St. Luke’s performs landmark surgery for spinal disc problem

Surgeons at St. Luke’s Medical Center in Quezon City recently implanted prosthetic discs in the cervical spine of a 32-year-old patient, successfully performing a groundbreaking surgery that could help make vertebral disc replacement as commonplace in the Philippines as hip joint or knee replacement.

Dr. Mario Ver, consultant of St. Luke’s Institute of Orthopedics and Sports Medicine, headed the team that did the innovative procedure.

It was the first artificial cervical disc surgery in the country and the first four-level total disc replacement in Southeast Asia.

The team implanted artificial discs to replace four "bulging" or degenerative cervical discs that had been causing severe pain in the neck for Lawrence Cuevas, a South Korea-based employee of the Philippine government.

The procedure took about eight hours and Cuevas was discharged from St. Luke’s four days later completely relieved of the neck pain.

"I can now move my neck more freely and the numbness on my left arm is gone," Cuevas said. "I was really confident that Dr. Ver would be successful in carrying out this procedure."

"We are proud to be one of the few centers in the region able to perform this procedure," said Ver. "The introduction of artificial disc implants as a safe and reliable option is a significant development that augurs well for patients who suffer cervical disc problems."

"As more of this kind of procedure is performed, we are hopeful the technology will become the new standard surgical procedure for disc problems not just in the cervical spine but in other areas of the spine as well," he said.

The St. Luke’s surgeons also performed the first lumbar artificial disc replacement surgery in the Philippines in 2005.

The new technique, which was first performed in Europe a few years ago, offers major advantages over the traditional procedure: it does not limit neck mobility and is not likely to cause stress on adjacent disc levels.

There are no restrictions on activities after surgery and a patient can return to work as soon as he feels up to it.

Spinal discs are located between the blocks of bone in the vertebra. They act as shock absorbers and add mobility and flexibility to the spinal column. With age, they can flatten and develop cracks, thus causing pain.

The standard surgical treatment is removal of the damaged disc followed by "fusion." A wedge of bone, usually taken from the patient’s hip, is inserted in the empty disc space and left to "fuse" with vertebrae. This relieves symptoms, but the "fused" vertebrae can limit neck movement and increase wear and tear on adjacent disc levels.

In the new procedure, the damaged disc is totally replaced with prosthesis designed to allow for motion at the treated level. Further degeneration above and below the treated disc is prevented.

The implant also incorporates an elastic nucleus to provide shock absorption similar to the natural disc.

"This is quite revolutionary," said Ver. "Just as hip and knee replacements have become commonplace, I would expect that replacement of cervical discs would be a widely available surgical procedure in the future."

"This operation is now becoming the most popular surgical approach for patients with this kind of problem," said Ver.

"Those who went through the operation recover much faster than those who underwent harvesting the bone graft which is the most painful site even several weeks after the surgery," he added.

Cuevas first complained of nape pain associated with recurrent stiff neck over two years ago. Then he began experiencing numbness in his left upper arm and difficulty keeping his head in one position for long periods of time.

"I did not enjoy going to Korean hospitals to seek medical attention because of the language of barrier. They could never understand me," he said.

By the time Cuevas consulted Ver in December the pain had become unbearable. He had difficulty sleeping and could not stay seated for long periods of time. MRI scans ordered by the doctor revealed the four "bulging" cervical discs.

Notwithstanding the surgeon’s initial reservations, Cuevas was determined to go for artificial disc replacement.

"The pain in my neck was getting to be unbearable and I wanted to be relieved of it already. The physical therapy and the pain medications did not improve my condition much. Besides, it was already affecting my work in the office," he said.

Cuevas was wheeled into the operating room of St. Luke’s at 7 a.m. of Feb. 10 and was in the recovery room eight hours later. He was up and about mere hours after the procedure. He can now hold his neck in one position for extended periods and has regained power and sensation in his left upper extremity.