New artificial discs mean less pain, fewer problems for back patients

Published: Sunday, April 24, 2005 9:18 p.m. MDT
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The Food and Drug Administration recently approved an artificial disc for back surgery, and shortly after, a Cottonwood Hospital surgeon implanted one in a patient.

While the disc, developed by CHARITE, is the first to receive FDA approval, it's by no means unique. There are several more right behind it in the pipeline, expected to get approval in the next couple of years, with still more likely to follow. And it's not the first time such a disc has been used in a Utah operating room. Others have been implanted in Utahns at various hospitals as part of the clinical testing required to get FDA approval.

But the arrival of artificial discs on the market marks a very significant point in the often-slow evolution of back surgery.

Artificial discs will be especially helpful to patients who in the past were told to live with their pain as long as possible, said Dr. Junius "Judd" Clawson, a spine surgeon at the Intermountain Spine Institute at Cottonwood, who led the team implanting the high-tech artificial disc in Cynthia Johnsen two weeks ago. Before coming to Utah, Clawson implanted artificial discs as part of clinical trials while working in Texas, so he was very familiar with them, he said.

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Johnsen, 26, was injured in a car accident four years ago. Since then, she's been unable to sit for long periods at work and was equally miserable if she had to stand for more than a few minutes, leaving her with few pain-free options. She eventually exhausted all the benefits of more conservative nonsurgical treatment and had to decide on either a spinal fusion or an artificial disc.

Spine surgeons typically try to avoid back surgeries in young patients. Those in their 20s, 30s and 40s are encouraged to put off having their spine fused as long as possible because fusion locks the impaired vertebrae to those on either side so they are supported but inflexible. Removing the motion typically removes the pain, but it brings with it less-desirable effects as well.

It's also common for adjacent sections of spine to take up some of the function that has been lost, so they get overworked and degenerate, leading to more pain in other places.

"When someone is in his 20s, you don't want to start down that road (of fusion), so you have to live with it" in part to avoid or delay the adjacent wear-and-tear, Clawson said. "We think we can do these (artificial discs) and not have those consequences."

The artificial disc resembles a high-tech sandwich cookie, with movable high-density plastic centered between two metal endplates.

The advantages are apparent, Clawson said, including earlier return to work, less rehab time, less pain initially following surgery. There were no significant differences in complications. By three months, studies show the discs are roughly equivalent to a fusion in terms of pain control.

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