Traditionally, spinal fusion surgery (rather than artificial disc surgery) has been the treatment of choice for individuals who have not found pain relief for chronic back pain through conservative treatment (such as physical therapy, medication, manual manipulation, etc.), and have remained disabled from their occupation, from their activities of daily living, or simply from enjoying a relatively pain-free, day-to-day existence. An interesting alternative to spinal fusion is the procedure of artificial disc replacement. Spinal fusion alleviates pain by immobilising the painful segment, thereby eliminating discogenic pain. Disc replacement is an attractive option because it eliminates the painful disc but maintains relative motion within the spinal segment. What follows is a review of selected internet sites providing up-to-date information for both orthopaedic surgeons and their patients.
www.nice.org.uk/ipcat.aspx?o=56892
The National Institute for Clinical Excellence (NICE) has issued full guidance to the NHS in England, Scotland and Wales on prosthetic intervertebral disc replacement. This is an excellent site for both orthopaedic surgeons as well as patients and provides several documents in PDF describing indications, a summary of the procedure, a literature review and specialist advisors’ opinions. The site also provides an excellent document for patients considering disc replacement surgery in which it discusses the possible risks associated with disc replacement surgery.****
www.spineuniverse.com/displayarticle.php/article1682.html
This is an excellent introductory article to disc replacement. The site provides a brief outline of the anatomy of the intervertebral disc as well as the pathophysiology of degenerate disc disease. Treatment options are discussed and examples of currently available prostheses are shown as well as some current indications for disc replacement surgery are provided. The site also mentions current clinical trials conducted and provides god references for further reading.***
http://www.spine-health.com/research/discupdate/artificial/artificial01.html
Spine-health.com was started in August 1999 and provides relevant medical information and education for adults with back and neck pain. The site is again targeted at a patient audience and provides a brief history of the evolution of spine surgery and the pathophysiology of disc-generated back pain. The site provides a review of a range of new devices related to lumbar disc replacement and chronic back pain relief, including: disc nucleus replacement, total disc replacement and facet technologies. This website is an excellent source of information and is well laid out and easy to read.****
www.spineuniversity.com/charite_disc/charite_disc.html
This article provides an overview of disc replacement with the CHARITÉTMTM Artificial Disc. It is an excellent source of information directed towards patients but also contains a concise and brief description of disc replacement surgery and discusses: (i) the anatomy of the lumbar spine; (ii) rationale of a replacement disc; (iii) preparations for the operation by the patient; (iv) descriptions of the disc and the surgery; (v) potential complications of disc replacement surgery; (vi) patient care after surgery; and (vii) rehabilitation.***
www.lni.wa.gov/ClaimsIns/Files/OMD/ArtificialDiscReplacement20041101.pdf
This website is run by the Washington State Department of Labor and Industries (L&I) and contains a section on medical treatment guidelines which are published by L&I as an educational tool for medical providers. This site provides a document in PDF describing the indications and criteria for disc replacement surgery and evaluates the current literature on artificial disc replacement. The various prosthesis studies are described and the document provides an excellent source for references.***