Content from Harvard Medical School

Disk Transplants Called Promising

Chinese surgeons say five patients had less pain after receiving transplanted disks in the spine, HealthDay News reported March 23. After five years, the immune system had not rejected the disks. The study was published in the journal Lancet. Experts told HealthDay that the research sounds promising. However, they said many questions remain and the technique needs to be tested on many more patients.

What Is the Doctor's Reaction?

This paper describes the positive early results from the world's first spinal disk transplants. The five patients studied had herniated disks in the neck. The procedure helped the neck pain, and patients' immune systems did not reject the transplanted disks. This is an intriguing study.

Low back pain and neck pain are common problems. They lead to many visits to doctors and account for much disability and lost work. The cost of these problems to individuals, insurance companies and society is enormous.

Most spine pain gets better fairly quickly. But it often recurs, and sometimes it becomes chronic.

Arthritis and disk problems cause much of this chronic pain. The disks are gel-like cushions that sit between each of the vertebral bones of the spine. They act as shock absorbers for the spine.

Sometimes the disks "slip" or bulge into other parts of the spine, and can press on nerves. The disks also can "degenerate" and lose flexibility and shock-absorbing qualities. When the disk shrinks, the nearby nerve pathways can become narrow. This can press on nerves, causing pain.

Most people with chronic spine pain are treated conservatively at first. This usually means medication, exercise and education. If this approach fails, surgery is often the next step. If there is a disk herniation, the initial surgery is often removal of the offending piece of disk (diskectomy).

If this fails to control symptoms, or if the problem is degenerative disk disease, spinal fusion surgery is done. A "fusion" involves joining bones together to try to reduce pain and stabilize the spine. Unfortunately, this does not always give long-term pain relief.

Surgeons continue to look for better approaches to chronic spine pain. Much of this work has focused on developing artificial disks, some of which allow normal motion of the spine. Surgeons can use these to replace a worn-out disk, preserving the space between the bones.

This article describes another approach: transplantation of human spinal disks. This was a very small study, involving only five patients with neck pain. The transplanted disks were taken from trauma victims.

It is not clear whether the same techniques would work for low back disk problems. No one yet knows if transplantation eventually will be an accepted method of treating spinal disk problems.

What Changes Can I Make Now?

If you have chronic neck or back pain or disk herniation, you can try many nonsurgical approaches to control your pain. You could consider:

• Taking medicines for the pain
• Seeing a physical therapist to learn ways to maintain spine motion while stabilizing the spine
• Wearing a neck collar or back brace for certain types of spine problems
• Seeing a chiropractor for manipulation, which can help chronic back pain. Some people advise against chiropractic manipulation of the neck because of potential side effects. You should discuss this with the chiropractor or your physician.
• Trying massage therapy
• Getting acupuncture treatments to control the pain

If you see a surgeon who recommends surgery, consider getting a second opinion. Sometimes a second opinion from a rheumatologist (arthritis doctor) or physiatrist (physical medicine doctor) is helpful.

What Can I Expect Looking to the Future?

It is probably too early to predict the future of disk transplantation. Further research hopefully will show whether this new technique is better for neck problems than the other types of surgery. Also, we probably will learn whether this technique can be used for lower back disk problems as well.

I believe that technological progress will have a big impact on spinal surgery. This may include new computer and imaging techniques and new surgical instruments. New tools will be developed to help doctors better diagnose problems that cause spine pain. Many surgical instruments will be computer-aided. I am sure that new substances will become available to stimulate new growth of bones and disks.

I hope that all these will lead to better and safer treatments for chronic neck and back pain in the future.

- Added to Medpedia December 2008