disease were included in the trial.

Recently there has been a great deal of media coverage about the potential upsides of the artificial disc—and it’s availability in the U.S. is certainly a newsworthy event. However, we would counsel patients to remember that the basics still hold true with the artificial disc as with any other major type of spine surgery—i.e. patients should make sure that the surgeon has the appropriate training, skills and experience (especially since it’s a new procedure for surgeons) and patients should make sure that they are the right type of candidate for the surgery. In addition, because it is a new technology, patients need to be aware of potential reimbursement issues (the procedure is thought to cost about $35,000), as well as the potential unknown risks of any new technology (e.g. how long will the disc last in the body? Will a revision surgery be necessary at some point?). For more information, see also All about the Charité artificial disc: now approved for use in the US.

Other types of motion preservation technologies are in the works

Many other types of motion preservation technologies are in development and various stages of clinical trials as well, including:

• Other artificial disc technologies, currently in various stages of research and investigation

• Technologies that replace just the inner core of the disc but leave the outer core intact

• Instrumentation that attaches to the back of the spine to help maintain motion but limit or eliminate the pain.

• Artificial discs for the cervical spine to treat neck pain

See also Lumbar artificial disc surgery for chronic back pain and Artificial disc for cervical disc replacement.

Newer studies on IDET available

IDET is another alternative to spine fusion for treating certain types of back pain from lumbar degenerative disc disease (or a contained disc herniation). While this procedure has been in use for a few years, it is still considered relatively new and long term results and potential adverse effects are not fully known yet. What is pretty new is that now there are results from a blinded, placebo-controlled study (the gold standard in medicine for determining the unbiased success rate of a given treatment), which showed that 40% of patients undergoing IDET achieved greater than 50% relief of their pain vs. 32% of patients who experienced greater than 50% pain relief after undergoing the sham treatment.

See also IDET: an alternative to invasive surgery for chronic low back pain.

Non-surgical care for lumbar degenerative disc disease

Last but certainly not least, continuing non-surgical treatments are an option for treating pain from lumbar degenerative disc disease (and for most other types of back problems as well). Most spine specialists will recommend a course of non-surgical care that almost always includes some type of physical therapy (exercise), and may include a very specific course of physical therapy such as dynamic lumbar stabilization exercises. Other treatments may also be combined with the physical therapy to help ease the patient’s pain and make it easier to tolerate the exercises. Such treatments may include one or a combination of the following: pain medications, injections, manual therapy, TENS units, and/or manipulation. See also Low back pain and degenerative disc disease treatments.

Final thoughts

This is an exciting time of new developments in spine medicine. As always, we recommend that patients do their own research on treatments, including understanding what makes a particular treatment successful, and the potential downsides and risks and alternatives. For the vast majority of patients with back pain, it’s ultimately up to the patient to decide on how to proceed with a treatment plan, so be sure to find as much unbiased information as possible to help you make your decisions.

Best regards,
Peter F. Ullrich, Jr., M.D., Medical Director
Stephanie Burke, President
Spine-health.com

About the Spine-health.com Newsletter: Each issue of the Spine-health.com newsletter, SpineNews Update, is written by the founders of Spine-health.com - Peter F. Ullrich, Jr., M.D., Medical Director for Spine-health.com and Stephanie Burke, President of Spine-health.com. The content in the newsletters is not peer reviewed by Spine-health.com’s Medical Advisory Board. The articles to which the Spine-health.com newsletters link have been peer reviewed by members of the Medical Advisory Board.