Tuesday, February 15, 2005

Back surgery evolves
UCI doctor is a proponent of new operation that uses body's ability to grow its own new bone.

By MAYRAV SAAR
The Orange County Register

It most often happens in your teens or 20s. You do something simple: fall off a mountain bike, take a spill at your restaurant job. Then, for the next 10 years, the injured disks separating the bones of your spine dry up, degenerate and collapse.

For most people, the result is occasional but manageable back pain.

For about 10 percent, though, the pain can be excruciating, in which case doctors will recommend that the vertebrae of the spine be fused together. In an intricate, expensive operation, a graft from a person's hip bone is placed between the vertebrae. Usually the hip bone becomes connected to the spine bones.

But 20 percent of the time, nothing happens. The vertebrae never fuse. The pain never goes away. And patients are left with aching hips to match their bad backs.

Dr. Charles Rosen believes there's a better way. For the last two years, Rosen and about 2,000 other spine surgeons around the country have been using a genetically engineered human protein to encourage the spine to grow its own bone - and leave the poor hip out of it.

In a four-hour surgery, surgeons place bone morphogenic protein, or BMP, in a titanium cage between the vertebrae that need to be fused. BMP acts as a kind of bat signal, calling stemcellsto swarm the site and grow new bone. The body contains its own morphogenic protein in small amounts, but not nearly enough to grow bone at the rate required for surgery, Rosen said.

"It's the exact protein that the human body produces when it needs to have bone formed," Rosen said. "It's synthetic, but it's exact."

Since BMP received FDA approval in 2002, 100,000 surgeries have been performed in the United States. That's a small percentage of the 115,000 spinal-fusion surgeries performed each year, and Medicare doesn't cover the procedure. But Blue Cross of California and other insurers are recognizing the benefit of the surgery and are starting to pick up the tab, and Rosen expects BMP to become the industry standard.

"We're getting close to 100 percent fusion success rates, which is unheard of. From my standpoint, it's incredible," Rosen said.

Ginger Prewitt is equally amazed. Having heard horror stories from an uncle who had the traditional hip-graft variety years ago, Prewitt was resistant to fusion surgery at first.

"When spinal fusion was presented to me, I said, 'Oh, no,' " Prewitt said.

Prewitt, 33, took a tumble at her Disneyland job when she was 21. Since then, she has had three minor back surgeries, which helped relieve the pain. But as often happens, the injured disk between her vertebrae eventually dried out, and her spinal bones were falling closer and closer together.

By October, the pain had returned and was so bad, Prewitt could no longer drive, walk her dog, work or even sit. She had little choice.

About two-thirds of adults have lower-back pain at some time. While most do fine without fusion surgery, the rate of lumbar fusion surgeries leapt 77 percent between 1996 and 2001, prompting the New England Journal of Medicine last year to publish an article titled, "Spinal-fusion surgery: The case for restraint."

The article argued that the $34,000 surgery is overused and not necessarily safer or more effective than a combination of physical therapy and pain management.

Rosen concurs that only about 10 percent of back pain patients actually need surgery, but he believes BMP is much safer and will help raise success rates of back surgery.

"Patients can be back to work in two to four weeks. It used to be three to five months," Rosen said. "But like any new procedure, (doctors) will be following it in the literature."

Prewitt, for one, is sold. Instead of the long recovery time and lingering pain her uncle experienced, Prewitt finds herself walking her dog, Maggie, and feeling wonderful three weeks after surgery.

"I'm feeling really good," she said. "The pain is gone."