VIA Disc is a minimally invasive outpatient procedure intended for patients with degenerated lumbar intervertebral discs. It helps to rebuild discs biologically. But before getting into the specifics of the procedure, we need to start with the condition that it targets for treatment.
What Is Degenerative Disc Disease?
The discs in your spine are rubbery cushions between the bones in your spinal column. These bones are known as vertebrae. These discs act as shock absorbers. As you move, bend or twist, your discs enable you to do that comfortably. When they are healthy, discs act as a structural cushion to help distribute shocks and pressures to your spine evenly.
The biomechanical ability to cushion shocks and pressures is enabled by a disc’s ability to absorb and retain water. Water within the disc generates a swelling pressure that resists loads and maintains the height of the disc.
After the age of 40, our discs can begin to degenerate. This is known as degenerative disc disease. Wear and tear of our intervertebral disks causes a loss of hydration – the ability we’ve discussed to absorb and retain water – along with degeneration of the discs themselves.
For many, as this degeneration occurs, we don’t develop any symptoms. But for about 5% of us, this disc degeneration prevents discs from doing their job properly. When this happens, it leads to back pain.
Illustration of an intervertebral disc functioning with natural cushioning
A new nonsurgical option is now available. It is called VIA Disc and is designed to rebuild damaged discs biologically.
The VIA Disc procedure is an allograft. An “allograft” is a tissue graft. The treatment is designed to help a disc regain and preserve its ability to absorb water and repair disc damage.
What Are Regenerative Biotherapeutics and Orthobiologic Medicine?
What do we mean about rebuilding discs biologically? The human body has the natural ability to heal itself in many ways. Cuts to the skin repair themselves, broken bones mend and a living-donor’s liver regenerates in a few weeks.
Regenerative Biotherapeutics includes therapies that support the body in repairing, regenerating and restoring itself – taking our natural healing ability and helping it along. These therapies prompt the body to enact a self-healing response.
Popular uses of regenerative biotherapeutics today include treatments from Non-Hodgkin’s Lymphoma and Leukemia to Osteoarthritis and Rheumatoid Arthritis, and many other conditions in between. Variations of regenerative biotherapeutics use therapies such as platelet rich plasma (PRP) and stem cells. When regenerative biotherapeutics is used to help heal musculoskeletal conditions it is also commonly referred to as orthobiologic medicine.
What Is VIA Disc?
VIA Disc is an orthobiologic regenerative therapy that seeks to reverse the age-related wear and tear of intervertebral discs – along with the degeneration and loss of hydration that results with this deterioration.
This treatment uses biologic growth factors and cytokines extracted from intervertebral discs. This extraction is enhanced with additional solutions to promote this therapy’s effectiveness.
During an outpatient, non-surgical procedure, this mixture is injected into the damaged disc. The strategy behind it is that by supplementing disc tissue, it seeks to enhance the biomechanics of the damaged disc. This in turn overcomes the imbalance that has occurred from degenerative tissue loss.
In more simple terms, the ability of a disc to cushion is regained. And its deterioration is halted and reversed. And with that, associated pain is reduced.
You may have heard of ‘degenerative disc disease.’ This term doesn’t actually refer to a disease, but instead to a condition in which a damaged spinal disc causes pain.
A Quick Review of Spine Anatomy
What role do discs play in our spines? Your spine is made up of a series of bones that run from the top to bottom of your back. Discs sit between each of these bones. They serve as shock absorbers and provide flexibility for your spinal column. Normally, each of your discs is directly adjacent to your spinal nerves.
Facet joints also play a key role in the spine. They are the connections between the bones of the spine. Thus, the spinal bones, discs, facet joints and nerves all function together to enable our mobility along with far more complex body functions.
What Is Degenerative Disc Disease?
With that quick spine anatomy review in-hand, we can now look at what exactly is degenerative disc disease. This condition is the progressive deterioration of spinal discs and arthritic changes in facet joints due to wear and tear with aging.
Bone spur overgrowth is related to degenerative disc disease. It can also cause a narrowing of the spinal canal, resulting in spinal stenosis, where the nerves running up that canal are compressed. This causes pain, numbness, and weakness in the legs.
There are a host of additional conditions associated with degenerative disc disease, including lumbar radiculopathy (also known as sciatica), neurologic claudication, and degenerative spondylolisthesis. They all are part of the challenges we face with our spine as we age and strive to remain active in our lives.
Illustration of a spine with degenerative disc disease.
Non-Surgical and Minimally-Invasive Treatments for Degenerative Disc Disease
In most cases, the initial preferred path to treat degenerative disc disease are non-surgical and minimally-invasive options. These include:
Medications: Over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs) can help control the inflammation, swelling and pain symptoms.
Physical Therapy: Some individuals experience disc problems due to excessive sitting or poor muscle development in the back. Physical therapy can help to improve and balance muscle mass, lower pressure on your back, and improve posture.
Weight Loss: If you are overweight, reducing your BMI can help significantly improve stress on discs and the spine, and reduce pain.
Epidural Steroid Injections: Flouroscopic-guided epidural steroid injections, precisely targeted near spinal nerves, discs, or joints, can reduce inflammation or pain.
Radiofrequency Neurotomy: This procedure uses radiofrequency waves to generate heat to target specific nerves. It temporarily disables those nerves’ ability to send pain signals. For some patients, radiofrequency ablation may reduce or eliminate pain for months.
Spinal Cord Stimulation: Spinal cord stimulators are medical devices that a doctor can implant in your body to manage chronic pain. They deliver electrical stimulation through thin leads to nerves along the spinal column. This modifies or blocks nerve activity to minimize the sensation of pain reaching the brain. A patient directly controls this stimulation activity by using a small external remote.
But what happens if these options prove to be ineffective or inappropriate for a patient?
Traditional Surgical Treatments for Degenerative Disc Disease
Until recently, the only options to treat degenerative disc disease other than non-surgical and minimally-invasive pain management have been surgical intervention and artificial disc replacement. Given the serious nature of this kind of back surgery, they traditionally are recommended only when all other alternatives have been exhausted.
Discectomy and Laminectomy Surgery
One of the first procedures developed for degenerative disc disease are a discectomy and laminectomy. In this surgery, a surgeon removes part of the bulging disc and part of the bone around the spinal canal.
There are two issues however that can result from this procedure. First, the removal of the disc material weakens the disc, so there is a risk for the disc to re-herniate. And second, the removal of bone can make the spine segment more unstable. As a result, pain can return in some instances. When it does, the resulting condition is called “Failed Back Surgery Syndrome.”
Spinal Fusion
In order to try to fix issues associated with discetomies and laminetomies, surgeons developed a procedure called spinal fusion. They targeted the issue of pain often being caused by spine instability. And spine instability was due to degeneration along with a loss of the height of a disc.
In the spinal fusion procedure, a spacer along with hardware is inserted to prop the disc up. The goal is to aleviate pain by preventing the degenerated spine segment from being able to move at all.
However, after spinal fusion, when one segment no longer can move, more force is exerted on other parts of the spine to compensate. As a result, new spine problems and sources of pain can crop up along adjacent parts of the spine due to the increased stress.
Artificial Disc Replacement (ADR)
To solve these problems, artificial disc replacement (ADR) emerged as an alternative. Rather than fuse two spine segments, the concept is to implant an artificial disc between them. This allows motion and props up disc height, alleviating the problems with fusion.
The artificial disc replacement technique however can have post-operative issues similar to that of spinal fusion surgery. In part, this is because the motion of an artificial disc joint isn’t natural. Stress on adjacent spine segments can still occur.
The Case for Surgical Spine Intervention and Artificial Disc Replacement
Despite the issues we’ve raised, there are circumstances where spine surgery is the most effective treatment to reduce pain and relieve symptoms. While spine surgery may limit flexibility, it can be successful in arresting pain.
If a medical professional or spine surgeon has recommended spine surgery to you, you should certainly consider it. Doctors evaluate many factors, and spine surgery may be the only viable alternative for a particular patient.
Physical Medicine and Rehabilitation doctors will normally recommend a spine surgeon when non-surgical and minimally-invasive spine pain management alternatives have been exhausted.
New, Non-Surgical Alternatives to Spine Surgery
Against this backdrop, two new alternatives to spine surgery have emerged: VIA Disc and the Intracept Procedure. These may be options for some patients seeking back pain relief and for who other non-surgical approaches have been ineffective or inappropriate.
What Is VIA Disc?
VIA Disc is a novel approach to address degenerated discs is to rebuild the disc biologically. In recent years, advances in regenerative medicine have advanced dramatically. They have taken their cue from the fact that the human body has a natural ability to heal itself in many ways. For example, skin cuts repair themselves, broken bones mend, and donated liver transplants regenerate.
Orthobiologic regenerative medicine is focused on taking this natural ability, directing it, and helping it along. The VIA Disc procedure uses biologic growth factors and cytokines extracted from intervertebral discs. These are enhanced with additional solutions to promote this therapy’s effectiveness. This procedure supplements tissue and cell loss that is associated with degenerative disc disease in the lower back.
During an outpatient, non-surgical procedure, this growth factor and cytokine mixture is injected into degenerated discs under imaging guidance with moderate sedation. The goal is for this supplement to stimulate the regeneration of the disc itself – and improve its functionality.
Studies have shown that those undergoing this procedure showed pain and function improvements that continued to be evident 12 months after the treatment.
What Is the Intracept Procedure?
Another option that has recently emerged is the Intracept Procedure.
Referencing back to our opening discussion about spine anatomy, at the point where discs meet the vertebrae bone is a layer called the vertebral endplate. This endplate is a mix of cartilage and bone that separates these two elements of your spine.
Research has shown that for some, back pain specifically originates in one or more of these endplates. If this is the source of your back pain, there is a new innovative way to treat it that doesn’t disturb the delicate function of your discs.
There is a nerve called the basivertebral nerve that interfaces with your vertebral endplates. The Intracept Procedure is a minimally invasive procedure that targets the basivertebral nerve to provide relief from chronic how back pain that originates in the endplate.
Prior to recommending the procedure, doctors who suspect the basivertebral nerve is the source of a patient’s pain will conduct a special imaging test to confirm their diagnosis.
This outpatient procedure is implant-free and preserves the structure of the spine. It ablates the basivertibral nerve with a radiofrequency probe to provide lasting pain relief.
Are You a Candidate for the Via Disc or Intracept Procedures?
While both VIA Disc and the Intracept Procedure show promise to address chronic back pain developed as a result of degenerative disc disease, they are only appropriate for some patients. You should discuss both options with your healthcare provider if you believe they may be appropriate options for your back pain.
KING OF PRUSSIA, PA – Dr. Jeffery Rowe of Main Line Spine recently completed the first Minuteman® G3 procedure in Pennsylvania. The Minuteman® G3 was developed by Spinal Simplicity LLC as an innovative, minimally invasive, simple solution to treat complex spinal disorders.
Dr. Jeffrey Rowe, MD (center) stands between two colleagues after completing the first Spinal Simplicity G3 procedure in Pennsylvania.
The device is intended for the temporary fixation of the thoracic, lumbar and sacral spine while awaiting bony fusion to occur. It is designed for attachment to the posterior non-cervical spine at the spinous processes through its bilateral locking plates. It is intended for use with bone graft material placed within the device.
Musculoskeletal pain is a broad term. It refers to any pain affecting the bones, muscles, tendons, ligaments and nerves. It can come on suddenly with severe symptoms, be acute or chronic, and be either localized to one area of your body or widespread.
The most common type of musculoskeletal pain is lower back pain. According to the National Institute of Health, about 80 percent of adults experience low back pain at some point in their lifetimes.
Lower back pain is the most common cause of job-related disability and a leading contributor to missed workdays. In a major survey, more than a quarter of adults reported experiencing low back pain during the past three months.
The good news is that if you are suffering with lower back pain, there are a wide range of options to treat it that don’t require major orthopedic surgery. Identifying appropriate treatment options however starts with identifying the underying causes.
What causes lower back pain?
Your lower back is subject to a lot of mechanical stress and strain. This happens because the weight in your upper body is supported by your spine.
The spine is made up of more than 30 small bones called vertebrae stacked on top of one another. A spongy piece of cartilage, called a disc, sits between each vertebra. It acts as a shock absorber, preventing the bony vertebrae from grinding against one another as the body moves.
The vast majority of lower back pain is mechanical in nature. As we age, the discs in our spine can gradually wear away and shrink, a condition known as degenerative disc disease or spondylosis. The National Institute of Health outlines some of the examples of mechanical causes of low back pain to include:
Sprains and strains account for most acute back pain. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendon or muscle. Both can occur from twisting or lifting something improperly, lifting something too heavy, or overstretching. Such movements may also trigger spasms in back muscles, which can also be painful.
Degenerative disc disease is one of the most common mechanical causes of low back pain, and it occurs when the usually rubbery discs lose integrity as a normal process of aging. In a healthy back, intervertebral discs provide height and allow bending, flexion, and torsion of the lower back. As the discs deteriorate, they lose their cushioning ability.
Herniated or ruptured discs can occur when the intervertebral discs become compressed and bulge outward (herniation) or rupture, causing low back pain.
Radiculopathy is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on this nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
Sciatica is a form of radiculopathy caused by compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and the adjacent bone, the symptoms may involve not only pain, but numbness and muscle weakness in the leg because of interrupted nerve signaling. This condition may also be caused by a tumor or cyst that presses on the sciatic nerve or its roots.
Spondylolisthesis is a condition in which a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column.
A traumatic injury, such as from playing sports, car accidents, or a fall can injure tendons, ligaments or muscle resulting in low back pain. Traumatic injury may also cause the spine to become overly compressed, which in turn can cause an intervertebral disc to rupture or herniate, exerting pressure on any of the nerves rooted to the spinal cord. When spinal nerves become compressed and irritated, back pain and sciatica may result.
Spinal stenosis is a narrowing of the spinal column that puts pressure on the spinal cord and nerves that can cause pain or numbness with walking and over time leads to leg weakness and sensory loss.
Skeletal irregularities include scoliosis, a curvature of the spine that does not usually cause pain until middle age; lordosis, an abnormally accentuated arch in the lower back; and other congenital anomalies of the spine.
With these and so many other potential causes and types of lower back pain, it’s best not to assume your pain is simply overuse or old age. Like most conditions, the earlier the problem is identified, the more treatment options are available. It naturally follows that early diagnosis also supports a higher probability of success with treatment.
