Air Force doctors perform alternative back surgery

(From left) Majs. (Drs.) Steven Cyr and Michael Peck ensure the abdominal area is ready for disc replacement here. Dr. Cyr is the orthopedic spine surgery chief at Wilford Hall Medical Center, and Dr. Peck is a general vascular surgeon with the 859th Surgical Operations Squadron. (Inset image) An X-ray image of the newly placed artificial disc helped surgeons ensure proper alignment and movement of the spine. (U.S. Air Force photos by 1st Lt. Benjamin Silva)

By 1st. Lt. Benjamin Silva
59th Medical Wing Public Affairs

LACKLAND AIR FORCE BASE, Texas -- Doctors at Wilford Hall Medical Center here performed a total-disc arthroplasty procedure March 7. The procedure was the first of its kind to be performed at any Air Force medical center.

Maj. (Dr.) Steven Cyr, chief of orthopedic spine surgery, successfully removed and replaced a spinal disc from Tech. Sgt. Loren Dick, an acquisition logistics manager from Scott Air Force Base, Ill.

Developed in Europe nearly 17 years ago, the procedure recently underwent a two-year clinical trial in America. The Food and Drug Administration approved it in October.

Previously doctors were limited in options for the treatment of chronic back pain, specifically lower-back pain.

“Typically, a patient with lower-back pain is first treated with nonoperative conservative measures, which include medications, therapy and bracing. For people who (do not improve with) those treatments, their only alternative would be operative care. The standard has always been spinal fusions,” Cyr said.

The new alternative procedure appears to be the most promising because it can provide patients with continued motion of that region, instead of fusing their vertebrae, Cyr said.

“With spinal fusions, doctors fuse the spine at one level, and the levels above and below end up absorbing the stress of the lost motion in that segment. Degeneration may eventually occur, causing more back pain near the fused site,” Cyr said. “In addition to stress being transferred from one level to another, the fusion itself limits the patient with respect to activities after the surgery, and in many cases Airmen get medically (discharged).”

Airmen who undergo spine fusion are limited in activity and normally do not return to functional duty for at least three months. They are not allowed to drive and are usually placed in a back brace to aid in the bone-fusion process.

“With total disc replacement, doctors have seen a much quicker turnaround; patients don’t have to wear a brace, they don’t have to be out of work for three months, they can return to active duty within a week or two, their restrictions are not as heavy, they usually start therapy a lot sooner and, in most cases, (they) experience less back pain,” Cyr said. “Hopefully, not only do we help our Airmen get better, but we are also possibly preventing future surgery for them as well by giving them continued motion at that level.”

A total-disc arthroplasty involves the complete removal and replacement of one lower back disc. The disc is removed and replaced with a three-piece medical device consisting of a sliding core sandwiched between two metal endplates. The sliding core is made from a medical-grade plastic, and the endplates are made from medical-grade cobalt chromium alloy. These materials are not harmful and are used in many other medical implants such as total hip and knee replacements.

The doctor’s ability to properly center and place the new disc in the spine is crucial.

“The key lies in making sure all the cartilage is cleared and the bone isn’t damaged. Once the area is clear, we then center and place the new disc in, restoring motion at that level,” Cyr said.

“I’m very excited to have this procedure done; I’m real tired of living in pain for the last four years, and I hope to be pain free after the surgery,” Dick said.

Before Sergeant Dick’s injury, he spent 13 years working communication navigation on Air Force aircraft such as KC-135 Stratotankers, MC-130H Combat Talon IIs and C-141 Starlifters. He moved to Scott in February 2003. Shortly after arriving, his wife died; he currently lives with his son, Derek, 6, and daughter, Rebekah, 3.

“I just want to be pain-free and play with my kids; that’s why I’m here,” Dick said.

Anyone who is interested in having this procedure done should see his or her primary care manager for a referral. To qualify for this surgery, a person must suffer from discogenic pain at one level of the spine and not have improved with conservative treatment for a minimum of 6 months. Individuals who either have an infection throughout their body or spine, spinal instability, previous anterior spinal surgery or poor bone quality such as osteoporosis are not candidates for this procedure.

Although the indications for the surgery are narrow and it is unlikely to replace fusions altogether, total-disc arthroplasty appears to be a great alternative for a select group of patients, officials said.

“I think this is a great thing for the Air Force and our Airmen. We have several Airmen who are eager and want to get back to work, and if we can assist them in restoring their back health and getting them back on track, I’m all for it,” Cyr said.