A bend in the road for back surgery

Artificial discs tested in Triangle

Chronic pain can make a man desperate -- so desperate he is willing to volunteer for mystery spinal surgery that may or may not provide lasting relief.

Adrian Reid, 38, is such a man. Plagued with debilitating pain in his neck and left shoulder, Reid, a software engineer from Garner, volunteered for a clinical trial that had him report to WakeMed Raleigh Campus for surgery last month.

He didn't know which of two surgeries he would get -- an established procedure to fuse two vertebrae in his neck or an experimental one that would replace his bulging disc with a springy silicone wafer.

Not even Reid's neurosurgeon knew which surgery he would be performing until moments before he picked up the scalpel.

"A computer in California makes that decision," said Dr. Kenneth Rich, who operated on Reid.

The pain Reid and other patients experience has driven them, along with their doctors and medical device companies, to embark on a grand quest. They're all searching for something that offers relief to the 26 million Americans who seek help for neck and back problems each year. Their pain exacts a huge cost: According to the National Institutes of Health, the annual cost of back pain is estimated at up to $70 billion, factoring in direct medical expenses and lost productivity.

One hoped-for solution is being tested in the Triangle. It is an artificial disc called NeoDisc, made by San Diego company NuVasive.

Disc replacement is not a new idea. Surgeons explored the approach as early as the 1950s, but it lost favor as popularity grew for other procedures, such as surgery to remove all or part of damaged discs. Disc replacement regained momentum in the 1990s, and since then, device makers have rushed to get artificial discs on the market.

Tentative inroads

At least a dozen companies, including NuVasive, are developing products designed to ease neck or lower-back pain. So far, just two companies have won approval from the U.S. Food and Drug Administration to market their discs.

Results for the new discs have been mixed, however. One approved device, a metal and plastic disc, has shown a tendency to slip out of place in some patients, requiring additional surgery to remove it. Often, patients then need a spinal fusion, which disc replacement is designed to improve on or even replace.

Fusion joins two or more vertebrae together in an effort to stop painful friction. But it can restrict range of motion. And the fused bones put additional stress on vertebrae above and below, causing damage over time that often requires additional surgery.

Also, results are spotty at best. Surgeons say 90 percent of fusion patients can experience a reduction in pain; studies show only about half experience total relief.

A ray of hope

Many surgeons, including Rich, are excited by newer artificial discs made of flexible materials so they're more like a natural disc. NuVasive's product, which is designed for use in the neck, is one.

"It moves; it's squishy," Rich said. "It's more like what's in us."

Half of the participants in the NuVasive trial are randomly assigned to have spinal fusion, and the rest get the silicone disc. Patients aren't told in advance which group they are in, in part to keep people from backing out. Some might prefer the newer surgery over spinal fusion.

Even so, recruits are not hard to find. People who suffer back injuries are often desperate for relief from chronic, life-altering pain. For many, the pain cuts into their ability to work, enjoy sports and hobbies, or spend time with family and friends. Some develop major depression; the condition is up to four times more common in people with chronic back or neck pain.