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It may not be a replacement procedure or alternative to fusion, since recent studies have shown that 100% of fusion patients had one or more contraindications to disc replacement. [164] [165] [166] The role of disc replacement must come from new indications not defined in today's literature or a relaxation of current contraindications. [161]
Since the disc is an avascular structure, it is an ideal environment for the growth of anaerobic bacteria. Propionibacterium acnes bacteria secrete propionic acid, which can dissolve fatty bone marrow and bone. Therefore, it was hypothesized that diffusion of propionic acid from the disc into the vertebrae results in bone oedema, i.e. Modic ...
Surgery is considered when symptoms persist after attempting conservative treatment. It is estimated 10-20 percent of individuals with low back pain fail to improve with conservative measures. [22] A discectomy is a common procedure used to alleviate the radiating pain and neurological symptoms associated with a herniated disc. [23]
Disc herniation can occur in any disc in the spine, but the two most common forms are lumbar disc herniation and cervical disc herniation. The former is the most common, causing low back pain (lumbago) and often leg pain as well, in which case it is commonly referred to as sciatica .
The second disc replacement to achieve wide clinical use was the prodisc total disc replacement; it continues to have worldwide use today. Designed by French orthopedic spine surgeon Thiery Marnay, M.D., in the late 1980s, early implantations of the prodisc device began in 1990, with a 7-11 year follow-up published in 2005.
The intervertebral disc is removed and replaced with a small plug of bone or other graft substitute, along with a height restoration device to un-impinge nerves, and in time, the vertebrae will fuse together. Intervertebral disc arthroplasty: also called Artificial Disc Replacement (ADR), or Total Disc Replacement (TDR), is a type of arthroplasty.
When a disc degenerates as a result of injury or disease, the makeup of a disc changes: blood vessels and nerves may grow into its interior and/or herniated disc material can push directly on a nerve root. [39] Any of these changes may result in back pain. [39]
In most cases of herniated disks and stenosis, rest, injections or surgery have similar general pain-resolution outcomes on average after one year. In the United States , acute low back pain is the fifth most common reason for physician visits and causes 40% of missed work days. [ 8 ]
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