Utah orthopedic, spine surgeon debuts artificial disc for neck

WEST JORDAN — Tammy Keyser can move her head any way she wants, looking up or down, shrugging, swiveling her neck to look over her shoulder. It's not a small feat for someone who had spinal surgery to repair a herniated disc just two weeks ago, with a small scar on her throat as the only indication.

Now she's back at work at Salt Lake Community College and more active than she's been in some time, because the pain is gone.

She is the first Utahn to have a new kind of artificial cervical disc implanted. The Medtronic Prestige Cervical Disc is made of stainless steel that allows full flexibility, unlike the more commonly used spinal fusion.

When a surgeon does a spinal fusion, he removes the herniated or ruptured disc and uses bone to maintain the space, then screws a small plate to the two vertebrae on either side of the disc, to hold it rigid until it fuses. Cervical spinal fusion is "one of the most successful surgeries" around, according to Dr. Armen Khachatryan, orthopedic and spine surgeon at the Center of Orthopedic and Rehabilitation Excellence at Jordan Valley Medical Center.

The Medtronic device won Food and Drug Administration approval last summer, and an FDA panel said it was superior to fusion, the gold standard surgery, "in both pain relief and overall function," Khachatryan said.

During clinical trials, he implanted about 15 of the devices and was pleased when it won approval. Now he's the first doctor in Utah to use it.

Some insurance companies have not yet approved payment for the technology — "a few have, and we are sure more will," said Medtronic's Chad Field — so it has been implanted only once in Utah, in Keyser, since it won market approval. But Field said about two dozen Utah surgeons have trained and are now able to implant the disc.

It doesn't change the length of the surgery much, Khachatryan said. The damaged disc still must be removed. But instead of inserting bone, the surgeon looks for the closest fit in terms of depth, width and length, then implants the artificial disc, which has a small ball that comes down on the bottom of the upper vertebrae and locks into a matching depression on the piece that goes on the top of the lower vertebrae. Then the artificial disc is fixed in place with screws. The patient is monitored overnight to make sure there are no complications and is released the next day.

Currently, the Prestige is available for people who have not had previous spinal surgeries. That's likely to change, Khachatryan predicts, as it is used more. Eventually, he believes it would prove effective for those who've had a spinal fusion if they need other cervical discs replaced.

Someone with no disc space can't have the surgery either. There has to be room for a good fit with the artificial disc.

A similar technique has been used for the lower back, but this is the first of its kind for the neck area.

Keyser, 45, said after surgery it was such a relief to have the pain from the herniated disc gone that she hardly noticed any from the surgery itself.

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E-mail: lois@desnews.com

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