Conservative Non-Surgical Therapy
Historically, conservative treatment options for Discogenic Low Back Pain (dLBP) have included physical therapy, pharmaceutical pain management (nonsteroidal anti-inflammatory drugs and/or a stronger anti-inflammatory), intradiscal injections, and lifestyle changes such as weight loss. While conservative therapies have shown efficacy, the pharmaceutical approach is not without risk, with some patients experiencing side effects, tolerance, and dependency. In addition, some patients may not respond to conservative care, thus a surgeon might raise the issue of surgical options.
While spinal fusion and total disc replacement (TDR) have been widely used as surgical treatment options for symptomatic disc degeneration, they do come with drawbacks. Fusion carries with it restricted mobility, while TDR requires the removal of the entire disc. In addition, these options are typically used during the latter stages of the disease when much of the damage has been done.
Spinal Stabilization Technologies™ offers a potentially more flexible, less invasive alternative surgical treatment: The PerQdisc™ Nucleus Replacement System.
Surgical Treatment Options
Spinal Fusion and Total Disc Replacement have been surgical treatment options for latter stages of symptomatic Disc Degeneration. Spinal Stabilization Technologies™ introduces a potentially less invasive alternative surgical treatment: The PerQdisc™ Nucleus Replacement System.
PerQdisc Nucleus Replacement
Nucleus replacement is a surgical procedure that limits tissue disruption to the intervertebral disc. Unlike fusion techniques, and TDR procedures that require aggressive resection of all or a portion of the disc, the PerQdisc surgical procedure aims to preserve the annulus fibrosus (AF) and cartilaginous endplates.
The PerQdisc Nucleus Replacement offers an anatomical and biomechanical, motion-preserving, surgical alternative to fusion and total disc replacement. The PerQdisc replaces the physical space of the nucleus, in an effort to recreate physiological motion, and redistribute the weight bearing forces and mechanical properties of the disc in a more natural fashion.
The PerQdisc is designed to treat dLBP by removing the damaged nucleus tissue while the nucleus replacement implant supports the annulus fibers and nearby tissue. The PerQdisc surgical technique requires a small dilation into the annulus fibrosus, which facilitates access and resection of the nucleus, allowing for a focused area of attention with minimal damage to surrounding tissue.
The PerQdisc’s innovative technology provides a patient-specific, form-fitting, custom implant, unique to each individual patient. (See figure 1.)
Figure 1. (Click image to enlarge.)
Spinal Fusion is a surgical procedure where two or more of the vertebrae of the spine are joined together using different combinations of implants and hardware. There are several varied surgical techniques, and devices that may be used to perform a spinal fusion. The goal is to restrict movement and ultimately relieve pain, inflammation and irritation by preventing abnormal motion in the degenerated disc. A controversial issue with spinal fusion is that it may result in adjacent level disease due to increased stress and motion in the segments above and below the fusion level.
A Total Disc Replacement (TDR) is an alternative to fusion surgery. A TDR surgery involves removing the intervertebral disc and replacing it with an articulating device that is intended to allow for movement in the affected segment. The goals of motion preserving devices include pain relief and a decrease in the incidence of adjacent segment degeneration. Although a TDR is designed to preserve motion, total removal of the disc is required, meaning that the resulting movements do not typically recreate the patient’s native physiological motion. Also problematic is that there are limited sizing options available.