Artificial Lumbar Disc

Congratulations to Rick Sasso, MD, a spine surgeon with Indiana Spine Group, on his recent patent assignment. This patent, filed in 2007 was approved in September 2011. US Patent number 8.016,831 is for” instruments and techniques for guiding instruments to a spinal column.”

This patent is related to spine surgery instrumentation and  techniques for anterior cervical discectomy and spinal fusion, as well as safely and accurately placing cervical artificial discs replacements into the intradiscal space. For more detail about this patent, visit this link.

I co-authored a book chapter on “Cervical Disc Replacement”, that has been recently published in Rothman Simeone The Spine – 6^th Edition.

The Spine is a continuing medical educational resource for spine surgeons and highlights state-of-the-art spine treatments and spine surgery techniques. In addition to the text, there is also a video resource for physicians highlighting different surgical techniques and procedures.

Some sections of this book include: Basic Science, Spinal Diagnosis, Surgical Anatomy and Approaches, Thoracic and Lumbar Disc Disease, Minimally Invasive Surgery, Spinal Stenosis, Spinal Fusion and Instrumentation and more. For more information about The Spine and a table of contents, visit this link.

In addition to the talks previously highlighted in prior blogs, I also gave a few talks on the cervical spine at the annual American Academy of Orthopaedic Surgeons continuing medical education meeting. One Instructional Course lecture, where I served as faculty, focused on the degenerative cervical spine and was entitled, “The Degenerative Cervical Spine: What You Need to Know”.  This talk focused on the evaluation and treatment options for the degenerative spine and it addressed anterior and posterior spine surgery options, as well as non-operative treatment options.

The other talk was a Podium Presentation of the research results for the five-year study of the Bryan Cervical Artificial Disc. This continuing medical education presentation was entitled, “Cervical Disc Replacement: Five Year Follow-up from the U.S. Prospective Randomized Bryan Trial”.  This link provides an overview of the initial results of this study – which followed spine surgery patients post-operatively for five years. Patients evaluated either underwent spinal fusion or arthroplasty (cervical artificial disc).

Congratulations to Dr. Rick Sasso for his recent publication! (Dr. Sasso is a spine surgeon with Indiana Spine Group). Dr. Sasso recently co-authored an article published in the recent issue of the SAS Journal. This journal is a publication of the International Society for the Advancement of Spine Surgery and the Society for Minimally Invasive Spine Surgery.

This article entitled, Lumbar Extraforaminal Decompression: A Technical Note and Retrospective Study Looking at Potential Complications as an Outpatient Procedure, published the results of a recent spinal study. This spine study retroactively evaluated the medical records of 100 patients from the same spine surgeon, who underwent spine surgery for lumbar disc herniation or stenosis. The spine surgical procedure was a type of decompression. This study concluded that extraforaminal lumbar decompression can safely be done as an outpatient spine surgical procedure.

This spine wellness blog entry will answer a recent question by a blog reader.

What is the best food and exercise for a degenerative spine?

Unfortunately, the lumbar disc between the vertebrae that degenerate, don’t have a good blood supply, thus it is difficult to get nutrients to these vertebrae. That is why once the lumbar discs degenerate, they cannot be “regenerated,” by certain foods or supplements.
 
For overall spine health, one of the best things that you can do for your spine is to maintain a healthy weight, and do weight bearing and aerobic  exercises such as walking, biking, and swimming. As well as core strengthening exercises. Additionally, aquatic exercise is a great type of exercise for individuals with spine problems. This link provides a good resource for aquatic exercise.

And remember, proper hydration is essential to a healthy spine. So make sure your water intake is adequate.

(This answer was provided by Alta Skelton, RN, MSN, NP-C, and Adam Ebbert, PT, CEAS.) 

I recently co-authored a few chapters in a continuing medical education book published by the American Academy of Orthopaedic Surgeons. This continuing education, instructional course lecture spine book focused on the Bryan disc and motion.

A few chapters of this book included:

• Emergency evaluation, imaging and classification of thoracolumbar injuries
• Nonsurgical treatment of thoracolumbar spinal fractures
• Surgical treatment of thoracolumbar fractures
• Update on cervical artificial disc replacement
   

In a prior blog entry, the results of a lumbar disc herniation study were reviewed. This study evaluated the results of the length of time, referred to DOS or duration of symptoms, prior to seeking treatment for lower back pain caused by lumbar disc herniation.

Again, this study concluded that the less the length of the back pain/symptoms (DOS), the more favorable the treatment results. Here is a summary of this presentation in a SpineUniverse article.

At the annual American Academy of Orthopaedic Surgeons meeting one podium presentation discussed “if the length of a person’s back pain/symptoms affects the outcome of treatment”.  

This was researched in respect to lumbar disc herniation. The purpose of the study was to determine if the duration of symptoms (DOS) affects outcomes following the treatment of intervertebral lumbar disc herniation (IDH).  This was evaluated for both operative and nonoperative spine treatments. 

Patients were evaluated with back pain / symptoms who sought care with less than six-months of symptoms, and those that had greater than six-months of symptoms. The study did conclude that treatment results were more favorable for both surgical and nonoperative treatments when patients sought treatment sooner for IDH. 

To read the poster presentation of this study, visit this link.

An article that I co-authored, published in the Journal of Spinal Disorders & Techniques, summarized a study on cervical spinal motion at the adjacent discs (adjacent segment motion) following spinal arthroplasty with a Bryan Cervical Disc as compared to a spinal fusion.  Radiographic analysis was used to measure this motion prior to surgery, and at designated intervals post-surgery. 

For an abstract of this study, visit this link. 

I recently co-authored a book that is now available on Amazon or through the publisher.  The book, entitled Spinal Arthroplasty: The Preservation of Motion, provides detailed information about spinal arthroplasty.  This medical education book includes information about cervical artificial discs and lumbar artificial discs that are used in the spine surgical treatment of cervical and lumbar degenerative disc disease.

A few chapter titles include: 

• History of Spinal Fusion
• History of Motion-Sparing Surgery
• Spinal Anatomy
• Spinal Biomechanics
• The Effects of Fusion and Motion Sparing Procedures on the Biomechanics of the Spine
• Biomaterials in Spinal Arthroplasty
• Total Disc Arthroplasty: Clinical Indications and Surgical Approach
• Cervical Arthroplasty: Biomechanics, Design Considerations, Clinical Outcome
  

Congratulations to Rick Sasso, MD, who recently co-authored a book
on spinal arthroplasty! This book entitled, Spinal Arthroplasty: The Preservation of Motion, is an ideal medical education resource for orthopaedic surgeons, spine surgeons, residents/fellows and health science libraries.

The book provides state-of-the-art information on everything related to spinal arthroplasty; including relevant spinal surgical anatomy, biomechanics, clinical indications, spinal imaging, and a complete overview of artificial disc implants - both cervical and lumbar. The publisher describes this book as “Lavishly illustrated with high-quality surgical and anatomical art and images, this landmark text brings this exciting and innovative technology to the forefront of spinal surgery with authority and style!"
 
This book is now available on Amazon and from the publisher. Also, the publisher link provides a complete Table of Contents. 

One spine surgery research study that I participated in - compared the post-operative results of cervical arthroplasty and arthrodesis on approximately 500 patients. The objective of this study was to compare any side effects of patients undergoing a cervical arthroplasty with the implantation of a Bryan Cervical Artificial Disc to those patients that underwent a spinal fusion.

In this study, of which there were 31 institutions where patients underwent spine surgery, there were 242 patients who received the Bryan Cervical Artificial Disc and 221 patients that underwent cervical discectomy and spinal fusion. Patients that participated in this study were over 21 years of age, had single level cervical degenerative disc disease causing radiculopathy or myelopathy as well as a few other clinical indicators. Once identified, these patients were evaluated before spine surgery and post-operatively at regular intervals beginning one and one half months following spine surgery up to 2 years. 

This study concluded that both procedures are safe, and that there is not a significant difference in adverse effects with the newer arthroplasty procedure utilizing the Bryan Cervical Artificial Disc when compared to the traditional surgical option of spinal fusion.

 To read the complete study,link here.

At Indiana Spine Group’s Back Talk continuing medical education symposium, as highlighted in a previous blog entry , there are two educational tracks that will be available for conference attendees on day one.  In addition to the general track discussed in the prior blog, there is a more in-depth track entitled, More Specifics | Spinal Diagnostics and Treatment. 

In this education track there will be a few sessions focusing on the diagnosis of spinal disorders and abnormalities.  One session titled Spinal Imaging | Technology and Diagnosis, will be presented by Stephen Pomeranz, MD. Dr. Pomerance is a radiologist. In this session, Dr. Pomeranz will provide an in-depth look at spinal imaging technologies and highlight the latest developments in spinal imaging technology and their applications in spinal diagnostics.  Additionally, using case studies, he will review radiological finds and diagnostic indicators. 

The second session of this educational track will focus on The Electrodiagnostic Evaluation, and will be presented by physical medicine and rehabilitation specialist Dr. Shashank Dave.  During his presentation, Dr.Dave will discuss the role and application of electromyography in the diagnosis of spinal disorders and diseases.  Additionally, he will review case studies which utilize electromyography and identify specific diagnoses. 

Another session presented for the in-depth track will focus on Diagnostic and Therapeutic Injections of the Spine.  This will be presented by minimally invasive spine specialist John Arbuckle, MD.  During this session Dr. Arbuckle will review and differentiate between the different type of therapeutic injections and will review the treatment efficacy of injections, the clinical protocols, indications and expected outcomes. 

The last session of this continuing education track will highlight spine surgery, and is entitled Surgical Perspectives | Fusion vs Arthroplasty, presented by spine surgeon Rick Sasso, MD.  During this session, Dr. Sasso will provide a detailed analysis of spinal fusion and arthroplasty and he will discuss motion preservation modalities for the treatment of generative disc disease.  He will highlight lumbar and cervical artificial discs as well as review research studies and discuss patient selection, indications and expected outcomes. 

While at the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS) in New Orleans, in addition to presiding as President of the Federation of Spine Societies spine specialty day, I also gave a few talks on cervical radiculopathy.

The first session that I moderated was on the current concepts in cervical radiculopathy.  The objective of this continuing medical education session was to provide the most up-to-date information on the pathophysiology, diagnosis and treatment of cervical disc disorders, including the role of selective nerve root sleeve injections and artificial disc replacement.

Another session that I served as a faculty member for was the spine instructional course lecture entitled, “The Degenerative Cervical Spine: What You Need to Know.”  This presentation provided an overview of cervical degenerative diseases and addressed the patient evaluation and treatment options, including anterior, posterior and non-operative options.

A recent blog entry highlighted articles about the cervical artificial disc, written by Dr. Rick Sasso  - a spine surgeon with Indiana Spine Group.

In this spine wellness educational video, Dr. Sasso discusses cervical artificial disc; the indications, overview of surgical procedure and the advantages of this procedure. 

In May 2009, the Bryan Cervical Artificial Disc received FDA approval.  This approval was previously written about in Dr. Sasso’s blog.  The cervical artificial disc provides an alternative spine surgical treatment for cervical degenerative disc disease.

Dr. Rick Sasso, a spine surgeon with Indiana Spine Group, has been a principal investigator in the studies with this spine surgical device – the Bryan Cervical Disc.  A few of abstracts of his published research studies regarding the cervical disc are available on the U.S. National Library of Medicine / National Institutes of Health web site. 

These include:

• Cervical kinematics after spinal fusion and bryan disc arthroplasty 
  
• Motion analysis of bryan cervical disc arthroplasty versus anterior discectomy and spinal fusion: results from a prospective, randomized, multicenter, clinical trial 
  

In October, I was a faculty member at the 8^th Annual Symposium on “Innovative Techniques in Spine Surgery.” This continuing education meeting, hosted in Phoenix, addressed the innovative and emerging technologies of spinal surgery including; arthroplasty, minimally invasive procedures, motion sparring technologies and biologics.  At this meeting I gave a talk on Lumbar Artificial Disc Replacement, and presented the results of the FDA studies for the Cervical Artificial Disc.

This education program was sponsored by the Organization of Spinal Teaching and Research.  The purpose of this group is to facilitate education and discussion among spine care providers and industry and this organization includes leaders in the field of spine surgery and technology that utilize the most advanced and effective technology available for the treatment of spinal disorders.

A lot of patients ask me about the differences with arthroplasty (cervical artificial disc) and spinal fusion; as well as how does the cervical artificial disc work. A few years ago, I was interviewed by Barbara Lewis on Sound Medicine. This segment titled, “New Artificial Cervical Discs”, can be heard by visiting this link. 

A few topics discussed during this interview included:

• Comparison of a spinal fusion to cervical artificial disc,
• More detailed information about the cervical artificial disc,
• Comparison of cervical artificial disc to artificial hip and knee,
•  The future of cervical artificial disc.

In my prior blog entry, I talked about the Bryan Cervical Artificial Disc study that has recently concluded.  To evaluate patient outcomes and functionality for this spine study, one measurement used was the neck disability index (NDI).  With this assessment, patients provide a self-evaluation and answer a series of questions of how their neck pain affects their ability to manage everyday life. 

Previously, I blogged about the research results of a spine patient study – which evaluated the clinical outcomes of patients who received a Bryan Cervical Disc compared to those that had a standard spinal fusion at 24-months post-operatively. I recently completed a new study, which evaluated these patients 48-months post-operatively. This study will soon be published.

In this study – the functional outcomes of patients at 48-months (4 years) following their spine surgery was evaluated. This study had two groups of patients – one group received a spinal fusion (Anterior Cervical Discectomy and Fusion - ACDF) and the other group received the Bryan cervical artificial disc prosthesis. This spine surgery was for the treatment of radiculopathy and myelopathy, after minimally invasive spine procedures were determined ineffective.

There were 47 patients enrolled in this spine study. Of this group, 21 were enrolled in the Bryan cervical disc arm of the study and their mean age was 40.  In the group that received a spinal fusion (control group), there were 26 participants and their mean age was 43.

This study concluded that patients that received the Bryan Artificial Cervical Disc at 48-months, when compared to the control group:

•     Had less neck and arm pain,
•     Greater mobility,
•     Less adjacent segment degeneration, and
•     Lower secondary operation rate.