WebMD Chat “Cage Implants for Degenerative Disk Disease”

“Cage Implants for Degenerative Disk Disease”

The opinions expressed herein are those of the guest’s alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only. Moderator: Greetings all and welcome to WebMD Live! Our guest today is Robert Pashman, MD, and we will be discussing cage implants. Greetings Dr. Pashman!

Dr. Robert Pashman:

Thank you for having me.

Question:

Is it normal to have tons of pain a year after the cage surgery?

Dr. Robert Pashman:

No, this would indicate that either something is wrong or the surgery did not address the primary problem.

Question:

This chronic pain back thing sure causes a lot of mental stress and life change. Any suggestions?

Dr. Robert Pashman:

Chronic pain, leading to medication use, can change personality and decrease lifestyle and function. Chronic pain should therefore be treated aggressively.

Question:

What are cage implants? Does it involve dissolving the disk itself?

Dr. Robert Pashman:

The disk is completely removed and replaced with a device (cage) which carries bone into the former disk space and produces a fusion between adjacent vertebra. The fusion decreases motion and eliminates pain.

Question:

How would you aggressively treat chronic pain?

Dr. Robert Pashman:

It depends on the source of that pain.

Question:

Is there any way to get rid of scar tissue forever?

Dr. Robert Pashman:

Scar tissue rarely produces problems. If a patient has been told that scar tissue is the source of their pain, they should get a second opinion and attempt to determine the true source of their symptoms.

Question:

I have had five lower back surgeries, the last with the cage.

Dr. Robert Pashman:

This case is too complicated to answer in this format. This question can only be answered by a complete understanding of the patient’s history and objective finding. My web site (www.eSpine.com) was developed to handle these types of issues.

Question:

My doctor said I need an operation called “360 degrees.” He wanted to replace disks four and five.

Dr. Robert Pashman:

Please expand on your question, thanks.

Question:

He said that the 360 degree operation involves going through abdomen and then flipping me over and replacing the two disks with cadaver femurs. Would the cage procedure be advisable in this case?

Dr. Robert Pashman:

Many surgeons use cages instead of cadaver femurs. I prefer femurs because it allows me the option of shaping the implant into a configuration which matches the patient’s anatomy. Since cages only come in set sizes, this option is not available.

Question:

How does Neurontin (gabapentin) help nerve pain?

Dr. Robert Pashman:

No one knows. Originally developed to treat seizures, Neurontin was found to have beneficial effects on nerve pain. Anecdotal evidence suggests that it is beneficial.

Question:

I had the 360 degree operation done in July of 1999, and it worked great!

Moderator:

Are there advantages to this procedure over others?

Dr. Robert Pashman:

360 procedure operations are, in many circumstances, advantageous because they increase fusion rates, restore normal spine contours, and allow early rehabilitation. I use them extensively in my own practice, especially for “redo” surgeries.

Question:

When I try to stand, I feel real jerky (almost like electrical shocks). What could cause this?

Dr. Robert Pashman:

You need a diagnosis. I suggest you contact a spine practitioner in your community. It is important that your neurological symptoms be adequately worked up. If a spinal diagnosis is made, someone with spine training may be in a better position to offer efficacious treatment.

Question:

What state are you located in?

Dr. Robert Pashman:

I practice spine surgery in California. Although I am an orthopaedic surgeon, I do exclusively spine surgery. More information about my practice can be found on my web site at www.eSpine.com.

Question:

Is this operation routinely done in Canada?

Dr. Robert Pashman:

New technologies have not been embraced in Canada as in the U.S. This is probably due to cost considerations. For the correct indication, I’m sure a physician can be found in Canada who will perform the operation. I operate on many Canadians who wish to push the process forward more quickly.

Question:

Thank you so much for your time and answers. Why do I feel like I’m being forced to bend over and it’s hard to straighten up sometimes?

Dr. Robert Pashman:

One potential answer would be that when the spine ages, the tendency is for the spine to bend forward. Less flexibility from the aging spine would suggest a reason for both these symptoms.

Moderator:

Thank you for being with us today Dr. Pashman!

Dr. Robert Pashman:

Thank you for having me.