The Risks and Challenges of Artificial Disc in the Low Back

While there are risks of any surgery, one should be especially cautious when it comes to operating on the spine. If you are faced with a back issue, no matter how simple or complex the issue may be, it is smart to get a second opinion before surgery if possible.

Spinal fusion is one such surgery in which one would benefit from an second opinion from a physician that specializes in the most advance artificial disc techniques currently available. Artificial disc replacement is an alternative to spinal fusion that can help maintain natural motion of the spine, reducing the risk of adjacent segment disease.

Artificial Disc Replacement for the neck area, referred to as the cervical spine, has been used successfully in the United States for over 15 years, beginning with the Charité® cervical disc released in 2004. More recently, artificial discs have become available for treating disc problems in the lower back, called the lumbar spine.

Increased Force on the Lumbar Spine

While the anatomy of the cervical (neck) and lumbar (low back) vertebrae and discs may be similar, the stresses experienced by the two spinal areas are vastly different. The cervical spine only supports the weight of the head. Conversely, the lumbar spine must support the weight of the head, arms and complete torso. This creates challenges when designing an artificial disc that can sustain the forces imposed on it during everyday activities and more strenuous activities like sports of exercising.

Shock Absorption

Natural discs not only function as the lubricant that allow the spine to rotate and bend, but they are also important for absorbing the shock of simply activities like walking or running. This shock absorption quality is especially important in the lumbar area.

Current artificial disc technology is able to maintain the natural bending and rotating function of the healthy spine, as compared to spinal fusion. However, current FDA approved technology does not yet account for the shock absorption properties found in the natural discs. Shock absorbing disc are on the horizon and will likely be seen in the near future.

Accessing the Lumbar Spine

Another challenge relating the lumbar artificial disc replacement is the difficulty in accessing the lumbar spine to perform the surgery. To install most current artificial discs approved in the United States, the surgeon must access the vertebrae from the front. This is not an issue for cervical (neck) artificial disc replacement in which the incision is made near the throat, only a short distance away from the target vertebrae.

Lumbar artificial disc, however, is more complicated, requiring an incision be made in the lower abdomen. The surgeon much then navigated through the abdominal area to reach the front of the spine. Generally speaking, many spine surgeons believe access to the cervical discs can be easier than the lumbar discs. This is also the case for revision surgery if the artificial disc wears down and needs to be updating, requiring an additional surgery.

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