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Q: Lower Back Pain ( Answered,   0 Comments )
Question  
Subject: Lower Back Pain
Category: Health > Conditions and Diseases
Asked by: knight25-ga
List Price: $11.00
Posted: 16 Oct 2002 11:21 PDT
Expires: 15 Nov 2002 10:21 PST
Question ID: 77355
Which are the best non-biased,most reliable,medical professional
reviewed, websites on lower back pain and its treatment,including back
surgery?  How does lower back spinal fusion surgery compare to
artificial disk placement surgery?
Answer  
Subject: Re: Lower Back Pain
Answered By: angy-ga on 16 Oct 2002 23:30 PDT
 
Hi, Knight25 !

There a few specialised sites you might like to look at.

Spine Universe has an in depth discussion of treatment options by
Kevin T Foley M.D. at:

http://www.spineuniverse.com/displayarticle.php/article510.html

and an excellent article on artificial disc replacement by Howard S.
An, M.D. Orthopaedic Surgeon Rush-Presbyterian St. Luke's Medical
Center Chicago, IL, USA and Kristen Karl Juarez, RN, MSN Clinical
Nurse Specialist Rush Presbyterian-St. Luke's Medical Center Chicago,
IL, USA at:

http://www.spineuniverse.com/displayarticle.php/article1671.html

They write:

"...However, if surgery is indicated the surgical treatment of choice
has traditionally consisted of a lumbar spinal fusion. Unfortunately,
there are a number of drawbacks to undergoing a spinal fusion. First,
the ability of the bone to heal or "fuse" varies. The average success
rate of a lumbar spinal fusion is approximately 75%-80%. Failure of
the fusion to heal may be associated with continued symptoms. Second,
a spinal fusion at one or more levels will cause stiffness and
decreased motion of the spine. Third, having a spinal fusion at one or
more levels will cause more stress to be transferred to adjacent
levels. The problem with the transferred stress is that it may cause
new problems to develop at the other levels, which may also lead to
additional back surgery.
For these reasons, neurosurgeons and orthopedic surgeons have engaged
in research to offer an alternative to lumbar spinal fusion surgery.
One promising area of research includes the development of an
artificial spinal disc. In order to better appreciate the advantages
and disadvantages of artificial spinal disc replacement, it is
important to have a basic understanding of normal spinal anatomy,
including the function of the spinal discs."

They go on to describe the anatomy and function. Then they say:

"Currently, artificial disc replacement is considered experimental and
is not approved by the Food and Drug Administration (FDA). Most of the
research that has been conducted on artificial discs has been carried
out in Europe. Different models have been developed, but the most
widely used and known artificial disc is the LINK SB Charite III
prosthesis made by Waldemar Link GmbH & Company, Hamburg, Germany. The
model consists of two metal metallic plates that have teeth to anchor
the implant between the bones or vertebral bodies. Between the two
plates is a rubber core made up of polyethylene that allows for motion
(See Figure 1). A metal ring surrounds the outside of the rubber core
so that it can be located on x-ray (See Figure 2).
In order to avoid complications that may arise from artificial disc
replacement surgery, careful selection of patients by the surgeon is
critical. At present, it is thought that the best candidates for
spinal disc replacement are adults with a one level symptomatic
degenerative disc. Patients whose bone may not be as strong due to
aging, or some other bone disorder, may develop problems if the
implant settles into the "soft" bone. Therefore, these individuals are
not considered optimal candidates for this type of procedure."

There are clear illustrations of both the metal and PDN implants, and
links to further articles including one on qualifying for the
artificial disc trials at:

http://www.spineuniverse.com/displayarticle.php/article1678.html

If you live in the US it might be worth while your following that up,
if your doctor approves. There are further articles on the discs at
Spine Univers including one at:

http://www.spineuniverse.com/displayarticle.php/article1520.html

and a video at:

http://www.spineuniverse.com/displayarticle.php/article1342.html


Spine Health has thorough articles and explains the treatment using
fusion and bone grafts.

http://www.spine-health.com/

(Don't leave out the hyphen or you will be at the sites of a holistic
health centre.)

Their articles seem authoritative, clear and unbiased. They have a
good breakdown of what is involved in the various surgical options, 
by Peter F. Ullrich, Jr., MD, updated in 2001. Click on "Surgical
treatments" on the home page menu, then follow the links on the left
for lumbar spine surgery. It includes a discussion of various bone
graft substitutes for spinal fusion by Scott D. Boden, M.D. He writes,
in Feb. 2001:

"Development of bone graft substitutes is currently one of the hottest
areas of interest in the spine community - for patients considering
spine fusion, spine surgeons and industry.
Judging by the amount of resources being devoted to the task of
developing a sage and effective bone graft substitute, it is probably
just a matter of time before we will no longer have to harvest a
patient's own bone as part of a fusion procedure."

http://www.spine-health.com/topics/surg/bone/bone03.html

In general they say:

"Lumbar fusion (or spinal fusion) for back pain caused by degenerative
disc disease is an option for patients who:
Have failed to get better after extensive conservative treatment (such
as physical therapy, medications)
Continue to have back pain that limits their ability to function 
Have received a diagnosis that a specific disc space is the pain
generator.
.....
Surgeons and researchers span the spectrum in terms of their beliefs
as to how useful fusion surgery is and when and how it should be
performed.
Some spine surgeons do not believe fusion surgery is at all useful and
is never indicated for the treatment of lumbar degenerative disc
disease.
Some spine surgeons are very willing to offer patients a fusion
procedure, and some surgeons are even willing to do multiple level
fusions.
As with most things in medicine, the truth lies somewhere in between
the two far ends of the spectrum of beliefs."

This site also has details of how to take part in clinical trials of a
new putty for use in spinal fusions, at:

http://www.spine-health.com/research/trials/putty/putty01.html


There are also general medical sites with resources on the subject:

MEDLINE is "the National Library of Medicine's database of references
to more than 11 million articles published in 4300 biomedical
journals. When you search MEDLINE:
You will find information about articles on your topic (the author,
title of the article, name of the journal, date published, page
numbers)
Many of the listings also have short summaries of the article
(abstracts)
Sometimes you will find a link to the full article 
Please note that most of the articles you will find listed in MEDLINE
are written for health professionals. Articles are for educational use
only and are not intended to replace advice from a health
professional."

The search tool for their database is at:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

A search under "spinal fusion" turns up 388 articles of both
specialist and general interest. There is also a mention of a recent
news item titled: "Bone growth protein expected to replace spinal
fusion surgery." So this is something you may like to ask your doctor
about.


The Department of Health and Human Services has a Combined Health
Information Database at:

http://chid.nih.gov/

A search under "Back pain spinal fusion" produced several articles
available for purchase with their abstracts. One by NASS (the North
American Spine Society) is summed up in part as follows:

"A surgeon may consider spinal fusion to treat a fractured vertebrae,
correct certain types of spinal deformities such as scoliosis,
eliminate pain from painful spinal motion, treat instability, and
treat some cervical disc herniations. However, treatment of back or
neck pain alone by spinal fusion is somewhat controversial because it
is difficult to locate the source of pain in many patients. Surgical
approaches and methods to fuse the spine all involve placement of a
bone graft between the vertebrae. Fusion may or may not involve the
use of hardware such as plates, screws, and cages. Regardless of
whether or not hardware is used, bone or bone substitutes must be used
to get the vertebrae to fuse together. Pain and recovery following
spinal fusion are generally greater than with other types of spinal
surgeries."

http://chid.nih.gov/netacgi/nph-brs?d=CHID&op4=and&s4=back+pain+spinal+fusion&l=20&Sect1=LINK&Sect2=IMAGE&Sect3=HITOFF&p=1&u=/simple/simple.html&r=3&f=G


Another booklet by J. Reynolds et al is outlined at:

http://chid.nih.gov/netacgi/nph-brs?d=CHID&op4=and&s4=back+pain+spinal+fusion&l=20&Sect1=LINK&Sect2=IMAGE&Sect3=HITOFF&p=1&u=/simple/simple.html&r=9&f=G

"The booklet describes the anatomy of a normal spine and explains why
fusing bones in the spine may help relieve pain. This is followed by a
discussion of grafting bone into the spine, using bone from a bone
bank or from the patient. "


Finally:

Med Help International is "....dedicated to helping patients find the
highest quality medical information in the world today. We offer
patients the tools necessary to make informed treatment decisions
within the short time lines dictated by their illness or disease.
Our "Virtual Medical Center for Patients" is a collection of
information and professional medical support gathered from the best
medical organizations and experts in the world. It is composed of:
A comprehensive, Consumer Health Information Library (utilizing the
Med Help Search Engine )
Question & Answer Medical Specialty Forums, which give patients the
ability to ask questions to leading physicians and healthcare
professionals
A Patient-to-Patient Network 
Daily Medical and Health News "

Questions to the "Ask the Doctor" Forums here are answered by working
health professionals from such organisations as the Cleveland Clinic
or the Henry Ford Health Systems. Some answers are more helpful than
others.

http://www.medhelp.org/index.htm


Obviously the decision as to which way to go has to be taken by you
(or the patient) in consultation with a doctor. But techniques in both
these alternatives seem to be improving rapidly. The disk replacements
seem to me to have the advantage of leaving some movement in the area,
but that is purely a personal opinion. Thank you for an interesting
question, and good luck.



Search terms:

"back pain treatment".
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