Spinal disc surgery options, the latest advancements from laminectomy to fusion to artificial disc insertions.
Disc injury occurs when the disc either ruptures or bulges friom wear and tear or trauma. Physical therapy, traction and non surgical procedures are always a better course than surgery if they work. What it they don't? here is the latest in modern medical treatment for spinal disc injury and surgery.
Surgical trimming of the disc is a procedure whereby the surgeon enters through the back of the spine and removes a portion of bulging or herniated disc. To access the spine, a portion of the lamina has to be removed. This is called a laminectomy for that reason. Laminectomy has been successful and less intrusive that fusion, and healing time is much quicker. However, it is major surgery and removal of a portion of the disc ensures the disc will be compromised later in life. It is however very effective at removing the actual offending disc material lying on a nerve.
A complete removal of disc material at surgery leaves the vertebrae on top of each other. Therefore surgically the material has to be replaced. There are currently two ways to accomplish this task, insertion of bone called a fusion, and insertion of an artificial disc.
Fusion is a complicated process of fusing the bone inserted into the spine. There are complications and failures related to this surgery. First, fusion sometimes fails to occur. The bone simply does not grow and lock into place. This will result in movement and laxicity in the spine and can have crippling effect on the patient. A second complication of fusion is that once fused, there is no movement in the spine. Therefore the spinal pressure of sitting and standing are transferred to other parts of the spine. It is not unusual to see the next level above a fusion wear out because of this pressure after many years. Therefore fusion, while a great remedy for someone with uncontrollable back pain can consider this a viable option.
Recently a newer solution has been advanced, the insertion of an artificial disc. Highly experimental, the theory is that by replacing the disc with a similarly functioning prosthesis, the downside to fusion will be reduced. Initially studies done on the efficacy of this type of insertion had been instituted by and conducted by doctors and manufacturers that stood to gain from its implementation. However here are some more recent study results.
A study of the Spine Athroplasty Society Journal reported that complications after surgery were the same as a percentage as fusion, under 10%, and the complications included failure of the disc to properly seat, infection or lack of symptom relief. In another study, performed at the Washington School of Spinal Medicine, patients with the prosthesis inserted did equally as good as the those that underwent fusion. However, one major benefit of the insertion of the prosthesis was almost normal range of motion, unlike fusion. Thus it is hoped that one of the major drawbacks of fusion would be resolved.
Because these studies are one to three years old, it is unclear if the long term effect will be to preserve the spinal motion and therefore eliminate the failure rate of discs above or below the fusion. Your medical professional should discuss all alternatives with you.
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