Low Back Pain and Sciatica and Disk Replacement
Effect of Disk Replacement on Low Back Pain and Sciatica
A relatively new procedure, total disc replacement is now available as an alternative to spinal fusion when the cause of the injury is a degenerated disc. In the procedure, an artificial disc is used to replace the damaged disc. In theory, it offers the ability to repair the damaged portion of the spine while still maintaining the mobility of the spine. However, this new procedure remains controversial. It may be appropriate for only a very limited group of patients. Patients with multiple degenerating discs or who have had multiple failed back surgeries may not be candidates for artificial disc replacement. There is also a device to replace only the nucleus pulposus, the soft inner part of the disc. The role of these new technologies is not yet established, and long-term outcome data are lacking.
Surgery as a treatment for low back pain and sciatica should only be considered after many other, less invasive, treatments have been tried and proven unsuccessful.
Bhagia SM. Slipman CW. Nirschl M. Isaac Z. El-Abd O. Sharps LS. Garvin C. Side effects and complications after percutaneous disc decompression using coblation technology. American Journal of Physical Medicine & Rehabilitation . 85(1):6-13, 2006 Jan.
Bridwell KH. Anderson PA. Boden SD. Vaccaro AR. Wang JC. What's new in spine surgery. Journal of Bone & Joint Surgery - American Volume. 90(7):1609-19, 2008 Jul.
Cohen SP. Williams S. Kurihara C. Griffith S. Larkin TM. Nucleoplasty with or without intradiscal electrothermal therapy (IDET) as a treatment for lumbar herniated disc. Journal of Spinal Disorders & Techniques . 18 Suppl:S119-24, 2005 Feb.
Conn's Current Therapy 2001. 53rd ed. WB Saunders Company; 2001.
Pain. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.n... . Accessed October 27, 2008.
Sciatica. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00351 . Accessed October 27, 2008.
Textbook of Primary Care Medicine. 3rd ed. Mosby, Inc.; 2001.
Updated Disketomy section on 6/7/2007 according to the following study, as cited by http://www.ebscohost.com/dynamed/what.php : Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356:2245-2256.
Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA . 2006;296:2441–50.
Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA . 2006;296:2451–9.
Zindrick MR. Tzermiadianos MN. Voronov LI. Lorenz M. Hadjipavlou A. An evidence-based medicine approach in determining factors that may affect outcome in lumbar total disc replacement. Spine . 33(11):1262-9, 2008 May 15.