BackWords

Sarah W. sent me this question by email:

“I have had back pain for more than 20 years. When I was in high school, I twisted my back playing field hockey, and it never really felt right again. In my 20s, the pain worsened, and an MRI showed that I had a herniated disc. A cousin of mine had disc replacement surgery, and has been doing really well with it. It seems like a pretty extensive procedure. Do you think it could help me?”

Sarah,

First of all, thank you for your question.

I know that having back pain be a part of your daily life can be really tough, and there are so many options out there to provide relief, it’s hard to make sense of it all.

First, let’s talk about the disc before we go over replacing it. The intravertebral disc is a small hamburger shaped capsule which lies in between two vertebra. It consists of two primary structures; the soft center called the nucleus, and the thick fibrous ring which surrounds it, called the annulus. When we are younger, the fluid in the nucleus it thinner and more flexible. As we get older, it thickens and becomes more like silly putty. The disc serves two primary functions: 1) It helps to absorb shock between the vertebra, and 2) It articulates two adjacent vertebra, so they can move freely. There are lots of ways a disc can become damaged, most commonly a disc bulge or herniation- were the annular part of the disc becomes compromised, and the outer portion of the disc becomes mis-shapen, and then encroaches into areas and onto structures which can cause pain.

Disc replacement surgery is a relatively new option for people with severe disc damage. Basically, the soft disc in between two vertebrae is removed, and replaced with a mechanical device which simulates the movement and function the disc had before it was damaged. The procedure is often used in place of a fusion, where two vertebra are fused together. There is a relatively long recovery period from this surgery, including the first few weeks of healing and physical therapy, followed by strengthening. The initial recovery period varies in length based upon the age and overall physical condition of the patient. And based upon the patients in my practice who have undergone the surgery, it can take a full year for a patient to feel ‘normal.’

There are varying statistics on the efficacy of disc replacement surgery. In my own practice, and in discussion with several other physicians, there seems to be about a 50% chance that disc replacement will make a patients pain go away.

As to whether it is appropriate for you- that would largely depend upon your specific disc injury, and a host of other factors which I cannot address without examining you and your imaging studies. I suggest you get on line, and look for surgeons in your area who are performing the procedure, and arrange a consultation. How did your cousin’s procedure go? Do you live near your cousin? Perhaps you could meet with their doctor.

I hope this information is a little helpful, and thank you so much for your question.

-Andy