Day 8

Today’s first surgical patient doesn’t have a first name. At least, as far as his medical records at Mbarara are concerned, his first name is C. C is a sixty-five year-old man who is, for all intents and purposes, a wheelchair-bound quadriplegic. Degenerative changes in his cervical spine (his neck) have compressed and damaged the spinal cord, leaving him with paralysis in his legs, a loss of bowel and bladder function, minimal function in his right hand and none in his left that has progressed over three months. Given this clinical picture, I was certainly caught off guard when, while lying flaccid on the operating table awaiting his anesthetic, C asked me whether the operation would allow him to walk again. I passed the question on to Dr. Lieberman anticipating an apologetic response and was astonished to hear that indeed, Dr. Lieberman hoped the operation would accomplish just that.

Similar to Prudence’s operation, Dr. Lieberman approached C’s vertebral column through the side of his neck, navigating around some critical anatomy. He handed me a retractor he was using to push aside a vessel and asked, “What are you holding right now?” “The common carotid,” I replied, referring to the main artery carrying blood to the head. “Correct,” he said, “if you slip, the patient will have a stroke.” Needless to say my hand cramped up a bit while standing there. Unlike most of the operations so far, C’s progressed without any surprises from our hosts (finally, no power outages!) and before we knew it, his decompression (making more room for the spinal cord) and reconstruction (rebuilding and fusing the bones together) was complete.  We were very soon ready for our second patient Ida, who was being walked (yes, walked!) into the OR for her surgery that afternoon.

image 1 Ida walking to OR Ida chose to walk (with some help) to the operating room prior to her surgery

Ida was not a new patient. Dr. Lieberman had operated on her cervical spine (the part in her neck) last year. She now returned with pain, weakness and tingling in her legs caused by spinal stenosis (when the spinal canal is narrowed and compresses the nerves in the cord). Last week, Ida had walked into our clinic slowly and with an unsteady gait, supported by her son who has since not left her side at the hospital for more than 20 minutes to stretch his legs. She wore a kind expression on her face that day that, along with her son’s iconic NY Yankees baseball cap, have made lasting impressions on us. Now, as Ida was assisted onto the surgical bed, I thought about her son who was undoubtedly pacing outside the double doors to the surgical wing, sporting his distinctive cap.

During Ida’s surgery, Dr. Lieberman carved out space around the compressed portions of the spinal cord and secured screws and rods in place to stabilize the spine. The highlight of my week came next, when Dr. Lieberman allowed me to secure a few screws and to help suture the incision. It’s a small thing for a surgeon, but as a medical student it was the first time I would leave my physical mark on a patient. The fact that it was kind-faced Ida who would carry the scars of those stitch marks made it even more meaningful.

Image 2 Ida & fam on private wardIda, her son and niece in the private ward the day after her surgery

The following day, I went to visit Ida and her son in the private surgical wards. Aside from a bit of pain, she was in great shape. As her son walked me out to the corridor, we chatted about their experience throughout his mother’s care. They had tolerated the crowded mini bus system over the 300 kilometer trip from Kampala to see us in Mbarara, only to find themselves completely disoriented and without instruction upon arrival at the hospital. Once admitted (to the private ward, no less), they had to provide their own food, bathing basin and other essentials. There were showers for those in the private ward, but no accommodations for a bed-ridden spine surgery patient. After speaking with Ida’s son, it was clear to me that in Mbarara and perhaps Uganda at large, a patient must be his or her own advocate. Without a middle man to coordinate between patient and doctor, the patient’s own initiative determines the outcome of his or her care. In fact, when it was time for Ida’s surgery, no nurse came to retrieve her. Exasperated, her son walked his mother to the surgical ward and received her stretcher after the operation was complete. The lesson of the day was embedded here: As part of the surgical team, I had a narrow view of our patient’s experience; as far as I knew, she had showed up to our clinic, arrived at the hospital for admission several days prior to surgery, and had made her way to the operating table just as was meant to be. But in between those encounters, Ida and her son had fought to get attention from uninterested nurses and administrators and had navigated a non-intuitive system in their efforts to seek optimal health care.

Day 9

After a surprisingly smooth day yesterday, we had a few curveballs thrown our way today (lest we should get too spoiled with things going as planned!) Our first patient today was Catherine, a 14 year-old girl with a large thoracic kyphosis (an over-pronounced curve in her upper back). Catherine’s condition was consistent with Scheurmann’s disease, a pathology of abnormal bone growth causing wedge-shaped vertebra that exaggerate the normal thoracic kyphosis. With her deformity, Catherine found it painful to carry baskets of food on her head as is common practice here. Dr. Lieberman’s plan was to straighten Catherine’s curve with metal rods anchored to the spine with vertebral screws. There were several power outages throughout the surgery, during which Dr. Lieberman could not use his ultrasonic bone cutter. Nevertheless, he adapted the procedure to the tools that he had until power returned. He would not be derailed by a simple power loss!

Image 3 Catherine Catherine

Image 4 Catherine x-raysCatherine’s x-rays

Our determination to get through the day unscathed met another challenge that afternoon. The autoclave (the machine that sterilizes our equipment between surgeries) failed during its cycle, leaving us potentially still contaminated equipment for the operation. Our second patient, Aguma, who had two level spinal stenosis (narrowing of the spinal canal with compression of the nerves) lay prepped and sleeping on the operating table while Dr. Lieberman, Rob and Sherri brainstormed alternatives. They decided to rerun the sterilization (a 45-minute cycle) while in the meantime proceeding with the operation using alternative tools. Rob scoured the hospital’s sterilized equipment room for substitutes while Sherri went through some of our own tool sets set aside for other procedures. With some creative ingenuity the decompression surgery (laminotomies and foraminotomies) got underway, and 60 minutes into the operation we received our freshly-sterilized equipment.

That evening, the hospital and university invited us to a buffet dinner at the Agip Motel. Those in attendance included the surgical team from the hospital, the university and hospital accountants, and two of the vice deans from the Faculty of Medicine. After the meal, each of our hosts in turn spoke of their gratitude to Dr. Lieberman and his team. They expressed their hope that the continued presence of the mission would allow them to build competence and expertise in spine surgeries, ultimately establishing Mbarara as the pinnacle spine surgery center of East Africa.  After a week of hard work in the operating room, the team was moved to see the appreciation and long-term vision of our host institution. After all, we weren’t simply there to operate on ten patients and call it a week. The mission was established to provide spine care to the less fortunate and train those who serve these patients.  As the saying goes, “Give a man a fish and he will eat for a day. Teach a man to fish and he will eat for a lifetime.”

Image 5 dinner with Hosp & University faculty dinner with hospital and university faculty and staff

After dinner, the team gathered in our hotel lobby and discussed the lessons of the day over a bottle of wine. Today taught us that surgery can be seen as a series of small failures that simply require some creativity and perseverance to overcome. Back home in the US and Canada, the autoclave failure would have resulted in a canceled/delayed surgery. But here in Uganda, with limited time and even more limited resources, we could not afford to delay the operation. Dr. Lieberman, Rob and Sherri went back to basics in the absence of their standard operating procedures, highlighting the importance of fundamentals in medicine. We saw the challenges of the day—the power outages and the autoclave failure—as tests of what a co-ordinated and experienced surgical team could accomplish when forced to improvise.

Day 4

Today was our first full day at the hospital, although “full” is an understatement. When we opened the clinic at 10am, the open-air waiting room was teeming with patients and their families lining rows of benches or sprawled on mats on the floor.

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The team got right to work; Sherry and Rob left to set up our supply room and prepare equipment for surgery the next day. Izzy, Zvi, Danielle and I were joined by the hospital’s own orthopedic surgeon, Dr. Deo. We parked ourselves in a small room with an examining table and brought in the first patient. Over the next ten and a half hours, we screened 67 patients and selected 16 as candidates for surgery pending results from their imaging. It was a long day, and at times a bit trying; after hours of sitting on a bench in a dark, hot, narrow hallway with minimal food and water, patients began pushing their way into the small examining room. They were understandably anxious; many of them had travelled long distances to Mbarara just to be seen by Dr. Lieberman. We explained sympathetically that we were moving as fast as we could, and they would simply have to wait longer. I was astonished by their patience and resilience. Amina, a thin, frail 85-year old woman with chronic back pain from spinal stenosis shuffled slowly into the examining room with a walking stick. The deep wrinkles in her face folded into themselves each time she winced, emphasizing the extent of her pain. For over 5 hours she had waited quietly and without complaint. After his examination, Dr. Lieberman explained to Amina that he could treat her pain through a surgical procedure called a decompression, though the surgery would carry significant risk given her age. This brave elderly woman became our first surgical patient the following morning.

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As the day dragged on we began to appreciate a specific luxury of North American medical care: the process of waiting. To Canadians like myself and Zvi, waiting a month to see a specialist elicits a groan and some exasperated comment about “the drawbacks of universal healthcare.” Waiting over an hour in an air-conditioned waiting room with cushioned seats and a Starbucks in the lobby prompts a similar reaction. Many of these Ugandan patients had lived for over 20 years with back pain. We saw teenagers and 20-somethings with spine deformities that in North America would have been corrected within the first two decades of their lives.  Here, “waiting” is measured in years rather than weeks or months.

For some patients, their long-awaited visit with Dr. Lieberman brought bittersweet news: they were candidates for surgery, but would have to wait even longer. Kenneth, a short 18-year old with a pockmarked face and a big smile, was born with severe scoliosis and has developed restrictive lung disease as a result of his rigid spine. He walks stooped over to the right because his scoliosis forces his left shoulder upwards. Unable to work with his deformity, Kenneth was hoping that an operation would restore his physical mobility and give him “purpose,” as he put it. But to treat Kenneth’s condition the spine surgery team would need three weeks in Uganda, and we only have six operating days here. Dr. Lieberman explained to Kenneth that he would have to wait until next year when there is the possibility of a longer mission.

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67 patients later, we were done for the day. On the drive back to the hotel, we reflected on some of the cases from that day, including Bernadette, a 45 year-old woman who injured her back while pulling a goat tethered to her waist. When one team member wondered aloud why anyone would tie themselves to a goat, Rob kindly provided an answer, as well as our quote of the day: “If you haven’t mutton-busted, you haven’t lived.”

Day 5

A lot was riding on today: our first day in the OR, our chance to test out the facilities and to work alongside new Ugandan colleagues. Today’s successes and failures would mold our expectations of what we can accomplish in a week and would give us a sense of the challenges we would face. For that reason, Dr. Lieberman deliberately selected a relatively straightforward procedure for our first operation, a posterior decompression in which portions of bone are removed to allow more space around a nerve root. We arrived at the hospital around 8:30am and went straight to the operating room to find the anesthesiologist, Dr. Emanuel already prepping the patient, Amina.

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Sherri and Rob snapped into action and began setting up instrument tables and equipment while Izzy and Zvi scrubbed in. It seemed like we were off to a good start….. until the power shut off. We stood in the window-lit operating room with the patient on the ventilator for about 20 minutes until power returned. The rest of the operation went smoothly and two hours later Amina was on her way to the ICU.

 

 

 

 

 

 

 

 

 

 

 

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With a lunchtime clinic scheduled in between surgeries, we barely had time to scarf down our energy bars before heading out to the corridor of waiting patients. One by one, the patients approached Izzy and Zvi holding their X-rays and CT scans. We were able to add two patients to our list of surgical candidates, and sent several more for imaging and follow-up.

In the meantime, Sherri began setting up the OR for the next case, 56 year-old Muhamoud. Muhamoud had severe vertebral lysis caused by tuberculosis in his spine. I was particularly excited for this case because Dr. Lieberman was planning to approach the spine anteriorly (from the patient’s front), navigating around the peritoneum (the space behind the abdominal organs) to the vertebral column. As Dr. Lieberman went to make his incision, he looked up to find that the anesthesiologist had left the room, leaving his nurse anaesthetist in the pilot’s seat. This wasn’t the only hiccup we would encounter that afternoon. As Dr. Lieberman pulled back the iliac vein to find the vertebral column, the nurse anaesthetist tumbled from his chair, grabbed at the ventilator tubing and crashed into the operating room table causing the patient to move. It was simply luck that the vein between Dr. Lieberman’s forceps did not tear.

That night at dinner, the team discussed some of the lessons of the day. Our first two surgeries in new territory were sobering examples of the importance of thinking on your feet. When things don’t go as planned, improvise. Today’s challenges also highlighted some of the prerequisites of good teamwork. Teams of longstanding colleagues (like the Texas team) work like well-oiled machines. They anticipate each other’s moves, communicate effectively, share expectations and have standard procedures that help things move smoothly. When veteran teams join forces with new colleagues (as the Texas team did with the Ugandan anesthesia team), processes that used to be fluid can suddenly become turbulent. Care must be taken to communicate effectively, lay down expectations and establish roles and responsibilities. Perhaps today’s anesthetic troubles were not from a lack of competence, but rather from miscommunication and incongruent standard practices.

Finally, and on a more personal level, I learned today that surgery is far more multidimensional than I had thought. Spine surgeries don’t necessarily need to be approached from the back, just like heart surgeries aren’t always approached from the anterior chest. Each approach involves different anatomy and with that, different challenges, considerations and risks. The human body is sort of like a labyrinth for the surgeon; sometimes, the best way of reaching a point of interest is not necessarily the most direct route.

All in all, our first surgical day was a great success. As a team, we fell naturally into our own roles and got through our first two surgeries with only a couple nicks along the way. It seemed like we could count on a very productive and rewarding week ahead.

With a dramatic increase in the number of advertisements and social media discussions, the concept of “minimally invasive surgery” – especially spine surgery – has become a hot topic. Experts in back surgery such as Dr. Michael Hisey of Texas Back Institute know that in many cases the hype is more about marketing than about medicine.

What is Minimally Invasive Surgery?

In a recent discussion, Dr. Hisey noted that the trend toward less invasive procedures in surgery has always been a guiding principle of Texas Back Institute for the past 35 years. “However over the past 10 to 15 years, this term – minimally invasive – has gained popularity,” he said.

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Since the first efforts to correct injuries or disease of the spine were made, over 50 years ago, surgery was recognized as potentially destructive to the structures of the spine. However, this was a necessary means to an end.

In order to gain access to the spine to complete procedures such as decompressing nerves, removing herniated discs, thickened ligaments, cysts and bone spurs, back surgeons are required to dissect muscle off the vertebrae.  While this can cause damage to joints and muscles and cause scarring around the nerves, it was necessary to address the patient’s problem.

Other collateral damage resulting from surgery were risks as well, such as  the spine being weakened when ligaments that hold the vertebrae together needed to be removed. Vertebral bones, including parts of joints, were removed in order to allow the surgeon access to the spine. This also weakened the spine and often caused scarring which led to further irritation and compression of the nerves.

Michael S. Hisey, M.D.

Every physician at Texas Back Institute is dedicated to pursuing minimally invasive surgery, in every phase of a patient’s treatment. Why? It’s one of the core philosophies of our practice. While there are many techniques and approaches, along with many high-tech tools used for minimally invasive surgery, all are centered around the core philosophy, to always perform the least invasive procedures possible

In fact, the surgeons at Texas Back Institute have pioneered many of the minimally invasive techniques which are used today. “Our physicians are always looking for avenues to advance minimally invasive spine surgery, ” says Dr. Hisey.

Common Misconceptions about Minimally Invasive Procedures

With all of the marketing noise about this minimally invasive surgery, what challenges do physicians and back surgeons face with patient expectations? Dr. Hisey says, “Many patients believe minimally invasive surgery can fix bigger problems than it really can. Unfortunately, not every back injury or pain from degenerative disease can be corrected with this type of surgery.”

“Patients are also surprised when we discuss the procedure and they learn there may not be a laser involved in the surgery. There are many techniques, but the use of a laser is not always a part of the procedure. Plus, this surgery is not less expensive to perform than traditional surgery. It takes a great deal of training and often specialized equipment for a surgeon to be able to perform minimally invasive surgery. This is often reflected in the expense of the procedure,” Dr. Hisey noted.

What Types of Back Problems Are Best Treated by this Surgery?

There are several conditions that lend themselves to minimally invasive surgery. Dr. Hisey notes, “Patients who have been diagnosed with a herniated disc are good candidates for this type of procedure.”

The American Academy of Orthopedic Surgeons notes that “a high percentage of back pain and leg pain is caused by a herniated disc.” The discs in the spine act as “shock absorbers” for the vertebrae and when wear and tear or injury causes them to herniate, intense pain in the back or legs occur.

“Spondylosis can also be treated effectively with minimally invasive surgery,” Dr. Hisey said. “This condition is the result of degenerative osteoarthritis of the joints between the spinal vertebrae. When it’s severe, it can put pressure on the nerve roots causing pain and muscle weakness.”

Advantages/Disadvantages of Minimally Invasive Procedures

Because there is less damage to muscles, tendons and ligaments around the spine during a minimally invasive procedure, the recovery time for surgery is much quicker. Additionally, there is less blood loss and tissue damage” Dr. Hisey noted.  However, there are also disadvantages to this procedure. “It might not be able to remove or correct all of the damaged tissue.”

Why Choose Texas Back Institute for Back Procedures?

With so much marketing information and often unreasonable claims about minimally invasive surgery, many people with back pain are trying to research every option. Basing a potential life-threatening or, at the very least, life-altering decision such as spine surgery on a Google search should be done with extreme caution.

Dr. Hisey concludes, “For more than 35 years, our practice at Texas Back Institute has been based on doing what is best for our patients, not what currently popular procedure is featured on a TV spot. When it’s appropriate, and based on the expert diagnosis of our spine  specialists, minimally invasive surgery will be advised. However, this decision will never be based on ‘what’s hot’ in the media.”

When searching for a procedure to eliminate chronic neck or back pain, the Latin expression – caveat emptor which translates to “Let the buyer beware” – is appropriate. The spine specialists at Texas Back are constantly researching surgical methods which are minimally invasive. For us, this is not a fad. It’s the foundation of our practice.

1st US Service Member to Receive Artificial Disc Celebrates 8 Years Pain-Free

He was a U.S. Marine on Active Duty, planning a career as a Naval Aviator, when a herniated disc stopped everything. Alex Fender saw all his plans postponed, then stopped indefinitely, as physicians repeatedly told him that he would be ‘medically retired’ from the Corps at the age of 21. It was a prediction he refused to accept.

In 2004, Fender met Dr. Scott Blumenthal, a spine surgeon at Texas Back Institute in Plano. After the initial exam, Dr. Blumenthal suggested an artificial disc, which was a new procedure at the time.

Artificial Disc Replacement had just recently been FDA approved back then,” says Dr. Blumenthal, “I had exceptional outcomes since performing the first disc replacement in the US and I knew Alex would be a good candidate for this procedure.”

Fender was up and walking pain-free hours after his surgery. He had no complications, served four more years on Active Duty, and was honorably discharged in 2008.

Today, Fender is a successful entrepreneur in Dallas. He now serves as CEO of Funnel Science, an internet marketing and SEO agency.

“Staying healthy is objective number one,” says Fender. “You can’t get on with your life if you’re not able to get up and go to work. Texas Back Institute gave me that opportunity, and I’m glad to be an example of how well this surgery works.”

Professional bass fisherman, Ryan Lovelace gets back to fishing

As a professional bass fisherman, Ryan’s pain was exacerbated by his participation in several fishing tournaments every year. In order to win or place in these professional bass fishing tournaments, the angler must catch as many bass as possible with the idea being that the final fish weight of his top 5 fish are compared to the other participants.

The fishing tournament typically lasts for two days and the more fish that are caught, the higher probability of getting 5 huge ones. This requires lots of casts. How many? “I typically cast 3,000 to 3,500 casts each day of a tournament,” Lovelace said.
Standing on his feet for about 8 hours and casting 3,000 times a day during a tournament took its toll on Ryan’s injured back. Over time, it wore down his L5 vertebra and Dr. Richard Guyer at Texas Back Institute recommended a microdiscectomy.
After this procedure was completed, Ryan spent less than 24 hours in the hospital for recovery and was sent home for rest and further rehabilitation. A short while after his operation, Ryan is getting back to his top fishing form. He hopes to be completely recovered and able to compete in the 2013 pro bass fishing season.

Best Doctors in Dallas 2012

September 26, 2012

D Magazine Announces It’s Best Doctors in Dallas 2012 List

D Magazine just published their newest issue and it included the 2012 Best Doctors in Dallas list.  Texas Back Institute is excited to announce several of our physicians made the list.  This year, Drs. Scott Blumenthal, Renato Bosita, Jr., Richard Guyer, Michael Hisey and Jack Zigler were all listed as “Best Doctors in Dallas”, by D Magazine.

At Texas Back Institute, we know we have fantastic physicians, but it is always nice to have a magazine as prestigious as D Magazine say this as well! Check out our profile below.

Photo by: Lisa Means

(Not pictured: Dr. Hisey)

The write up is a little hard to read above, so see below for a close up.

Written by: Jennifer Hayes

TEXAS BACK INSTITUTE

Orthopedic Spine Surgery, Physical Medicine and Rehabilitation

What’s New in Spine Care

Celebrating 35 years of excellence in spine care, Texas Back Institute is known worldwide for providing the latest, state-of-the art treatments and technology for neck and back pain. One example is a new FDA-approved neuro-stimulation system which can help provide instantaneous pain relief for patients with chronic pain. This new spinal implant uses the same “human controller” technology which is found in interactive games, such as Wii and smartphones, and can understand whether a patient is sitting, standing, running, or walking and can adjust the level of stimulation accordingly.

Texas Back is on the leading edge of robotic spine surgery and helped develop the first surgical robot in the world designed specifically to operate on the spine. Accurate to less than half a millimeter, it enables surgeons to plan the optimal surgery using a computed tomography (CT)-based 3D simulation of the patient’s spine. Surgeons can map out the patient’s spinal anatomy and plan the entire procedure before the patient even arrives for surgery. This allows the surgeon to be more efficient and precise and anticipate potential complications before they occur. This technology can be used in biopsies, to treat thoracic-lumbar fusion and vertebral compression fractures, and to correct scoliosis.

The goal for any spine surgery patient is to be able to get back to living an active lifestyle while retaining as much motion as possible. Both of these goals can be achieved through artificial disc replacement. This surgery allows patients to continue their dynamic lifestyle by combining a motion-preserving technology with a minimally invasive approach. Surgeons at the Texas Back Institute were the first in the U.S. to use this technology in a clinical trial in 2000 and have continued to be on the forefront of artificial disc replacement surgical techniques. As we get older, the discs in our spine begin to dehydrate and degenerate which can cause pain and numbness in the arms, legs, shoulders, neck, and sometimes hands. The artificial disc is designed to restore proper spacing between the vertebrae and also preserve the motion of a healthy disc. Texas Back participates in numerous clinical trials involving artificial disc replacement. Many of these trials have an immediate positive impact on patients. Our experience shows faster patient recovery while preserving motion in the spine. Minimally invasive spine surgery has been a philosophy of Texas Back Institute since its inception and continues to be the goal with every patient.

The physicians at Texas Back Institute are leaders in surgical and non-surgical treatment options for back and neck pain, from the most common outpatient procedures to the most complex cases. Thanks to advanced diagnostic testing and an unparalleled commitment to patient care and satisfaction, physicians can identify potential causes of your back and neck pain and create a treatment plan for your specific needs.

Texas Back Institute has locations in Plano, Frisco, Arlington, Dallas, Denton, Flower Mound, Fort Worth, Mansfield, McKinney, Rockwall, Trophy Club, Midland, and Wichita Falls.

Artificial Disc Replacement

September 25, 2012

Dr. Scott Blumenthal was the first Orthopedic Spine Surgeon in the US to perform an Artificial Disc Replacement (ADR) surgery. This life changing surgery has now helped over 1,400 Texas Back Institute patients. Recently SpineUniverse.com featured a blog post about the history of artificial disc replacement.

The History of Artificial Disc Replacement

How Long Has This Spine Procedure Been Used?

          Submitted by on September 10th, 2012

Artificial disc replacement (ADR) or total disc  replacement (TDR) is a surgical procedure which replaces a degenerated disc in  the spinal column with an artificial motion device. It has been used in the  United States since the year 2000, but it originated in Europe almost 30 years  ago.

Before performing the first ADR in the United  States in March 2000, I did a lot of research on the procedure, including  visiting with a number of surgeons in Europe as well as the inventor of the  first FDA-approved ADR, Karin Buttner-Janz. Besides inventing the artificial  disc, she is well-known for being an Olympic and world champion gymnast from  East Germany.

With 12 years of experience, we have now  performed more than 1,400 disc replacements in our private practice alone.  Patients now have access to spine surgeons with extensive experience in disc replacement right here in the in the United  States.

Total disc replacement is an alternative to  spinal fusion. It is an innovative process of surgically removing a damaged  disc from the spinal column and replacing it with an artificial disc. This procedure can significantly benefit patients who suffer from herniated discs or degenerative disc disease with or without leg or arm pain.

Artificial disc replacement gives patients an opportunity to retain  mobility in both the neck (cervical spine) and lower back (lumbar spine). By  replicating the movement of a normal disc, ADR helps to alleviate adjacent disc  degeneration minimizing the need for additional spine surgery due to disc  degeneration or herniation.

Since 2000, a number of FDA studies of other  artificial discs began enrolling patients in the United States. Over a dozen  studies have been completed in the United States and currently there are four  discs approved for use in the United States.

The FDA-approved disc available for the low back  (lumbar spine) is the ProDisc-L.  For the  neck (cervical spine), the Bryan, Prestige, and ProDisc-C are available.

Looking forward to the future of artificial discs  in America: at least a dozen or so discs are either currently in-trial or have  completed the trials for FDA approval and will hopefully be available in the US  soon.

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