New disc gets Watsonville woman back in action Megha Satyanarayana - Sentinel Correspondent

WATSONVILLE - Stephanie Williams led a busy life before her lower back injury in 2004. The 38-year-old worked at Dominican Hospital, toted around her 14-year-old daughter, and she hung Christmas lights with her husband for the holidays.

After her injury, she could barely drive to her doctor appointments, and watched the Christmas lights go up without her. Mostly, she stayed at home.

Last month, Williams became the first person in the Monterey Bay area to undergo disc replacement surgery. Her artificial disc, approved by the federal Food and Drug Administration in August, is only the second approved disc replacement device available in the United States.

Before the surgery, Williams rated her pain an eight on a scale of one to 10. Now, she's a three or four, and looks forward to simple things like shopping at the mall, and driving longer distances. Soon, she says, she will head to Disneyworld.

"I'm blessed to have had this surgery," she said, "and the pain gets less as time goes by."

Williams has degenerative disc disease, where one of the protective cushions between the vertebrae in her back cracked, dried up and became worn. She felt burning and stabbing in her lower back and legs that never seemed to get better, even with physical therapy, strong painkillers and steroid injections.

Until recently, her best option for pain relief might have been to fuse together the two vertebrae nestling the worn disc, limiting her ability to move her lower back. However, in the past two years, the FDA has approved two types of artificial discs and Christopher Summa, Williams' doctor, thought she was a good candidate for the surgery.

Summa removed Williams' withered disc and replaced it with the latest artificial one, which he says will not limit her movement as much as fusion, but will still support her weakened back.

Williams was a good candidate for the complicated procedure, said Summa. She is between 25 and 60 years of age, and has only one bad disc in an otherwise healthy back.

"With degenerative disc disease," he said, "patients have unrelenting back pain for at least six months, and as a last resort, they talk to a surgeon."

Six months is sometimes enough for back pain to heal on its own, he said, making surgery of any sort unnecessary. For Williams, the six-month mark came while she was undergoing testing with Summa and his colleagues. Her pain had not changed, and Summa decided to replace her disc. Eighteen months later Williams finally got approval from her insurance company for this "experimental treatment," and was ready to go.

"I had done everything I possibly could, so I was ready for the surgery," she said. "Any relief would be better than what I was going through."

The surgery is complicated, said Monterey orthopedic spinal surgeon Mark Howard, who also does replacements. Doctors have to go through the stomach to put in the disc because going through the back risks damage to the spinal cord.

Doctors must take special care with two large blood vessels that run the front length of the spine. Scar tissue can build around the blood vessels, nestled near the vertebrae. It makes doing any follow up procedure dangerous. During surgery, there is risk of bleeding, infection and nerve damage.

It is rare, Howard said, but complications from surgery can be fatal.

In addition, said Summa, pain relief after surgery is not 100 percent. Williams still feels pain in her legs, even though her back pain is getting better.

Replacement discs are made of some of the same materials found in knee and hip replacements, but are fairly new in the United States. The first FDA-approved replacement came in October 2004, for a product developed and already in use in Europe. The disc in Williams' back was approved just weeks before her surgery. It is made of two metal plates anchored to the vertebrae above and below the worn disc. The replacement disc fits inside, and is made of a tough plastic sometimes found in bulletproof vests.

These discs are so new, some doctors are not yet sure they are any better in the long run than the older fusion procedure. Some of the surgical risks are the same, said Dr. Glenn Harper, a Santa Cruz spine surgeon, and there have been no studies to show if the artificial disks prevent a long-term complication seen in fusion patients - wearing down of the spine above and below the damaged disc. He is not against disc replacement, but does not think he will switch over completely right away.

"If a patient comes in, thinking this is the answer to their back problems," he said, "that may not be correct."

Still, Summa and Howard are optimistic about artificial discs. Summa prefers the newer version because it is more supportive than the previous model. Howard sees a bright future for these devices, as they go through multiple generations of improvements. Now they both wait to see how patients like Williams fare over time.

"This is an exciting new technology for younger patients," said Howard. "This is a very viable alternative to fusion."