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Surgeons at Wyckoff Heights Medical Center, a member of the NewYork-Presbyterian Healthcare System, have implanted the FDA's first approved artificial disc into the spine of a 37-year-old man from Brooklyn. The surgery was one of the first of its kind to be performed in the tri-state metropolitan area, and the first in Brooklyn or Queens.

Unlike traditional spinal fusion surgery, an artificial disc allows the spine to maintain its natural flexibility and ability to absorb force. The procedure greatly diminishes back pain, permits quicker recovery times and shorter hospital stays.

The four-hour surgery was performed by Dr. John Boockvar, Assistant Neurological Surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, Assistant Professor of Neurological Surgery at Weill Medical College of Cornell University, and Chief of Neurological Surgery at Wyckoff Heights Medical Center; and by Dr. Gary Gwertzman, Attending Surgeon at SUNY Downstate Medical Center, Assistant Professor of Surgery at SUNY Downstate College of Medicine, and Attending Surgeon at Wyckoff Heights Medical Center.

Six days after surgery, the patient's Oswestry Disability Index (ODI) score, a self-reported questionnaire to measure disability, decreased to 26 percent. It had been 84 percent prior to the operation.

The Surgery

Entering the body through the abdomen, Dr. Gwertzman, the vascular surgeon, carefully navigated around the iliac veins and arteries, the major vessels that move blood throughout the body, and proceeded to create access to the spinal column. The approach is done from the front of the body to avoid damaging the delicate spinal cord, which rests behind the vertebrae of the spine. Once access to the spinal column was secured, the operation was handed over to Dr. Boockvar, the neurosurgeon.

Using a variety of instruments including a laparoscope, Dr. Boockvar removed the damaged disc that lay between the L5 and S1 vertebrae, and replaced it with an artificial one – sliding the disc between vertebrae as if sliding a coin into a slot.

The artificial disc – known as Charité and manufactured by DePuy Spine, Inc., a subsidiary of Johnson and Johnson – is about the size of a quarter and constructed of a high-density plastic sandwiched between two metal plates. Grooved teeth on the plates' outer sides keep the disc in place, as does the natural pressure of the spine.

"Spinal fusion," a surgery which involves removing a damaged disc and "fusing" the adjoining vertebrae with metal rods or screws, has been the traditional method of repairing collapsed or herniated discs. Fusion immobilizes vertebrae and keeps them from "rubbing against" each other, a common cause of back pain.

However, fusion has its drawbacks. Since it immobilizes a section of the spine, vertebrae on either side of the fusion must absorb more force to compensate. And this increases the risk that problems elsewhere along the spine will develop.

"Charité mimics a real disc," says Dr. Boockvar. "The entire spine remains flexible, and we anticipate the incidence of secondary adjacent-level problems to be reduced, as compared to spinal fusion."

The Charité Artificial Disc was originally developed at the Charité Clinic in Berlin, Germany, in the mid-1980's through cooperation between orthopedic spine specialists and the staff at Waldemar Link GmbH, a Hamburg-based manufacturer of medical devices.

American clinical trials for Charité began in May 2000, and a Stage III clinical trial, typically the final stage before a medication or procedure is awarded clearance by the FDA, was completed in April 2004. The Federal Drug Administration, satisfied that the Charité could safely and effectively treat back pain, approved it for the treatment of degenerative disc ailments in October 2004.

For more information, please contact the office of Dr. John Boockvar at 212-746-1996.