Addressing Misinformation for Artificial Disc Replacement Surgery

Meanwhile, ADR continues to make medical history as a primary solution for patients suffering from painful degenerative disc disease. 


I can understand when someone is reluctant to recommend something that they do not understand. But I am surprised when physicians do not reach out to learn more about the benefits of medical technology such as artificial disc replacement (ADR) surgery. Especially when the clinical data is so compelling.


Data from multiple clinical studies is unambiguous: artificial disc replacement offers far superior patient outcomes than procedures like spinal fusion. I was either a principal investigator or co-participated in many of the most recent clinical studies of ADR in the last 15 years. In one of them, published a few years ago in the Journal of Neurosurgery, my colleagues and I concluded a 24-month study that compared cervical spinal fusion with two-level cervical ADR surgery using a popular artificial disc called the Prestige LP.


This study involved nearly 400 patients. Half underwent two-level cervical disc replacement, and the others were treated with anterior cervical discectomy and fusion (ACDF). We focused our attention on the overall success of the respective procedures based on specific criteria like patient pain complaints, post-operative revisions, and retained flexibility and movement. The results presented stunning implications for the future of therapeutic treatment of common spinal disorders like degenerative disc disease. Of the patients who had cervical disc replacements, their success rate was 81.4% compared to 69.4% of patients who had a cervical spinal fusion.


A later follow-up study that I co-authored not only comport with earlier findings and showed continuous improvement. ADR patients continued to show statistical superior outcomes over fusion patients 10 years after their surgery. Another result from the study was even more compelling: normal, healthy discs next to fusions required later surgery twice as often as discs that were adjacent to artificial discs. One would assume that this latter finding might cause physicians to be more cautious about recommending spinal fusions.


Late last year, I completed a clinical study as the principal investigator of the M6-C artificial disc. It has a unique semi-flexible viscoelastic core that gives it the ability to mimic dynamic movement of natural discs. In fact, it’s the only artificial disc that can do all eight movement variations: flexion (forward fold), extension (backbend), lateral (side bend), rotation (twist), axial extension (lengthen), and compression. And once again, the clinical data is extremely promising and continues a compelling narrative of statistically superior favorable patient outcomes over spinal fusion.


Which leads me to the most crucial point of all. I did not become an advocate for artificial disc replacement because I invented the concept. I don’t own a company that designs and builds artificial discs. I’m a medical practitioner who has a unique perspective as a patient of many of the procedures and therapies that I prescribe. Ever since artificial disc replacement surgery gained FDA approval (2005 for lumbar, 2007 for cervical), the story of success has expanded. Both technology and surgical technique have undergone breathtaking advancement that always resets optimism. So naturally, I’m interested when I hear about a procedure that offers so much promise.


As a physician, I am focused on anything that can give patients a positive outcome. Degenerative disc disease is a treatable medical condition. And a tool like an artificial disc, one that has a consistent story of success, is bound to hold my attention. I engage the doubters. We discuss differences of opinion. And sometimes I can convince someone to change their mind. But some doubters instead chose to spread misinformation to their patients.


One blatant example is the status of artificial disc replacement and FDA approval. Every day I meet patients at my private practice in Beverly Hills, CA, and still, they tell me about doctors and therapists who claim that ADR surgery is not fully approved by the FDA. It is approved.


Or that the long-term clinical advantages of ADR are unproven. It is proven.


Or that artificial disc replacement is not recommended for patients with multiple level degenerative disc disease. It is, and I do it often for my patients and I’ve had it done for myself as a patient.


One patient sent me a link to an article on a website operated by a major medical university in California that contains many of these stunning errors and other misrepresentations.


I’m not surprised that patients are confused and maybe a little worried. But as a back surgery patient myself, it is upsetting to see such a waste of opportunity. There are millions of potential patients who suffer from chronic spine pain. When you suffer as they do, as I have, you want a decisive answer to essential questions. What can I do to relieve my chronic neck and back pain? How can I keep my natural flexibility? Who will help me be greater than better?


Among the patients I see every day, I see myself when I was in pain and nearly broken by excruciating and debilitating pain. I have had eight surgeries for my back and neck. As luck and genetics would have it, my spine was in awful shape. My first surgery was nearly 20 years ago when I had a microendoscopic discectomy for a very painful cervical herniation. I was waiting for the FDA to approve artificial discs. As a physician and a surgeon, I knew that I did not want fusion. But not long after the procedure, I reherniated the disc and was in so much pain that I couldn’t wait and opted for a cervical spinal fusion.


About nine years later, an adjacent disc degenerated and herniated with the same symptoms. I knew then that my condition was hastened by the fusion. This time, I had an artificial cervical disc. I later had three artificial lumbar discs and one fusion – for each procedure I had, there was a choice. I had options.


Other patients want those same options. Plus, they expect a medical community dedicated and focused on solving problems. They want physicians who offer suitable treatments and are confident of good outcomes. But misinformation limits opportunity. Bad information removes options.


When patients meet me for the first time, many look at me with hope. The causes for their conditions are as varied as their individual circumstances; back and neck pain knows no limits, and it crosses all demographics and lifestyles. There are just as many young and athletic patients as there are aging and sedentary ones. But the goal for every patient is the same – get better, put the pain behind them, and regain the freedom of movement.


We work together on a treatment plan that matches each unique situation. We weigh every option. And in my world, artificial disc replacement is no longer a “new procedure” or “experimental.” It is a page-turning medical success story that all patients should at least be allowed to consider.


That’s how we all are greater than better.

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