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  Disk Replacment  
 
  Disk replacement (called “anthroplasty”) is becoming available in the United States with the potential of significantly expanding the options available to sufferers of severe back pain. Following more than a decade of use in Europe, several artificial disks are in FDA trial (one has been approved at the time of this writing.)

Disk anthroplasty is generally considered in patients with a condition called “Mechanical Low Back Pain” when the pain is not related to the spinal nerve and there is degeneration of intervertebral disk. The traditional approach to this condition is to remove motion at the degenerated disk in the hope of removing or reducing pain. Called a “fusion” operation, the results for long-term pain elimination have been mixed. A common problem with fusion operations is the potential for creating new problems at disks adjacent to the treated disk called “Adjacent Level Disease.”

One way of thinking of this is considering that the spine provides flexibility similar to a green twig. When you move your hands up a twig, effectively shortening it, greater stress is placed on the remaining length of twig, and the risk of it breaking increases. Similarly, a fusion operation concentrates stresses on the remaining disks that were not fused. This has been a recognized problem with fusion operations for a long time and therefore has been considered a last option for most patients.

Disk replacement is an exciting new option. The goal of the disk anthroplasty procedure is to maintain motion at the treated level by replacing rather than fusing the disk. Intuitively, this would provide pain relief and reduce the occurrence of “Adjacent Level Disease.” (Research is underway to document this expected outcome.)

The idea of disk replacement is exciting to both the surgeon and the patient. But, caution is the best position to take. Only a properly educated and trained spinal surgeon can make appropriate recommendations whether a disk replacement is in the patient’s best interest. The National Spine Foundation’s goal is to participate in and support continued research on the outcomes of disk arthroplasty and the development of new devices and techniques.

It is also important to note that disk anthroplasty is a technically demanding procedure that involves changes to many surgeons’ operative practices. A goal of the National Spine Foundation is to become a center for training surgeons on disk anthroplasty.
 
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