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Options for Spine Treatments
Advancements in Spine Care and Spine Surgery
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Advancements in Spine Care and Spine Surgery
The concept of replacing a damaged disc with an artificial disc is not new. Surgical disc replacement has been performed in Europe for more than 10 years, and this concept is currently the topic of intense interest in the US. The current artificial disc replacement procedure for degenerative disc disease requires that the spine surgeon insert a small prosthetic (artificial) disc comprising a polyethylene core that slides between two metal end plates. The core of the artificial disc floats allowing for movement. The end plates are attached to the vertebral body with anchoring teeth located along the rim of the end plates. The prosthetic discs can be used to replace degenerative and herniated discs, helping to relieve chronic back pain. The unique chemical composition of the core of the prosthetic disc allows for deformation, thus movement of the spine, unlike inflexible bone fusions that prevent normal movement.
Each year approximately 200,000 Americans undergo spinal fusion surgery, requiring removal of the intervertebral disc and joining together of the adjacent vertebrae using bone grafts and/or metal screws. Fusion may help to relieve pain but limits /restricts mobility. An artificial disc would act as a spacer between adjacent vertebral and would allow for segmental movement. The TDR procedure is not for everyone. A successful outcome requires that the disc adhere to adjacent bone. Those who do not have strong bones (vertebrae) are more likely to suffer from a failed procedure. Other contraindications for this procedure include excessive degeneration or multiple failed back surgeries. However, the outcome is good when TDR is used in correctly selected patients.
Gene Therapy
Current treatments for many spine problems require bone grafts. Future spine surgery will require other forms of tissue grafts and replacements. Currently, a significant percentage of spinal fusions may fail to form adequate bone. In 1997 a gene was discovered that induces bone growth. Further research with cell cultures and animal studies suggests that the gene is key to the body's ability to build new bone. Technology used to grow new bone has enormous potential. Although not available yet, local gene therapy for spine fusion is positioned to move from bench research to the operating room. Similar technology may be developed to assist intervertebral disc replacement or repair. The discovery of the human genome will lead to ongoing investigation of gene therapy and the development of cloned tissue banks that will have applications for tissue replacement or repair in surgical spine care.
Nucleoplasty and Disc Repair
In the near future, disc replacement, disc regeneration and in vivo disc repair may replace the role of fusion for many patients. Surgical fusion will likely remain a viable option for some although many individuals will benefit form the placement of an artificial disc. The potential advantage of the artificial disc over fusion is that the replacement will result in a reduction of pain, improved function will the preservation of some motion at the level of the involved disc. Other forms of disc intervention may include reestablishing the gel-like nucleus of the disc through the injection of protein compounds that may also serve to help seal torn inner annular fibers.
Research is currently underway to develop artificial replacement materials for the nucleus pulposis deformable (center of the disc). Materials, which are being studied, include hydrogels and various polymers. This procedure attempts to maintain or restore the normal intervertebral disc space height, and to help restore mobility to the spinal segment and therefore the spine as a whole.
Each year approximately 200,000 Americans undergo spinal fusion surgery, requiring removal of the intervertebral disc and joining together of the adjacent vertebrae using bone grafts and/or metal screws. Fusion may help to relieve pain but limits /restricts mobility. An artificial disc would act as a spacer between adjacent vertebral and would allow for segmental movement. The TDR procedure is not for everyone. A successful outcome requires that the disc adhere to adjacent bone. Those who do not have strong bones (vertebrae) are more likely to suffer from a failed procedure. Other contraindications for this procedure include excessive degeneration or multiple failed back surgeries. However, the outcome is good when TDR is used in correctly selected patients.
Gene Therapy
Current treatments for many spine problems require bone grafts. Future spine surgery will require other forms of tissue grafts and replacements. Currently, a significant percentage of spinal fusions may fail to form adequate bone. In 1997 a gene was discovered that induces bone growth. Further research with cell cultures and animal studies suggests that the gene is key to the body's ability to build new bone. Technology used to grow new bone has enormous potential. Although not available yet, local gene therapy for spine fusion is positioned to move from bench research to the operating room. Similar technology may be developed to assist intervertebral disc replacement or repair. The discovery of the human genome will lead to ongoing investigation of gene therapy and the development of cloned tissue banks that will have applications for tissue replacement or repair in surgical spine care.
Nucleoplasty and Disc Repair
In the near future, disc replacement, disc regeneration and in vivo disc repair may replace the role of fusion for many patients. Surgical fusion will likely remain a viable option for some although many individuals will benefit form the placement of an artificial disc. The potential advantage of the artificial disc over fusion is that the replacement will result in a reduction of pain, improved function will the preservation of some motion at the level of the involved disc. Other forms of disc intervention may include reestablishing the gel-like nucleus of the disc through the injection of protein compounds that may also serve to help seal torn inner annular fibers.
Research is currently underway to develop artificial replacement materials for the nucleus pulposis deformable (center of the disc). Materials, which are being studied, include hydrogels and various polymers. This procedure attempts to maintain or restore the normal intervertebral disc space height, and to help restore mobility to the spinal segment and therefore the spine as a whole.
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