Motion Preservation Surgery
in Fort Worth TX
Motion preservation is a somewhat new concept. This group of surgeries aims to provide an alternative to fusion surgery, which could colloquially be thought of as “motion restriction,” since it fuses at least two vertebrae together and prevents motion in that section of the spine. That’s actually what makes fusion successful — by eliminating movement between vertebrae, issues with nerve compression and impingement can be lessened or eliminated.
With motion preservation, the goal is to not have to fuse vertebrae, enabling the patient to keep a full range of motion. There are currently a variety of options in various stages of development and clinical study. Dr. Tinley currently performs one of these motion preservation surgeries — total disc replacement with the FDA-approved ProDisc-C and ProDisc-L devices. This is an exciting new option for our patients from Dallas and the surrounding areas.
What is motion preservation spine surgery?
Really any procedure that enables the patient to avoid spinal fusion could be deemed a motion preservation spine treatment. These would include various procedures Dr. Tinley performs at DFW, everything from a cervical laminectomy, to lumbar decompression, to micro discectomies. The only criteria would be that they could not include fusion, which can be necessary if the procedure creates instability when seeking to remove areas of the vertebra that are pressing on either the spinal cord or nerve roots exiting the spinal column.
With new procedures and devices, a new series of alternatives are becoming available for motion preservation. They include:
- Total disc replacement — These replace the entire disc with an artificial disc.
- Disc nucleus replacement — These replace only the disc nucleus, leaving the outer portion of the disc intact.
- Interspinous process spacers — These devices open the area of the vertebra where the nerve endings exit the spinal canal and head down to the legs.
- Posterior dynamic stabilization devices — These are similar to the rods used for fusion, but they allow movement while providing stability, rather than locking the two vertebrae together as an infusion.
- Facet replacement — These devices will replace the facet joints in the back of the spine.
Let’s get into the first FDA-approved motion preservation surgery — disc replacement surgery. You can think of this procedure as being similar to modern knee replacement. Instead of replacing a damaged knee joint, Dr. Tinley replaces a seriously damaged, degenerated disc with an artificial disc. As with the artificial knee prosthesis, the artificial disc mimics the function of the natural disc. This allows the patient to be free of the pain he or she was experiencing from nerve compression without the limitations that fusion can place on movement. As the surgery title implies, motion is preserved.
Who is a candidate for motion preservation surgery?
Anyone who suffers from cervical or lumbar back pain due to degenerating or injured discs could be a good candidate for motion preservation surgery with Dr. Tinley. These patients would be suffering from neck or back pain or pain that is radiating down into the arms and legs due to compression in the nerve roots exiting the spine.
These surgeries with Dr. Tinley replace the damaged spinal disc with an artificial disc. They present an alternative to spinal fusion.
While there isn’t a definitive better option here, if a patient would rather not have the potential limitations of fusion surgery, motion preservation options could be a good way to go.
What are the benefits of motion preservation surgery?
Spinal fusion is effective for treating pain and other conditions caused by disc degeneration, but it will inevitably lead to reduced mobility simply because the patient has a single piece of fused vertebra instead of the two (or three) individual vertebrae he or she had before. In addition to decreasing some degree of movement, fusion creates biomechanical stress on the adjacent vertebrae above and below the fused vertebrae. Over time, these other vertebrae can begin to break down due to the new stress loads placed on them, loads that formerly were spread across the fused vertebrae.
As its name implies, motion preservation surgery with Dr. Tinley preserves motion and keeps more vertebrae from becoming damaged. Also, these surgeries allow for faster recovery times than full fusion procedures.
How is motion preservation surgery performed?
Currently, the motion preservation surgery performed by Dr. Tinley is total disc replacement using the ProDisc-C in the cervical spine and the ProDisc-L in the lumbar spine. Both of these procedures are similar in how they are done.
First, the patient is put under general anesthesia. For both the cervical discs and the lumbar discs, access is made from the front of the body. Most cervical disc problems originate in the C4-C7 levels of the seven-vertebrae cervical spine. In the lumbar spine, all five vertebrae and their four spinal discs can be problematic. In the cervical spine, a one-to-two-inch incision is made in the front of the neck. The thin platysma muscle that lies just underneath the skin is cut and moved aside, and the pre-vertebral fascia, a thin layer of tissue that surrounds the spine, is removed to expose the spinal discs. An incision is made in the outer ring of the disc, the annulus fibrosus, and the entire soft inner core of the disc, the nucleus pulposus, is removed. Most of the remainder of the outer disc is also removed, but some may be left in place.
Next, the vertebrae are spread to their normal height and the ProDisc-C is placed into space. The ProDisc-C has what is called a keel that protrudes on the top and bottom pieces. These keels are placed into the upper and lower vertebrae and ensure instant stability and fixation. In between these pieces is the polyethylene center that simulates the natural spinal disc. Once the artificial disc is placed, the incisions are closed, and the surgery is complete.
With lumbar disc replacement, the process is very similar. An incision is made in the abdomen. Muscles are moved as necessary to gain access to the vertebrae. Then the degraded disc is removed and replaced by the ProDisc-L in basically the same way as the cervical disc was replaced.
What is recovery like after having artificial disc replacement?
In addition to maintaining movement, another huge advantage of avoiding fusion with artificial disc replacement is recovery. Most people are able to return to everyday activities, such as light work and driving, within a week of having surgery. Full recovery typically takes from 6-12 weeks; that’s when heavier lifting and more vigorous activities can be resumed. If the patient had serious nerve compression, it will take some time for the nerve to fully heal. This can take up to one year or more. Most of the pain with both cervical and lumbar disc replacement doesn’t come from the spinal area, but from the small incision made either in the neck or abdomen to gain access to the spine.
These are not overly painful or difficult recoveries. Our DFW Center for Spinal Disorders patients are thrilled with the ease of their recovery, and with their final results.
How long will my artificial spinal disc last?
Since these procedures have only been performed since the early 2000s, there isn’t long-term data from which to pull. However, early studies of artificial discs such as the ProDisc-C and ProDisc-L show that at 5- and 10-year intervals they are still functioning at completely optimal levels. Manufacturers, such as Centinel Spine (makers of the ProDisc), say they have designed and tested their artificial discs to be able to handle 40-50 years of normal wear and tear.
That means it’s a good bet you will only need one spinal disc replacement surgery for the remainder of your life.
Schedule Your Consultation in Fort Worth, TX
If you’re interested in learning more about motion preservation surgery please contact us for a consultation at (817) 916-4685 or fill out our contact us form. We will discuss your needs and concerns, and determine your best course of action.