(EOVA) Geek Club

People participate in journal clubs or book clubs. Geek Club is my affectionate term for documenting summaries of all the geeky stuff I read. I work as a physiatrist at the East Orange VA hospital in NJ. This may also serve as a resource for the residents who rotate through there.

Tuesday, December 25, 2007

Intervertebral Disk Transplantation Shows Promise in Spine Disease

Lancet. 2007;369:993-999, 968-967.

March 22, 2007 — Preliminary experience in 5 patients with degenerative spine disease suggests that transplantation of fresh-frozen intervertebral disks preserved motion and stability of the spinal unit, despite some signs of mild degeneration in the disks over follow-up. Neurologic symptoms in all patients were also improved compared with before-surgery levels...The authors report that by the end of 3 months after surgery, good union of the graft end plates was seen in all patients...One patient with incomplete paraplegia caused by trauma, for example, improved to Frankel Grade D at final follow-up, from Grade B prior to surgery....No patient had any signs of immunoreaction to the graft. There was no olisthesis, but some mild degenerative changes were seen in the transplanted disks, they note..."I think this is a feasible surgical alternative to spinal fusion or artificial disk replacement," Dr. Luk told Medscape. "In a fusion, the motion of the segment will be lost. For artificial disk replacement, the major concern is the long-term outcome and the difficulties and risks with revision surgery. This biological approach enables the body to remodel the graft according to biomechanical laws."
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2 comments:

Gautam Malhotra said...

here's a comment from a friend of mine who wishes to remain anonymous
"There was another article on spine transplant a few months ago. I think it was a Chinese study looking at the cervical spine.

Like most spine surgery studies I've seen, they choose outcome measures that, IMO, are not particularly relevant. The outcome measure of whether the surgery takes- "good union of the graft end plates ", is a neccessary, but by no means sufficient criteria for calling surgery a success.

There are some surgical trials that look at functional outcome measures, like the Oswestry Disability Index, Short Form-36, etc. Those are more useful, IMO. I want to know what the patient can do after the surgery that they couldn't do before hand. Many studies, for example, show that certain types of spine surgery do not have success in returning patients to work.

Also, the long term complication rates for articial disk have been poor, and I am skeptical about the long term complications for transplant. Since they use an anterior approach, revisions can be extremely challenging, especially because they can have adhesions to the great vessels. "

December 27, 2007 at 7:35 PM
Gautam Malhotra said...

this is my response.

I would have to agree that artificial disc transplants have been disappointing thus far. But I found this quite exciting. joint replacements have completely revolutionized the way we are able to manage end-stage arthritis. Although this is only a very tiny step towards doing something similar in the spine, I can't even imagine how disk transplants may revolutionize the way we deal with spondylosis in the future.

I think your point about outcome measures is an extremely important one for all of medicine to consider. The authors of the study could have really strengthened their argument for disk transplants had they considered outcome measures such as the ones you listed.

December 27, 2007 at 7:40 PM

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