St. Luke’s performs first artificial disc replacement operation in RP

St. Luke’s Medical Center has achieved another first in the field of orthopedic surgery. It recently performed the first artificial disc replacement operation in the country.

The team of doctors, who performed the almost four-hour operation, was headed by Dr. Mario Ver, director of St. Luke’s Institute of Orthopedics and Sports Medicine.

CF, a 44-year-old woman from La Union, had suffered chronic lower back pain since 1993. Her back pain was so severe that she could hardly walk and was bedridden for extended periods of time.

"There were days when I couldn’t sleep well because I was unable to find a position that would help relieve me of my pain," she said. "Sometimes, the pain was so great that I was forced to stay home and this really affected my job at the provincial government."

According to Ver, CF had exhausted all the treatments available for her condition. Back pain is a common ailment. While some patients are cured of their back ailments, there are those who suffer recurring back pain, which may only be cured through surgical intervention.

There are two types of back pain – sciatic and discogenic. A pinched nerve is usually the cause of the sciatic type of back pain. There is severe pain in the lower back and down the back of the thigh and leg along the route traveled by the sciatic nerve.

This nerve is the large, long nerve that originates in the spinal cord and exits near the base of the spine. This can be corrected through a laminotomy or laminectomy, the surgical chipping away of the thin bony arches of one or more vertebrae in order to remove the part of the bulging disc, thus freeing the compressed nerve root. Most patients are able to recover after this procedure.

The discogenic type of back pain, however, is more difficult to cure. The source of the pain is the disc, which has developed cracks leading to the absence of water in the middle of the disc. This ailment can be cured but it will depend on the kind of treatment employed for the condition.

"The middle of the disc is made up of water and when there is a crack in the disc, the water is let out and this causes the pain in patients," Ver said. "Since the disc has no blood supply in adults, it cannot heal itself and the pain will continue to be there."

Since the usual practice is for the back pain to be treated conservatively, CF was given medicines like oral analgesics to deal with the pain. She also underwent a series of physical therapy and was even administered epidural steroid injections but to no avail.

Last year, CF was diagnosed to have Degenerative Disc Disease (DDD). Degenerative changes in the spine, accompanied by pain, are some of the most common diseases of modern civilization. This degeneration can be the result of the natural aging process, an injury to the spinal disc or other related factors.

"I told Dr. Ver that I could no longer stand the pain," she said. "My life has been affected by the back pain and I told him that if there was a procedure available to relieve me of this pain, I would undergo it right away."

Back in 1987, the artificial disc replacement surgery was introduced in East Germany. This procedure, however, was only given approval by the US Food and Drug Administration last year.

Spine arthroplasty or total disc replacement is a promising alternative treatment for DDD. By replacing the degenerated intervertebral disc with an artificial disc prosthesis, stability can be restored and the mobility of the motion segment is also maintained.

CF agreed almost immediately to be the first patient to undergo the procedure in the country. The disc Ver used has proven to be particularly successful in operations performed in Germany when there is intervertebral disc damage in the lumbar vertebral region.

Developed at the Orthopedic University Clinic of Berlin Charité in Germany, the disc consists of two metal endplates made of high quality cobalt chromium alloy – an implant material which has been proven to be extremely well-tolerated by the body.

The metal endplates are attached to the vertebral bodies by means of small anchoring teeth along the border as well as a bioactive porous coating. A polyethylene siding core or spacer is placed between these endplates that allows near-normal physiological motion.

"Studies have shown that patients who undergo this procedure recover very quickly," Ver said. "In fact, patients are encouraged to get up and walk as soon as possible and this is usually a few hours after surgery."

This is what happened to CF who was up and about hours after the operation. She was, in fact, discharged three days after surgery, ambulatory and much improved without the back pain and numbness and weakness of the lower extremities.

A week later, she could go up and down the stairs without any difficulty. She could even bend painlessly and with much ease.

"I used to have difficulty lifting my left leg when going up the stairs because it hurt my buttocks," she said. "Now I can walk properly and I do not experience the pain I was so used to. The surgery was a success if you ask me because the pain is all gone and I will be able to resume my regular activities."