Artificial Disc for Degenerative Disc Disease

45 yo with severe degenerative disc disease (DDD) of the lumbar spine continues to complain of back pain. Physical therapy, NSAIDs and opioids relieve the pain only temporary. He has had lower back pain (LBP) for 9 months.

PMH:
Negative apart from LBP due to DDD

Medications:
Aleve, Percocet

What would you do?
The patient was referred to a spine surgeon who recommended an artificial disc.

What is an artificial disc?
The Charite™ artificial disc is an alternative to spinal fusion for patients who have one diseased disc between L4 and L5 or between L5 and S1.

The artificial disc was originally developed at the CHARITÉ University Hospital in Berlin, Germany in 1980's.

Spinal fusion joins the vertebrae above and below the disc into a single immobile segment. The advantage of Charite disc placement is that patients can recover quicker and retain far more flexibility as compared to spinal fusion.

How is the surgery performed?
The placement of the artificial disk is done through an abdominal incision as opposed to the spinal fusion which requires an approach from the back.

A vascular surgeon is often present during the Charite disk placement to make sure that major vessels (aorta and vena cava) and not affected by mistake.

Who qualifies for artificial disc surgery?
- patients with diseased disc between L4 and L5 or between L5 and S1
- patients who have failed at least six months of conservative treatment

Who does not qualify for for artificial disc surgery?
- disc deterioration or instability at more than one spinal level
- osteoporosis or osteopenia

What happened?
The patient had a Charite disc placement and an uneventful recovery.

Final diagnosis:
Artificial Disc Placement for Degenerative Disc Disease

References:
Charitedisc.com
Prospective randomized study of the Charite artificial disc: data from two investigational centers. Spine J. 2004 Nov-Dec;4(6 Suppl):252S-259S
Artificial Disc Offers New Hope for Treating Back Pain. Listen to NPR story.
For Back Pain, Few Easy Answers on Surgery. Listen to NPR story.
Image source: Medgadget