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There are many newer technologies in development, which can be highly successful in the appropriate patient. The early development of the artificial disc goes back almost 40 years, shortly after Sir John Charnley invented the total hip arthroplasty or replacement. The newer generations of artificial discs for the spine were developed in the late 1980s in Europe with entry into the US in the 1990s. There now are several FDA approved arthroplasties for the neck as well as low back, with many more currently in FDA trials.
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Cervical disc replacement drawing |
One important fact to understand is that not all back pain is cured by fusion or disc arthroplasty. The sources of the pain are very complex and may involve multiple factors. If the source of the pain is from the disc itself, a posterior fusion, which should immobilize the two involved vertebrae, is not always successful in pain relief, probably due to microscopic motion in the anterior part of the spine at the disc. Also if most of the pain generators are in the facet joints, doing an anterior disc replacement will also not always relieve the pain. Sometimes even with sophisticated CT, MRI, bone scan, discography, and diagnostic injections the exact source of the pain cannot be determined. In those cases, it is best not to do anything surgical and treat the patient conservatively with pain management therapies.
In well screened patients with appropriate indications, disc arthroplasty surgery in the cervical or lumbar spine can be a great benefit. The advantage of disc replacement is that motion is partially or completely maintained. Theoretically preserving motion and possibly preventing early degeneration of adjacent discs above and below the surgical disc. Theoretically if the arthroplasty should fail, due to repetitive stresses and shear forces, it can be replaced or the joint space fused with traditional bone graft. Again depending on the pain mediators, not all fusions may relieve the pain symptoms.
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