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Artificial disc replacement as good or better than spinal fusion surgery
Date:2/27/2009

A disc in the spine is similar to a jelly donut, with a squishy center surrounded by a tough outer portion. It functions like a shock absorber between the vertebrae. When a disc ruptures, or becomes herniated, the squishy disc tissue can spread into the spinal canal and press against nerves, causing numbness, weakness or pain.

For years, the surgery to treat cervical disc disease relieved pressure by removing the offending disc and then fusing the bones of the spine together. Surgery to implant an artificial disc also removes the damaged disc, but instead of using metal rods, screws and bone grafts to fuse bones together, the surgeon replaces the disc with an implant.

Patients in the study were randomly assigned to receive either the BRYAN Cervical Disc or standard fusion surgery. Ultimately, 242 received the artificial disc, and 221 had spinal fusion. Improvement following surgery was measured with a tool called the neck disability index (NDI). Two years post surgery, patients in both groups had improved NDI scores. Both had less neck and arm pain and were less likely to experience numbness. Overall, the surgery was rated as successful in 83 percent of the patients who received artificial discs and 73 percent of those who had fusion surgery (230 vs. 194). Part of that difference, Riew says, can be explained by better motion in the neck for those who had artificial discs implanted.

He says the neck is always slightly restricted following spinal fusion surgery. Since bones in the neck have been fused together, it is impossible to regain full range of motion. But the defect is subtle.

"Fusion adds a small amount of stress in the spine above and below the fusion site, so bone can break down a little faster than normal," Riew explains. "If the patient is a young person, then they may need another operation in 20 or 30 years. The hope with artificial cervical disc replacement is the preserved motion may protect against additional s
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Contact: Jim Dryden
jdryden@wustl.edu
314-286-0110
Washington University School of Medicine
Source:Eurekalert

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