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Local Physician Performs 1st Artificial Disc Replacement in Pennsylvania

Jocelyn IdemaEarlier this year, Jocelyn Idema, DO, of Washington, PA-based Advanced Orthopaedics and Rehabilitation, became the first spine surgeon in Pennsylvania to perform lumbar disc replacement using Aesculap's activL Artificial Disc.

This is a breakthrough approach to treating chronic lower back pain caused by degenerative disease. The procedure is designed to help maintain normal motion in a person's lumbar spine. Previously, patients would receive lumbar fusions for certain types of back pain.

"This was unfortunate when it came to younger patients because if you fuse a level in the back, it no longer moves," explains Dr. Idema. "This means the motion has to come from somewhere. Usually the disc above it has to work a lot harder which can cause degeneration at the level above. Then you may end up adding on to the fusion 10, 15, or 20 years down the road."

This new and better technique involves an artificial disc that is now in its third generation, notes Dr. Idema.

"It's a good technique for younger patients with isolated low back pain that we can identify is caused specifically from the disc degeneration," she says. "They have to have minimal joint arthritis otherwise their back pain will continue because they're still having that motion back there."

Based on outcomes from the Artificial Disc clinical trial and Dr. Idema's own patient feedback, she believes that the activL Artificial Disc represents the next generation of spinal disc replacement technology.

The activL includes cobalt chromium endplates that affixes to a patient's vertebrae with bone-sparing spikes to help stabilize it. It then uses mobile ultra-high molecular weight polyethylene core to support the controlled translational and rotational movements. Dr. Idema trained on the technique under Scott Blumenthal, MD, at the Texas Back Institute's Center for Disc Replacement in Plano.

According to Dr. Idema, the ideal candidate is anyone younger than 50 with isolated lower back pain on one level or one disc.

"One recent patient had isolated pain on the very last disc on his back and it was nearly bone on bone at that point," she says. "So we placed the artificial disc in there so that the disc above, which was nice and healthy, would remain that way as long as possible."

The procedure, which usually takes two hours, begins from an anterior approach through a patient's stomach. A vascular surgeon would assist Dr. Idema to help get her down to the spine. This is usually the longest portion of the procedure, taking anywhere from 20 minutes to an hour. Adding the artificial disc then just takes about an hour.

Since the procedure begins through the front of a person, there is some manipulation of the intestines. As a result, the patient has to stay in the hospital for about 48 hours until their intestines start to "wake up" again. However, Dr. Idema says that the patient is typically up and walking immediately after surgery and can begin physical therapy the same day of surgery.

While this procedure has provided immediate relief to patients, Dr. Idema cautions that surgeries such as this are still always the last resort.

"We evaluate all patients and send them to physical therapy or prescribe medication to try and help with the pain," she says. "Typically, 90% of the time that helps them to the point where they don't need anything else. If they do come back after six weeks—which is the usual benchmark to see if physical therapy is going to alleviate their pain—we then get an MRI to see what's happening in the back."

Since X-rays only give physicians only one piece of the puzzle, it's then just a matter of what appears to be their pain generator. With the back, Dr. Idema says the pain can be the result of all sorts of things—muscles, ligaments, arthritic joints, or degenerative discs. Another organ may be the cause of the pain too. For example, your kidneys and intestines can refer pain to the back.

"It's really my job to figure out which one of these is the problem," says Dr. Idema. "The lumber disc replacements are effective for young patients who have isolated degenerative disc disease. So if you're under 50 years old and have isolated pain on just one disc and physical therapy, medication, and epidural injections did not work, then we're left with a surgical option. This procedure can reduce your pain, increase your range of motion, and get you back to work faster than other alternatives."

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For more information, visit www.advancedorthopaedics.net.

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