Fabien Bitan, MD, a spine surgery chief at Lenox Hill Hospital in New York City, successfully performed an M6 artificial cervical disc replacement surgery on a 29-year-old woman.
The patient was suffering from post-traumatic cervical disc herniation due to a car accident.
Dr. Bitan used the M6-C disc in the operation. Here, he details the surgery and outlines how cervical disc replacement could evolve in the future.
Note: The following responses were edited for length and clarity.
Question: Can you briefly describe the procedure? What was the most challenging aspect?
Dr. Fabien Bitan: When a disc becomes painful because of an accident or other cause, the treatment is to remove it. However, the space between the vertebrae cannot be left empty. Traditionally some bone material is placed in the space between the vertebra that eventually heals and is incorporated realizing a fusion.
The alternative is to use an artificial disc which restores motion and avoids many of the fusion's drawbacks. This new M6 artificial disc is different in the fact that for the first time the insert is viscoelastic mimicking the normal disc instead of a rolling device. This should in theory improve the biomechanic of the replacement. The most challenging aspect is the precise placement of the device. As opposed to fusion where the placement is not pivotal as long as you get bone to heal, in artificial discs the placement has to be close to perfect because imperfections can lead to dysfunction of the spine joints leading to pain and early arthritis.
Q: How do you see the M6-C disc developing as an alternative to spinal fusion?
FB: In my opinion artificial disc technology should gradually replace many indications for fusions. Fusions will however remain a valid option for severe cases or in spinal deformities or instability. Technology evolves constantly. M6 is the latest advance but experience and time will tell if it constitutes a real improvement on the patient's standpoint. Other companies are coming up with original designs. I would like to point out that the disc I have been using for years gave me and my patients great satisfaction. We need to remain open and vigilant and let the competition work its magic. The best choice is not always the most attractive device. Our loyalty as physicians must be with the patients, who put their trust in our hands, not with the manufactures.
Q: What do you see as the next big trend in spine?
FB: Multilevel artificial disc should be accepted mostly because this is where the benefit of this procedure over a fusion is the most obvious.
New design should make it less challenging for spine surgeons who don't necessarily have hundreds of cases of experience. Thus far perfect positioning is still challenging and I like to say that a good fusion is still better than a sub-optimally placed artificial disc.
Regenerative medicine such as stem cells promise to one day replace all these surgical procedures. Future or science fiction? We will see.