Artificial Lumbar Disc

One unique session for “Back Talk”, the continuing medical education symposium sponsored by Indiana Spine Group, will feature a hands-on component. During this session, entitled Hands-On | Surgical Case Studies, attendees will have the opportunity to get a first-hand look at spinal instrumentation, cervical artificial disc implants and other surgical devices used during spine surgery. Spine surgeons Kenneth Renkens, MD, and Thomas Reilly, MD, will lead this discussion. As they review the technology, they will discuss spine surgery case studies including diagnoses, recommended surgical interventions and expected outcomes.

For more information about Back Talk, and a complete continuing medical education conference agenda, click here.

An article in Science Daily entitled “Artificial Disc Replacement As Good or Better Than Spinal Fusion, Study Suggests”, highlights a published study that I co-wrote. 
 

In this article in Science Daily, co-author K. Daniel Riew, MD – a cervical spine surgeon at Washington University Orthopaedics and Barnes-Jewish Hospital, stated that one of the most important findings of the study was that people who received the Bryan Cervical Disc were able to preserve all of their motion.

 

I was recently interviewed for a news story that announced the FDA approval of the Bryan™ Cervical Disc. The Bryan Cervical Disc is an artificial disc used in cervical arthroplasty. 

This story also appeared on their web site which generated a few reader’s comments/questions. This blog entry – will address some of those questions. 

Blogger question: Can it be used in the lower back?

The Bryan Cervical Disc can only be used in the cervical (neck area) spine. There are two FDA approved artificial discs for the lower back (lumbar spine). They are: CHARITE Artificial Disc, approved by the FDA in 2004 and the ProDisc. Artificial lumbar discs are a surgical option for some patients who are being treated for degenerative disc disease or other related spinal conditions. These links provides more information about the artificial lumbar disc - (article one and article two).

Blogger question: Does this work for someone who has had a fusion done 10 years ago?

The answer to this is no. When a spinal fusion is performed, two bones are “fused” together; meaning that they are attached. In that this procedure is done with the goal of a permanency – it can not really be undone to have cervical arthroplasty performed. 

In blog discussions about the cervical artificial disc, specifically the Bryan Cervical Disc, it was announced that this disc has now received FDA-approval.  One key advantage of cervical arthroplasty and the Bryan Cervical Disc is that patients maintain their natural neck motion as compared to a spinal fusion. (Spinal fusion is the current standard spine surgical treatment for degenerative disc disease.)  

A study that I participated in and co-authored, specifically evaluated the patient’s motion – comparing post-operative neck motion. Patients who received the Bryan Cervical Disc in cervical arthroplasty were compared to those that underwent a spinal fusion and anterior discectomy. 

In a prior blog, the recent FDA-approval of the Bryan Cervical Disc ™ was announced. One of the advantages of this device and cervical arthroplasty, as a spine surgical treatment for degenerative disc disease, is that patients can return to work and their normal activities in a relatively short period of time. Generally, this time period is quicker when compared to a spinal fusion – which is the current standard spine surgical treatment to this newer procedure and technology. At this time, spinal fusion is the standard surgical treatment.

A study recently published in Neurosurgery, concluded that patients that underwent cervical arthroplasty returned to work on average about three months sooner than those patients that underwent a spinal fusion and cervical discectomy. The patients who received the cervical artificial disc returned to work in a median time frame of 101 days following their spine surgery (cervical arthroplasty) as compared to 222 days in the group that underwent the spinal fusion and cervical discectomy.  

In a recent blog entry, Indiana Spine Group announced the FDA approval of the Bryan™ Cervical Disc. This cervical artificial disc, provides spine surgeons an alternative device for implantation when performing cervical arthroplasty.  In 2007, the Prestige Disc received FDA approval. In a recent press release, Dr. Rick Sasso stated that “The Bryan Cervical Disc more closely mimics natural spine disc movement with shock absorbing characteristics than a previously approved device.”

Indiana Spine Group is excited to announce that we are one of the providers of this latest technology. At this time, physicians with Indiana Spine Group are the only ones using the Bryan Cervical Disc in cervical arthroplasty in Indiana. 
 

Dr. Rick Sasso, a spine surgeon with Indiana Spine Group, was a principal investigator in the clinical trials for the Bryan Cervical Disc.  Additionally, Dr. Kenneth Renkens was an investigator in this trial. Dr. Renkens is a neurosurgical spine surgeon with Indiana Spine Group. 

To learn more about the Bryan Cervical Disc, click here.  
 

For more information or to schedule an appointment, call 317.228.7000 or
toll-free 866.947.7463.    

In September, Indiana Spine Group is sponsoring a continuing medical education symposium entitled “BACK TALK: Comprehensive Concepts in the Diagnosis and Treatment of Spinal Disorders”. At this conference I will be providing a few talks – one is on spine surgery; specific to the cervical spine surgery patient. The other talk is on the future of spine care. 

During the cervical spine surgery talk, I will be discussing the cervical pathology and diagnoses indicative for spine surgery – both degenerative and traumatic. Additionally, I will discuss common cervical spine surgical procedures, their indications and expected outcomes.

In the talk about the future of spine care – I will review the latest FDA-approved technologies and treatments. Additionally, I will discuss interventional and surgical innovations that are either in development or clinical trials. Additionally, this presentation will provide highlights about the cervical artificial discs; i.e. the Prestige™ artificial disc and the Bryan™ artificial disc. 

In March, I attended and presented at the annual continuing medical education meeting of the American Association of Neurological Surgeons in Phoenix. This meeting was entitled,  The Backbone of Spinal Surgery: Evidence, Appraisal and Advocacy. At this meeting, I co-presented a special course entitled – New Developments in Arthroplasty. 

The overall objective of this course was to review the indications for cervical and lumbar arthroplasty. (Arthroplasty is the procedure that utilizes a cervical artificial disc or lumbar artificial disc – and this artificial disc is used as an alternative to spinal fusion). 

The overall course objectives were as follows:

·         Have an understanding of the indications and contraindications for arthroplasty.

·         Discuss the associated complications and management strategies for them.

·         Gain a better understanding of the biology and biomechanics of the devices.
 

In this study, patients diagnosed with cervical radiculopathy or myelopathy that required surgical intervention were randomly selected. Patients either had cervical artificial disc (Bryan artificial disc) or anterior cervical discectomy and fusion. The study then followed the patients for two-years to determine their functional outcome and radiographic results. 

In summary, this study concluded that the Bryan artificial disc replacement was a comparable surgical alternative to an anterior cervical discectomy and fusion for patients suffering with 1-level cervical disc disease. (1-level is where only one of the spinal discs is affected). Following surgery, both groups showed improvement in their functional outcomes. In respect to the patient’s range of motion, at two-years – those patients that underwent the Bryan artificial disc replacement had a greater range of motion than those that underwent the anterior cervical discectomy and fusion. This study did demonstrate that the artificial disc replacement is a comparable procedure to the spinal fusion. Further studies are underway, to determine longer term results of this investigational device.

Another study that I participated in has recently been completed, and the results published. This study compared the results of Bryan artificial disc replacement to anterior cervical fusion, two years following spine surgery. This study is entitled, Artificial Disc versus Fusion | A Prospective Randomized Study with 2-Year Follow-up on 99 Patients.  

This study evaluated 99 patients for a two-year period. Patients were from three spine surgical centers that were involved in the US FDA Investigational Trial for the Bryan artificial cervical disc. One of the centers involved in this investigational trial was Indiana Spine Group. I was honored to implant the first Bryan cervical artificial disc in the US, in May 2002.

Recently, I had the honor of being the co-chairman of an annual spine meeting hosted by the American Academy of Orthopaedic Surgeons.  The focus of this meeting was “Contemporary Techniques in Spinal Surgery 2008”.

At this meeting I gave presentations on spinal decompression and reconstruction techniques, including; ACDF, corpectomies and struts.  I also presented information that compared the cervical artificial replacement procedure with the spinal fusion.  Additionally, I was a lab instructor – which provided hands-on training to orthopaedic surgeons. A few procedures reviewed included X-Stop – a procedure which utilizes a device in spine surgery for lumbar spinal stenosis; XLIF – this is a minimally invasive spine surgery procedure used to treat back pain that is caused by degenerative disc disease. 

This past year, we have been enhancing the spine education information provided on Indiana Spine Group’s web site.  Recently, we have added a spine education video that was made on cervical artificial discs.  In this video I provide an overview of this spine surgical procedure - Cervical Artificial Disc.  To view this video on cervical artificial disc – click here.

In the recent issue of Spine, an article that I co-wrote was published. This article is entitled, Comparison of BRYAN Cervical Disc Arthoplasty with Anterior Cervical Decompression and Fusion: Clinical and Radiographic Results of a Randomized, Controlled, Clinical Trial.

This article summarizes the results of a two-year clinical research study, following spine surgical patients that either had a spinal fusion or a cervical artificial disc implanted.  In conclusion, the study showed that cervical disc arthoplasty is a viable spine surgical alternative for patients suffering from single-level cervical disc disease.  

For more information, here is the abstract to the study.

Physicians with Indiana Spine Group presented at the fall conference of the Indiana State Chiropractic Association this past weekend, on November 1 and 2. 

On Saturday Dr. Kevin Macadaeg, a minimally invasive spine specialist, spoke on minimally invasive techniques used to help manage spinal pain.  Additionally, he addressed diagnostic and therapeutic spinal injections.  Spine surgeons - Dr. Thomas Reilly, Dr. Kenneth Renkens and Dr. Rick Sasso also spoke on Saturday.  Dr. Reilly discussed when spine surgery is a potential treatment option.  Dr. Renkens’ talk entitled “Understanding Lumbar Surgery”, focused on the lower back and reviewed spine surgery options and indications for the lumbar spine.  Additionally, he discussed the different types of lumbar fusions and their applications.  Dr. Rick Sasso focused on cervical surgery, and his talk was entitled “The ABC’s of Cervical Surgery”.  In this talk, he discussed common cervical surgical procedures; including spinal fusion and cervical artificial disc replacement. 

On Sunday, minimally invasive spine specialists Dr. Jonathan Gentile and Dr. John Arbuckle reviewed case studies of minimally invasive diagnostic and therapeutic techniques.  Spine surgeons Dr. Thomas Reilly and Dr. Paul Kraemer also reviewed case studies of surgery patients.

For more information about this conference, click here.