RGV doctors begin to offer new treatment for neck pain

McALLEN - For some people with severe neck pain related to a so-called "bulging" or "deteriorating" disc in the neck, surgery might be the only answer.

Traditionally, for those patients, doctors have performed a surgery that fuses the vertebrae together to stop them from moving. Now, there's a new option.

This week, an orthopedic surgeon at McAllen Medical Center started performing surgeries with a new device that could replace the old "spinal fusion" approach and preserve the neck's mobility.

Other Rio Grande Valley doctors, however, are reluctant to start using the device because its long-term reliability is still unknown.

The U.S. Food and Drug Administration in December approved the Synthes ProDisc C, a metal-and-plastic device that serves as a replacement for the disc - the protective cushion - between two vertebrae in the neck. The device helps preserve the space that would normally exist between those vertebrae, according to the FDA.

Another disk-replacement device, the Prestige cervical disc, was approved by the FDA last summer.

"With the old way, fusion, (patients) would do well for a while, but it caused stress to the vertebrae over time, and they often ended up needing a second operation," said Dr. Ray Fulp, a McAllen orthopedic surgeon. Fulp performed a handful of cervical disc-replacement surgeries on Monday - the first ones in the Valley, he said.

"This device is motion sparing. It's designed to replicate the normal motion of the cervical spine ... and that hopefully will prevent the need for future surgeries," he said.

Other local doctors said they aren't performing the procedure yet because they're not convinced it's any better than the older approach.

"It's something new to treat neck problems, but it hasn't been proved yet that it works better," said Dr. Alejandro Betancourt, a Harlingen neurosurgeon. Betancourt said he isn't using the devices for now, opting for the time-tested fusion procedure instead.

"I don't think it's going to be a panacea," Betancourt said. "I could do (the surgery), but I don't think there's enough literature, research on it yet."

The disc-replacement approach does have some promise in treating cervical-disc problems, but it will take time for the evidence to come in, said Dr. Rex Marco, associate professor in the Department of Orthopaedic Surgery at The University of Texas Health Science Center at Houston.

"Some people really feel it's going to be a better solution than spinal fusion," Marco said. But because the devices are so new, doctors don't know the long-term results, he said.

Marco believes that most cases of back pain can be resolved without surgery. Many of his patients improve with rehabilitation, he said.

"I don't think surgery is the best thing most of the time," Marco said. "It's potentially a really good solution for only a small group of people."

Also, most insurance companies won't yet pay for the new procedure, some surgeons said.

Cost of the new cervical device is about $3,000 to $6,000, said Stephen Sutton, sales consultant with Synthes, which markets the ProDisc C. That figure doesn't include other hospital costs.

According to a study from the Hospital for Joint Diseases in New York, N.Y., disc replacements in the lower spine end up costing less than spinal fusions, however - about $36,000 for the disc replacements versus $46,000 for fusion surgery, the study says.

Some evidence exists that patients could recover more quickly from the disc-replacement procedure, Marco said. But overall, it's still too soon to know the trend, he said.

Fulp, for one, is convinced that the new procedure is better than spinal fusion, and thinks it will benefit his patients.

"It's a new and improved technology ... and the studies have been very encouraging," he said.