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Not all new technologies, however, have lived up to their promise. Intradiscal Electrothermal Therapy (IDET), for instance, was heralded as the next best treatment for low back pain attributed to tears in the outer wall of the intervertebral disc (annular tears). In theory, IDET involves the use of heat to modify the collagen fibers of the disc and destroy pain receptors in the area. While early results seemed promising, in one Australian study, half of the participants received the heated catheter and the other half received no heat. Both groups yielded the same pain relief results. On the other hand, in Dr. Dillin’s opinion, one of the most promising advances in spinal surgery today is evolving bone morphogenic proteins. These genetically produced proteins stimulate a person’s own bone cells to produce more bone, eliminating the need for bone graft from another part of the body (autograft), which can cause significant pain, or from another person’s bone (allograft), which can cause disease transmission. Artificial discs are another developing area that has the potential to revolutionize spinal surgery. An artificial disc is a device that is implanted into the spine to imitate the functions of a normal disc — to carry load and allow motion. Traditionally, the operative treatment for disc pain has been spinal fusion, where disc tissue is removed and bone is placed between the vertebral bodies. This eliminates movement in the affected area, which is thought to significantly reduce pain. A normal, healthy spine allows movement at each of the discs throughout the spine. Artificial discs are designed to allow motion after surgery that is as normal as possible. The Food and Drug Administration (FDA) approved the first artificial disc for patient use in October 2004. Other areas of great potential on the horizon are the continued refinement of imaging techniques and genetic medicine. With more advanced imaging, physicians can more effectively visualize areas where pain originates. It will help spinal surgeons make further diagnoses and more effectively decide whether or not to perform surgery — allowing for a more selective application of surgery. And the promise of genetic medicine is that it may someday help discs and spinal cords regenerate completely. Still, with all of the latest advances at a surgeon’s disposal, it is important that the doctor work diligently to balance technology with an individual patient’s needs when consulting on a spinal surgery. Patient history, physical exam and completed imaging studies are all evaluated when deciding whether or not surgery is appropriate for a patient, and if surgery is indicated, which procedure will have the most measurable benefit for the patient. “You don’t want to aim a cannon to knock a Coke bottle off the fence,” Dr. Dillin said. “To determine the proper course of action, the surgical questions are simple: If a surgeon alters the anatomy what does the patient get out of it? And, since the patient is trading one abnormal anatomical state before surgery for another abnormal state created by surgery, what is the value of that change for the patient’s life? Also, how does surgery measure up against nature — or conservative treatment — with a particular condition?” “Decision making in spinal surgery is a critical process,” Dr. Dillin continued. “An operation permanently alters the anatomy of the spine. Therefore, a patient needs to receive a recognizable benefit. After all, surgery is not about changing X-rays — it is about changing quality of life.” |
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