As many as 65 million Americans will suffer from back pain in their lifetime. But patients rarely find the relief they need. For those with extreme chronic pain, there has long been just one surgical option—lumbar fusion, a highly invasive procedure in which two vertebral sections are “fused” together using bone extracted from the pelvis. Back pain is eliminated, but so is the ability to bend and twist the affected portion of the spine. Fusion patients can barely get their hands past their knees, let alone touch their toes.
That’s why Frank Cammisa Jr., chief of spinal surgery at the Hospital for Special Surgery, is developing an inventive surgical technique known as total disc replacement (TDR). Most chronic back pain is caused by damaged discs, which put intense pressure on nearby nerves. In TDR, the disc is replaced by a prosthetic fashioned out of titanium, cobalt chrome, and polyethylene, the same kind of materials used in knee and hip replacements. In 2000, Cammisa read about a French physician who was using TDR, and traveled abroad to learn more. Cammisa had been skeptical of the procedure because he thought the synthetic material would wear down or easily slip out of place. But when he examined the French patients, some of whom had lived with synthetic discs for ten years, he was immediately impressed. “There had been no major wear, and the discs didn’t migrate,” he says. One woman was a professional dancer. Six weeks after the surgery, Cammisa says, “she and her partner were dancing like Ginger Rogers and Fred Astaire.”
Later that year, Cammisa imported the procedure to the U.S. and designed the first clinical trial for TDR. Since then, while seeking FDA approval, he’s done 60 TDRs—the trial team has performed close to 1,000—and he’s had extremely promising results: 90 percent of patients reported significant pain relief and a return to normal range of motion.
Because synthetic discs can be inserted through a small abdominal incision (lumbar fusion requires cutting through the lower back muscles), recovery time is also much swifter. After two weeks, Cammisa will let his patients drive a car. After three months, they’re back playing golf or tennis. Fusion patients aren’t allowed anywhere near a fairway until they’ve had as much as six months of rehab.
One of Cammisa’s patients, Robert Lanspery, had TDR in November. His degenerative disc disease had left him in excruciating pain. “I’d be walking, and I’d just suddenly fall down,” he says. “It felt like someone shot me in the lower back.” Two weeks after his surgery, he was walking a mile. “I hadn’t golfed in three years because of the pain. I’ve already gone out twice and played eighteen holes. Now,” says the 59-year-old IBM technology consultant, “work is the only thing that’s preventing me from playing more often.”