New technology for old backs:  Refuse to fuse

In 1960, the first total hip replacement surgery was performed. Eight years later, the first artificial knee joint was implanted. Forty years later those surgeries are commonplace, giving thousands of patients pain-free mobility. Individuals with arthritic spines haven’t been so fortunate. Until now, the options have been exercise and physiotherapy, medications, various shots which offer temporary relief, and finally, fusion, which eliminates motion, yet itself does not guarantee pain relief.

But things are changing rapidly in the ‘spiney’ world. Many observers think that the next decade will bring numerous dramatic shifts in the way spinal pain is treated. Technological advances are snowballing. Add to that Internet-savvy patients, who can now find out what is available just about anywhere on the planet, and ask for it themselves, - the sum total is a worldwide movement to less invasive, motion-retaining treatment for spine problems. Most of these new surgeries are less invasive, and/or have much faster recovery times.

At the beginning of May, the Spinal Arthroplasty Society held its fifth annual international conference in New York City. Close to one thousand surgeons and other professionals involved or interested in new replacement technology attended the meetings to learn from physicians who have been working with the technology. A couple of days in advance of the conference, Global Patient Network, an Internet organization dedicated to helping spine patients, held its own ‘pre-conference’ for interested patients. Close to 60 patients from all over North America heard nine leading spine surgeons discuss new technologies such as lumbar and cervical disc replacement, flexible fixation systems as an alternative to fusion, artificial disc nucleus, endoscopic surgeries, and so on.

The general consensus of the American and European surgeons was ‘refuse to fuse’. Although it is the ‘gold standard’ and sometimes the best option, there are many alternatives. Fusion is the endpoint. Patients should investigate every other potential treatment before choosing fusion. And the options are growing. Not only is there a trial on inserting an artificial disc nucleus into a desiccated disc, there is also talk of an artificial disc that can be easily inserted flat and rehydrated like a sponge. A motion-preserving treatment for facet joint arthritis has just been approved for trial in the US.

Relatively new to North America, artificial discs originated more than a decade ago in Europe. They may offer relief, without the inherent loss of range of motion that comes with fusion. There are a number of artificial discs on the market, some approved and some in trials in various parts of the world. Among them are the SB Charité III, the ProDisc, the Kineflex and the Maverick for lumbar (low back) replacements, and the Bryan, the ProDisc-C, the Kineflex-C, the Cervitech PCM, and the Prestige for cervical (neck) replacements. When artificial disk replacement (ADR) is not appropriate, if stability is critical, surgeons may recommend a dynamic hardware system, such as the Interspinous U, Wallis Stabilisation, or Dynesys. Clearly, spinal arthritis is about to meet its match.

So Grandma’s ‘bad back’ may soon be a thing of the past. With every year that goes by, new alternatives to fusion appear. As one surgeon said about ADR, “They used to fuse knees and hips. Now we wouldn’t think of doing that.”