Talking Artificial Disc Replacement
History of Artificial Disc Replacement
Working with FDA in testing the efficacy of the procedure, Texas Back Institute was one of the pioneers in artificial disc replacement, performing the first one in March 2000 in the lumbar spine. Dr. Scott Blumenthal played an integral role in this FDA trial and has contributed extensive research and insights into artificial disc replacement.
Helping reduce the pain caused by injured or diseased discs in more than 5,000 patients has been a life-changing experience for each of these patients. Plus, these procedures and patient follow-ups have provided an extensive trove of data on the efficacy of this ground-breaking treatment. After more than 25 years, Texas Back has participated in more than 14 different FDA trials of both cervical and lumbar discs.
These longer-term studies have shown that with disc replacement spinal motion is maintained, and there is less of a chance of needing more surgery in the future.
Dr. Blumenthal Talks Artificial Disc Replacement on eHealth Radio
Recently, Dr. Blumenthal joined eHealth Radio host, Eric Michaels, to discuss this procedure.
Eric Michaels: Thanks for joining us once again here on eHealth Radio Network. This is your host, Eric Michaels. eHealth Radio gives you the most current health information, news and advice featuring some of the leading innovators in healthcare and wellness who were changing healthcare, as we know it.
For more eHealth Radio reports, we invite you to visit our main radio channel site at ehealthradionetwork.com. Joining us once again, we have Dr. Scott Blumenthal, a spine surgeon with the Texas Back Institute and the first and one of the very few surgeons in the US to devote his practice solely to the research and application of artificial disc replacement.
Today, our focus is on breakthroughs in back health, pioneering cervical disc revision surgery, and. Dr. Blumenthal will explain the surgical breakthrough, why it’s needed, and what patients can expect as an outcome. And Dr. Blumenthal, thanks for joining us once again.
Dr. Scott Blumenthal: Thank you for the invitation.
Eric Michaels: You are certainly more than welcome, and the pleasure is all ours to have you on the program. We understand that you are not only a leading spine surgeon, but the nation’s first and now one of the very few surgeons in the US to devote your practice solely to the research and application of artificial disc replacement.
Tell us what inspired you to commit this level of focus and expertise to this specialized surgery.
Dr. Scott Blumenthal: It’s kind of a monumental time because we’ve just hit the 25th anniversary of the first artificial disc done at Texas Back Institute as part of an FDA trial to make this technology available for patients in the US. And the reality is it kind of falls into two places because there are two areas in the spine where discs tend to wear out, herniate, rupture, and basically degenerate. Those are in the cervical or the neck, and the lumbar, which is the low back.
We started with the lumbar region 25 years ago. We then moved to the cervical region which we’ve been doing for about 23 years. The initial couple years were all under FDA trials, but since 2004, with the FDA approval of the first lumbar disc, it’s now pretty much available for anybody who would otherwise qualify. Before this, those patients who would otherwise qualify were told by other surgeons that they were only a candidate for a fusion procedure.
Most of those patients would, in fact, be candidates for disc replacement, and that’s how we’ve built our practice at the Center for Disc Replacement, Texas Back Institute.
Eric Michaels: Phenomenal, and thanks for giving us some background on that. We appreciate it. Now backtracking with an educationally focused question, can you explain to us the importance of the cervical disc and its role in overall health and mobility for the spine?
Dr. Scott Blumenthal: There are seven cervical vertebrae found in the neck area of the spine. The neck moves in many different directions. There are certain discs, the ones in the middle mostly, that tend to experience most of the stress. Those are the ones that we had tend to have problems with as we get older.
And the most common diagnosis in the cervical spine that could require a surgery would be what’s called a “herniated disc” in the neck, with the symptoms causing mostly neck and arm pain. This is not uncommon. Most of us have either had issues like that or know friends or relatives that have, and up until the last couple decades, the only option was a fusion, which restricts motion and tends to transmit stress to the other levels and wear those other levels are quicker.
The cervical artificial disc was developed to preserve motion, and in fact, the long-term research has shown the chance for needing further surgery is about a third to a fourth the chance compared to a fusion, and that is a huge game changer.
Eric Michaels: I have no doubt that the listers can appreciate game changing information and procedures when it comes to your spine, no doubt.
Now explain how the cervical disc can be damaged in the first place, and what are the conditions in which an artificial disc replacement surgery is necessary?
Dr. Scott Blumenthal: The most common reason, unfortunately, for disc problems is simply age-related wear and tear. Much like every joint has a lifespan, if you live long enough, you’re going to wear out your hip joint or your knee joint.
The cervical discs tend to take the wear and tear of everyday life, and a person can have an injury that can cause a herniated disc, but that’s less common than just wear and tear. It may be caused by a trivial motion such as looking quickly over your shoulder. This can initiate neck pain or the neck and arm pain that can signal a problem with that disc.
While the initial attempt at treatment is usually non-surgical or conservative, meaning medication, rest, physical therapy, or maybe a steroid injection, ultimately when that fails, the treatment is surgical, and that’s where the artificial disc can remove that damaged disc, get the pressure off the nerve, but also preserve the motion and hopefully decrease the chance of the other discs wearing out too quickly.
Eric Michaels: We appreciate your response and for joining us. Once again, we’re speaking with Dr. Scott Blumenthal, a spine surgeon with the Texas Back Institute, and also serves as a clinical assistant professor of orthopedic surgery at the University of Texas Southwestern in Dallas, and is an ongoing contributor to the first nonprofit foundation created for arthroplasty patients here on eHealth Radio’s, health news and spinal health channels, a part of the eHealth radio network.
Now, continuing in a broader sense, can you share some of the trends in spinal injury and surgical need you are seeing? And in addition, can you tell us why you’re seeing an uptick in this type of surgery?
Dr. Scott Blumenthal: The cervical artificial disc procedure has really expanded across the US. It’s not just in centers of excellence, but many surgeons who are used to doing that type of surgery, which was previously the fusion surgery, are performing this procedure. Now we’ve learned from our hip and knee colleagues that there is a certain percentage of discs that will either wear out, or for some other reason, need to be revised.
In the case of hip and knee replacement, it’s up to 15% over a 10-to-20-year period. We did some retrospective research at the Center for Disc Replacement at TBI and found that the revision rate in the cervical spine is about a percent and a half, which really compares favorably to the hip and knee.
What research is suggesting is this. There are hundreds of thousands of these being done, and if 1 to 1.5% need to be revised, then that technique now needs to be established. We first started seeing this at our institute maybe five to seven years ago, and we’ve established now some treatment pathways to determine when a disc needs to be revised, and how it needs to be revised. There are really two options, either to a fusion or to another disc.
We’ve honed down the technique and have been lecturing all over the US and the world now on our algorithm for treatment. This is because not only are we seeing some from our own busy center, but we’ve become a referral site for other surgeons whose patients need further treatment. We’ve gained that expertise because we’ve got the volume and have seen them first. We’ve also published on it and have now been teaching it all over the world at this point.
It’s kind of the next echelon, but we’ve learned from our hip and knee colleagues, if you are going to do arthroplasty, you really need to have an idea when those small percent do need some additional treatment or surgery.
Eric Michaels: Finally, Dr. Blumenthal, are there any common-sense recommendations that you could share to keep individuals healthy and free of spinal injury? I’m sure the listeners would appreciate that.
Dr. Scott Blumenthal: With disc issues, there’s always nature and nurture to consider. Certainly, if you are a linebacker in the NFL, you’re putting your cervical discs at risk because you’re using your head as a battering ram. Although they’re teaching techniques to avoid that now, there’s always a component of your genetic component, certainly these things do tend to have a genetic component, so some people are more prone to disc problems earlier.
When patients ask, “why is my disc wearing out and I’m younger?” It’s the same thing as why do some people get gray hair in their thirties and others don’t get them until their sixties? It’s just kind of your nature. It’s your genetics.
For basic spine health, the most important thing to do is to stay healthy. Particularly for the lumbar discs, it is important to maintain an ideal body weight for yourself, to exercise regularly, and practice good nutrition. Good nutrition and exercise help strengthen the muscles around the spine. We know that a healthy intake of protein is good, so we need good protein in our diet, we need exercise, and we need optimal weight management.
Eric Michaels: Once again, we thank you for joining us once again for all the insight, advice, and information shared and, also your common-sense recommendations. Much appreciated. If listeners wanted to get information on the Texas Back Institute online, where’s the best place to get further information?
Dr. Scott Blumenthal: We have a website, Center for Disc Replacement at Texas Back Institute. We also have a Texas Back Institute website where you can see these surgeries on YouTube. Recently, I downloaded a video of revision cervical disc surgery, and this is the first video on this subject at this point.
Eric Michaels: And as always, listeners, you can refer to the show notes of this broadcast to have access to this link at any time for your convenience.
Again, Dr. Blumenthal, all the best and thanks again for joining us here today on eHealth Radio. Again, we’ve been speaking with Dr. Scott Blumenthal, a spine surgeon with the Texas Back Institute, and serves as a clinical assistant professor of orthopedic surgery at the University of Texas Southwestern in Dallas. He is an ongoing contributor to the first non-profit foundation created for arthroplasty patients and for all the details, once again, visit texasback.com.
This has been your host, Eric Michaels, thanking you for your continued support of the eHealth Radio Network. Join us again soon for another episode that will help further expand your knowledge of those things that are important to your health and wellness.
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