Additionally, incorrrectly diagnosed cases that may require additional screw fixation to the spine, i.e. spinal fusion, is a notorious cause of ‘failed back surgery syndrome’ after spinal decompression for lumbar canal stenosis. Therefore it is  mandatory for patients seeking advice regarding surgery be reviewed by a spinal surgeon that is competent at making an accurate diagnosis followed by a stepwise management and counseling of the condition before possibly considering minimal invasive surgery.

It is interesting to note that he strongly advises against use of manipulation, saying; “Manipulation can make sciatica and brachialgia worse and should not be considered until the patient has been seen and assessed by a spinal medical or surgical specialist. Although both sciatica and brachialgia can settle down spontaneously without any intervention, they are very different from simple mechanical back or neck pain, and the two should not be confused. While some people get twinges of sciatica or brachialgia for short periods of time from minor nerve root compromise, when there is significant nerve compression patients get no respite at all and find the pain all consuming, stopping them from standing or moving properly, and usually also stopping them from sleeping.”

Anyone suffering unnecessarily from back problems should have a look at these expert articles that clearly explain the latest diagnosis and treatment options.

Bone healing following fractures and for that matter, following spinal fusion that is used to treat low back pain from disc degeneration, involves a complex interplay of local biological and biomechanical factors that help stimulate bone formation. Currently donor bone is harvested from the pelvis (hip bone) for spinal fusion but this method can cause pain locally with delay in mobilisation, extra bleeding, prolonged surgical time, local infection and the quality of the bone harvested remains inconsistent. At best, the fusion rates are also suboptimal and quoted to be approximately 70 – 80 %. This protracted healing process takes some 4 to 6 months to produce bone that is sufficiently strong enough to withstand daily weight-bearing loads and up to 9 months for the remodelling process to occur before normal bone is achieved.

The technique described at USCD is impressive but clearly is in its infancy. At present, only a few surgeons like myself routinely use BMPs (bone morphogenic proteins, notably recombinant BMP-2 or r-BMP-2) to accelerate spinal fusion as this method has been demonstrated to produce near 100% fusion rates at 3 months, albeit at a price. But I would consider this money well spent especially if a near 100% fusion rate is achieved and of course, this is less of a concern if the costs are reimbursed by the patient’s insurance company. BMP used for spinal fusion has been shown in many clinical studies to greatly improve the quality and quantity of the spinal fusion and with that, associated greatly improved clinical results, i.e. much reduced low back pain.

Therefore, any biological methods that accelerate the fusion process, such as the one described, remains highly desirable as this allows patients to mobilise and rehabilitate quicker, associated with no harvest donor bone graft site problems and an early return back to work and activities, including sports. The indirect effects of this would be greatly improved psychological and economic societal costs. I look forward to hearing about this new technology for its use in bone healing in humans.

Let us know if you’d like to learn more about BMP.

Mr Lam accepted the prestigious award on behalf of the staff: “I am deeply honoured and  extremely grateful that my work has been recognised in this way by the EEDCM. I have accepted this award on behalf of the Guy’s and St Thomas’ Trust, my colleagues and patients that I have treated. This award will inspire us to continue with all our good work at the hospital”. See the press release

The piece began:

Each year, 40 to 60 percent of American adults suffer from chronic back pain. For patients diagnosed with severe degenerative disc disease, neurosurgeons must perform surgery called discectomy — removing the IVD — followed by a fusion of the vertebrate bones to stabilize the spine. Even after all that effort, the patient’s back will likely not feel the same as before their injury.

Khai Lam, Consultant Orthopaedic Surgeon at the London Bridge Hospital has a view of his own.

There has been a great deal of debate regarding the feasibility of growing one’s own disc for auto-transplantation, so called ‘autologous disc transplantation’. The main main challenges are 1) ability to harvest the correct disc and cellular material, 2) growing the cells in optimal laboratory conditions, 3) implanting the cells in a biomechanical and biocompatible scaffold, and 4) surgical methods to transplant the bio-scaffold containing the healthy living cells into the spine. From the cellular point of view scientists have shown that there are 3 different types of cells that exists in the human disc but presently they are uncertain as to their origin and true function. Additionally scientists and surgeons are uncertain whether these cells will continue to remain viable once harvested and their ability to regenerate outside the spine when the mechanical loads are totally different. The next major hurdle relates to the ability to create a biologically and biomechanically compatible scaffold that would keep the cells alive in the laboratory before incorporation into the spine. Then the surgical technique of scaffold transplatation remains very destructive indeed and is by no means performed via minimally invasive surgery. The latter, however, is being increasingly practised by some surgeons when performing fusions and/or disc replacements. These current state of the art surgical techniques carry much more reproducible results and cetainly are not considered experimental. Therefore autologous disc transplantation remains an attactive but experimental treatment option but there are presently far too many early hurdles and uncertainties to allow for its use in humans.