- Anatomy of The Spine
- Back Pain in Children
- Caring for your Spine
- Emerging Spinecare Trends
- Evaluation of Spinal Disorders
- Exercise and The Spine
- Intervention - Spinal Disorders
- Intervertebral Disc
- Non Surgical Options
- Nutrition and Spinecare
- Options for Spine Treatments
- Pregnancy and Back Pain
- Prevalence of Spine Disorders
- Sleep and the Spine
- Spinecare Introduction
- Spinehealth and Disease
- Surgical Interventions
- Treatment with Medications
- Understanding Back Pain
Spinecare Topics
Surgical Interventions
Surgical Interventions
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Surgical Interventions
An artificial disc is essentially a device that can be implanted
between two adjacent vertebrae in place of the biological disc. The
artificial disc is implanted into the spine to imitate the function of
a normal disc. It is designed to serve as a spacer, to accept physical
loads and to allow motion between adjacent vertebrae. The recovery
time is typically better than with spine fusion. The return to normal
activities is usually quicker with disc replacement than with spinal
fusion.
There are different types of artificial disc designs. They can be generally classified into one of two categories; total disc replacement and disc nucleus replacement. The type of disc replacement to be used is dependent upon the clinical presentation and the degree, pattern and type of compromise of the biological disc. As the name implies, the total disc replacement requires that all or most of the biological disc be removed so that the replacement disc can be put in its place. With a disc nucleus replacement, only the gel-like center of the disc is removed followed by replacement with an implant. The outer portion of the disc is left in place.
Artificial discs are generally made of metal and/or plastic-like (biopolymer) materials. These materials have been used in other bioprosthetics for years. Total disc replacement has been performed in Europe since the late 1980s. The current artificial disc design has two plates usually made of metal. Each plate is attached or fixed to vertebra. Many devices have a softer, more deformable material between the two plates that serve as a spacer and provides the capacity for movement. The soft compressible material allows the surfaces to glide over it. Most nucleus replacement devices are made of plastic-like biopolymer materials. One of the materials is referred to as a hydrogel that expands when it absorbs water. This material can be placed into the center of the disc so that it provides volume and shock absorption.
The indication for disc replacement will vary for each type of implant. General indications include persistent disabling pain after an adequate course of conservative care. The level of disc involvement should be identified though clinical correlation with advanced imaging techniques such as CT discography and MRI. There are a number of conditions that may be contraindications for disc replacement. These conditions include but are not limited to the presence of spondylolisthesis (slippage of a vertebrae) at the level to be operated on, osteoporosis (thinning of bone), vertebral body fracture and an allergy to material to be used, spinal tumor, severe obesity, chronic steroid use, severe degenerative changes involving the facet joints, autoimmune disease and pregnancy. Therapeutic alternatives to disc replacement include no care, conservative non-operative care, minimally invasive intervention and spinal fusion surgery. Long-term outcomes and potential complications associated with disc replacement have not been totally established. The potential complications associated with this procedure include but are not necessary limited to infection, blood vessel injury, nerve damage, breakage of the device, movement or dislodging of the device, persistent or increased pain, new pain, sexual dysfunction, injury to adjacent structures and death.
Microendoscopic Discectomy
Microendoscopic disc removal is performed through a relatively small incision, big enough to allow for the creation of a relatively small window. A specialized endoscope with a camera can be placed into the intervertebral disc and used to remove disc material. The microendoscope refers to a small version of a video‑assisted surgical scope. This approach has not yet gained great popularity because it is used through such a small window of access. This limits the surgeon’s movement and maneuverability. The small portal of access also makes it somewhat difficult to visualize the area. This becomes important when there is small blood vessel breakdown and resultant bleeding which obscure the surgeons view. When this occurs it is important that the surgeon stop the bleeding prior to continuing to remove material. The potential benefits of the Microendoscopic discectomy approach include reduced degree of tissue compromise and increased speed of recovery. The idea of a microscopic approach using imaging technology will continue to gain acceptance and it will be applied to many spinal surgical procedures.
There are different types of artificial disc designs. They can be generally classified into one of two categories; total disc replacement and disc nucleus replacement. The type of disc replacement to be used is dependent upon the clinical presentation and the degree, pattern and type of compromise of the biological disc. As the name implies, the total disc replacement requires that all or most of the biological disc be removed so that the replacement disc can be put in its place. With a disc nucleus replacement, only the gel-like center of the disc is removed followed by replacement with an implant. The outer portion of the disc is left in place.
Artificial discs are generally made of metal and/or plastic-like (biopolymer) materials. These materials have been used in other bioprosthetics for years. Total disc replacement has been performed in Europe since the late 1980s. The current artificial disc design has two plates usually made of metal. Each plate is attached or fixed to vertebra. Many devices have a softer, more deformable material between the two plates that serve as a spacer and provides the capacity for movement. The soft compressible material allows the surfaces to glide over it. Most nucleus replacement devices are made of plastic-like biopolymer materials. One of the materials is referred to as a hydrogel that expands when it absorbs water. This material can be placed into the center of the disc so that it provides volume and shock absorption.
The indication for disc replacement will vary for each type of implant. General indications include persistent disabling pain after an adequate course of conservative care. The level of disc involvement should be identified though clinical correlation with advanced imaging techniques such as CT discography and MRI. There are a number of conditions that may be contraindications for disc replacement. These conditions include but are not limited to the presence of spondylolisthesis (slippage of a vertebrae) at the level to be operated on, osteoporosis (thinning of bone), vertebral body fracture and an allergy to material to be used, spinal tumor, severe obesity, chronic steroid use, severe degenerative changes involving the facet joints, autoimmune disease and pregnancy. Therapeutic alternatives to disc replacement include no care, conservative non-operative care, minimally invasive intervention and spinal fusion surgery. Long-term outcomes and potential complications associated with disc replacement have not been totally established. The potential complications associated with this procedure include but are not necessary limited to infection, blood vessel injury, nerve damage, breakage of the device, movement or dislodging of the device, persistent or increased pain, new pain, sexual dysfunction, injury to adjacent structures and death.
Microendoscopic Discectomy
Microendoscopic disc removal is performed through a relatively small incision, big enough to allow for the creation of a relatively small window. A specialized endoscope with a camera can be placed into the intervertebral disc and used to remove disc material. The microendoscope refers to a small version of a video‑assisted surgical scope. This approach has not yet gained great popularity because it is used through such a small window of access. This limits the surgeon’s movement and maneuverability. The small portal of access also makes it somewhat difficult to visualize the area. This becomes important when there is small blood vessel breakdown and resultant bleeding which obscure the surgeons view. When this occurs it is important that the surgeon stop the bleeding prior to continuing to remove material. The potential benefits of the Microendoscopic discectomy approach include reduced degree of tissue compromise and increased speed of recovery. The idea of a microscopic approach using imaging technology will continue to gain acceptance and it will be applied to many spinal surgical procedures.
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