By Kathleen Louden
Special to the Tribune

(October 10, 2006 - Chicago, IL) In his late 50s, Ken Peterson already was walking with a cane and suffered back pain so severe that many days he couldn't get out of bed. The condition worsened to the point that work was impossible, so last year he took early retirement from his job as a school librarian.

"I was bent over a cane for almost two years, and the pain kept getting worse," the Chicagoan said.

After conservative treatments failed, he was ready for a more invasive alternative. And now, pain-free at 59, he has found it.

It's a new approach to spine surgery that can avoid disc removal and spinal fusion, thus preserving flexibility.

Peterson had degenerated discs. Those shock absorbers that cushion the vertebrae, or bony segments of the spine, were worn out. The good news was that he was eligible for a new surgical implant that would support his spine without the need for spinal fusion.

For years, the main surgical option for people with degenerated or bulging discs was removal of the damaged discs, followed by fusing the vertebrae above and below the removed disc. Spinal fusion prevents motion in that area and therefore eliminates or decreases lower back pain, but it has disadvantages. Besides reducing mobility, the procedure can accelerate wear on the disc above the fusion.

Artificial-disc replacement can avoid the need for fusion, but not everyone is a candidate for disc replacement, according to Dr. Frank Phillips, an orthopedic surgeon at Rush University Medical Center. Phillips had spinal stenosis, or narrowing of the spinal canal, making him ineligible for disc replacement.

Now the new alternative is available and may preserve the natural motion of the spine. Called the Dynesys dynamic stabilization system, the implant is made of flexible surgical polyurethane and nylon cord instead of the rigid metal implants typically used in spinal fusion.

"It is designed to allow movement of the spine without fusion," Phillips said.

Phillips used the Dynesys system when he performed Peterson's back surgery last October, and Phillips' insurance covered the cost. Now free of back pain, Peterson called the procedure remarkable.

"I'm much more flexible than before the operation," he said. "Without it, I might be bedridden by now."

Peterson also appreciated the short recovery period for the Dynesys system -- about three months instead of six to nine months for spinal fusion.

He said he has resumed activities that he long hadn't been able to do. "I love working out at the gym," he said. "And I'm taking acting classes."

Dynesys is approved by the Food and Drug Administration as a fusion device in the lumbar spine, or back. The manufacturer is conducting a clinical study to evaluate other uses, including the use without fusion, but its Web site (zimmer.com) warns that the device's safety and effectiveness have not been established for use without fusion.

Until more data are available, Phillips said, he is very selective about which patients get the new device without fusion. He performs dynamic stabilization in patients whose instability in their vertebrae is not yet severe enough for spinal fusion. He also uses Dynesys in patients undergoing a fusion at two or three levels in their lumbar spine and whose disc at the next level shows wear but does not yet need fusion.

"I'll use Dynesys on the next level, which hopefully will prevent the disc from wearing out," Phillips said.

Reprinted by permission Copyright © 2006, Chicago Tribune

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