New surgery option for back pain

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Degenerative disc disease

Steamboat Springs spine surgeon Henry Fabian describes degenerative disc disease as "basically arthritis of the spine." The spinal column has 23 spinal discs that act as shock absorbers and flexible joints between the 24 vertebrae. Over time, discs can become less elastic due to dehydration or injury. Sometimes this condition irritates the numerous spinal nerve roots, causing severe and long-lasting pain.

Lower back pain due to degeneration of vertebral discs is a massive health problem in this country, affecting an estimated 12 million people. Last year, 200,000 Americans sought relief with spinal fusion surgery.

Now, some people in the Yampa Valley who have degenerative disc disease may be helped by the newest technology - artificial disc implantation.

"The most exciting aspect of the artificial disc is that it allows patients to maintain the natural motion of the spine," said Dr. Henry Fabian, director of the Spine Center of Steamboat Springs. "Unlike spinal fusion, which immobilizes the fused vertebrae, an artificial disc implant is flexible."

This technology recently was approved by the Food and Drug Administration. Fabian said Yampa Valley Medical Center is one of only three hospitals on the Western Slope that offers this new surgery.

Ross Kelly, 53, a lifetime resident of Steamboat Springs, is back to many of his pre-surgery activities after receiving an artificial disc at YVMC on July 18. As the first patient to benefit from this technology, he is "relearning what normal range of motion is."

Kelly first suffered back pain in 1992 and had several subsequent minor injuries. "The pain is insidious," he said. "It grows on you. It eventually became a radiating pain down my legs, and I was having problems maintaining my balance and walking.

"The intensity was getting to the point where it was affecting my personality and the way I behaved," he added. "It was starting to really affect my lifestyle."

Kelly had tried a variety of pain relief treatments such as epidural injections, physical therapy, acupuncture and medications, including the now-discontinued Vioxx. He had undergone a variety of scans, MRIs and even a high-level test called "provocative discography," which involved an injection of contrast dye into the disc to search for the source of pain.

"Ross was an excellent candidate for the artificial disc," Fabian said. "Surgery is considered when a patient has suffered from chronic back pain for more than six months and conservative treatments have failed. The source of the back pain also must be well-defined."

Because Kelly had just one degenerating disc and it was identified as the only source of his back pain, Fabian recommended artificial disc implantation.

The Charite artificial disc, the first one available in the United States, is made of two metallic endplates and a movable, high-density plastic center. Surgery requires a team approach between a general surgeon and spine surgeon.

"Dr. Allen Belshaw and Dr. Ed Kimm are the other members of the surgical team," Fabian said. "The general surgeon provides access to the spine through the abdomen, moving blood vessels and internal organs aside."

After removing Kelly's diseased disc, Fabian implanted the artificial disc. Kelly was then on the road to recovery.

"I only stayed in the hospital overnight," Kelly said. "It is very invasive surgery, but the pain from the surgery was so much less than what I had experienced from my back problem. I felt immediate relief."

Fabian said artificial disc implantation is available in only three communities on the Western Slope: Grand Junction, Durango and Steamboat Springs.

"It is so new that some insurance companies don't cover this surgery yet," Fabian said.

Kelly still wears a brace at times. He does not lift heavy objects or hyper-extend his back.

He continues his physical therapy treatments with Nicole Rabanal from Kinetic Energy, who was allowed to observe his surgery.

Kelly said the artificial disc has several advantages over spinal fusion, in addition to preserving mobility.

"Spinal fusion creates stress on the vertebrae above and below the fusion, but the artificial disc doesn't. Also, recovery time is considerably quicker with the artificial disc. I feel like I've gained several years," he said

Fabian said Yampa Valley Medical Center has been chosen as a clinical trial site for the next generation of artificial disc implants.

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