Artificial Discs

Robert Filice, M.D. Former staff physician
 

The 11-02-2004 edition of The Wall Street Journal ran an article on Johnson and Johnson’s newly approved artificial spinal disk. Once an adequate number of surgeons is trained (it is a very technically difficult operation) the procedure will be offered as the new alternative to fusion operations in the treatment of degenerative disc disease. The manufacturer’s hope is that many chronic back pain sufferers who have been holding off on having surgery will now commit to this new procedure. Aside from the technical risks which involve an abdominal incision and the temporary exterior displacement of all the contents of the abdominal cavity, the surgery also offers all the well known risks of general anesthesia, possible damage to nerves in the operative field, local or systemic infection, and inadequate pain relief because of inappropriate misapplication of the procedure. I believe that of all the risks enumerated, this last one is the gravest.
 

When new technology arrives in this country, as long as it involves a drug or a surgical procedure, it is widely and enthusiastically promoted in the national media. This naturally creates excitement among those affected by the condition in question. In this case, the millions of people with chronic low back pain will now be going to their doctor and asking whether this procedure might help them. The danger lies in the fact that the operation will be applied over-liberally for pain conditions in which it is unlikely to help. This will subject many individuals to the risks (including death) of the procedure without giving them a reasonable chance of success. The history of orthopedic surgery is full of procedures that were inappropriately applied for the wrong conditions. Strain of the spinal ligaments, sacroiliac strain, and iliolumbar ligament strain are a few of the common conditions that cause chronic back pain that may be misdiagnosed as arising from degenerated disks showing up on MRI. Individuals with chronic pain mistakenly thought to be arising from the degenerative disks will inappropriately be subjected to the risks of this surgery, and will not benefit at all. Any kind of surgery is unlikely to help patients with chronic degenerative disc disease. Since the process is systemic, and other spinal segments are also usually affected, how is spinal disk replacement supposed to “change the natural history of the disease” as one physician supporter so enthusiastically is quoted a saying in the Journal article? Add to that the fact the X-ray and MRI findings often fail to correlate with the patient’s pain, and you have a recipe for disaster.

 

 

 

My point is to warn my readers that there’s a new phenomenon out there in the orthopedic world…spinal disk replacement. The mentality is exactly the same as hip and knee replacement surgeries: ie, don’t do anything about the cause, wait for the condition to get unbearable, and then replace the “broken” part. This may work for cars, but I can assure you it is a bad approach for the human body. Remember that orthopedists rarely examine the lower back in such a way as to reproduce the patient’s pain. As a result, they rely excessively and inappropriately on scans and X-rays, and therefore make a lot of mistakes in diagnosis and treatment. If the mistaken treatment is innocuous, nothing is lost. But when the offered treatment is risky, like surgery, a lot of innocent people may get hurt. What to do? In any chronic musculoskeletal condition, but especially in chronic low back case, see a Prolotherapy doctor before agreeing to any tests or invasive procedures (including surgery, epidurals, and steroid injections). Prolotherapy favorably mobilizes the body’s own healing mechanisms, and with proper diagnosis successfully addresses back pain at its source, and without surgery.