“Is this a model or is it the real thing?”


I had the pleasure of meeting with one of our local orthopedic surgeons, Dr. Benjamin Bjerke, and the Zimmer-Biomet rep, Christina Escobar, to talk Mobi-C Disc Replacement technology and surgical technique developed by Zimmer-Biomet. Incredibly interesting.

Seeing the prosthesis, my first question was, “Is this a model or the real thing you are showing me?” It was much smaller than I anticipated!

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Secondly, I found the specificity of the patient suitable for this intervention impressive – someone with neck pain and or radiculopathy (pain down the arm originating from nerve root compression in the neck) without much cervical spondylosis (degeneration of the discs and joints in the neck) and good vertebral alignment. The Mobi-C can replace discs at one or two levels of the cervical spine between the third and seventh cervical vertebrae.

So lets take a look in more detail.

Anatomy and Pathology of the Neck

  • The cervical spine has discs between each bone that provide cushioning for movements and body loads. The discs and bones in a healthy neck allow bending from side-to-side and front-to-back, and turning left-to-right. Disc problems can start from over-use, an accident, or just the wear and tear of daily life.  When a disc degenerates it becomes thinner and provides less padding to absorb movement.  Degenerated discs can also bulge (herniate) and pinch the spinal cord or nerves, which causes loss of feeling, weakness, pain, or tingling down the arms and hands. Below  you can see the normal cervical spine anatomy and adjacent is a graphic of what a spine with pathology may look like:

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Treatment Options

  • Before artificial discs were available, patients would traditionally receive an Anterior Cervical Discectomy and Fusion procedure to alleviate the pain from a herniated disc. In a fusion surgery, the disc is removed and either a bone spacer or a plastic implant is placed in the disc space to restore disc height and remove pressure on the pinched nerves or spinal cord.   A metal plate and screws is placed on the front of the vertebral column to hold the implant in place.  The result – a segment that no longer moves, or is “fused”.  The potential downside of a fusion procedure, in addition to the loss of motion, is that it can create additional stress on the spinal levels above and below it.  This can cause degeneration at those levels and potentially result in another future surgery.
  • An artificial disc like Mobi-C is an option instead of a fusion that will also be placed inside the disc space to restore height and remove pressure on the pinched nerves. However, the Mobi-C device is designed to allow the neck to maintain normal motion and thus limit adjacent levels from degenerating, possibly preventing future surgeries.

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Since Mobi-C cervical disc replacements are preferred over fusions because they preserve movement in the spine, lets take a look at this video to see what happens in the spine when a patient with the Mob- C implanted flexes and extends his/her neck versus a two level fusion:

Cervical disc replacement procedures are anticipated to experience rapid growth in the near future, due to multiple factors:

  • A growing library of clinical evidence demonstrating the long term safety and efficacy of cervical disc replacement.
  • Cervical disc replacement is being shown as a superior treatment to fusion for use at two cervical levels.
  • Better outcomes of cervical disc replacement over fusion such as reduced re-operation rates, reduced adjacent segment degeneration rates and surgeries, as well as a faster return to work.
  • Most patients return to work within six weeks of surgery. In the U.S. Mobi-C clinical trial, the return to work time was 20.9 days shorter for Mobi-C patients compared to fusion patients for two-level surgery and 7.5 days shorter for Mobi-C patients compared to fusion for one-level surgery.

What about physical therapy after the Mobi-C disc replacement?

  • Wear a neck collar to lessen neck movement for around a week after the surgery.
  • Avoid heavy lifting, repetitive bending, and prolonged or strenuous activity for up to 6 weeks after surgery.
  • When your surgeon releases you to start physical therapy the physical therapist will do a comprehensive evaluation to assess your cervical, scapular and shoulder range of motion as well as cervical, arm and trunk strength. Based on the data collected, you will be given specific exercises to address any deficits to ultimately improve your function. You may start of with cervical isometrics and progress to upper thoracic and arm strengthening exercises as well as neuromuscular reeducation of the deep neck muscles. The physical therapist will also utilize soft tissue mobilization techniques to limit scar formation and address any myofascial pain and muscle trigger points, present from inactivity. You will need to participate fully by being totally compliant with the home exercise program you are given by the physical therapist at your very first visit.

Successful outcomes are determined by multiple factors which include choosing the right surgical procedure done by a skilled surgeon, following post operative activity limitations and brace use as well as being totally compliant with physical therapy instructions and exercises. It is a 3 person team that makes your recovery work: you (and your home supporters), the surgeon (and their staff) and the physical therapist (and their clinical team members).

Thank you to Zimmer-Biomet for help with supplying me with information and photographs.

Motivated to Get Healthy Via the Cost of Healthcare.


My last post on hip pain suggests the need for us all to be educated healthcare consumers and takes us back to the original goal of this blog – to be a credible, unbiased (by selling, advertizing or marketing products, for example) healthcare information source within the expertise of the writer.  Clearly, if it takes 21 months and three providers to correctly diagnose hip pain, we must all be willing and able to ask questions of our healthcare providers (doctors, physical therapists, physicians assistants, nurses, hospitals, insurance companies).

$2.8 trillion ($2,800,000,000,000 – enough zeros?) is estimated to be spent on healthcare in 2013. In 2010, we spent just over $8000 per capita in the US and our life expectancy at birth ranks below countries that spend far less. Spain spends about $3000 per capita and has a life expectancy at birth of 82 and Japan spends $4000 per capita and has a life expectancy of 83.

Consider that the healthcare industry spent $5.36 billion lobbying Congress from 1998 to 2012 while the defense lobbyists spent $1.53 billion. Will this system change to your benefit as a patient?  I do not think it will change in the near future and will thus continue to cost us all way more than we can afford.

I suggest we make the healthcare system challenges a mute point by using this reality as motivation to take charge of our own health. For example, what small lifestyle change can you make to start on the road to a healthier you today?

As a physical therapist I am partial to movement so why not move more each day. That means doing little things such as walking stairs, walking at lunchtime, taking family time and walking around your neighborhood after work with your kids, standing up from your office chair 10 times every two hours, anything you can think of that will increase your activity level.

A dietician may have ideas such as portion control, cutting out refined and fatty foods, eating more fruits and vegetables, drinking more water.  All you dieticians out there, feel free to post your ideas of simple, easy ideas people can use to start the process of improving their health.

What about a wellness visit to your primary care doctor?  Dr Ronald Hicks in Sparks, Nevada has been my primary care physician for almost 17 years.  Every visit I have with him involves discussions about some form of healthy living (sun block, exercise, diet, stress), and I am a health person.  He tells me he has many diabetic patients who do not control their blood glucose using simple dietary restrictions, exercise, regular montoring and medication use.  I am floored by this.  If we know what we need to do to control a disease which is potentially fatal, why do we not do it? (A lead into a future post maybe?)

In conclusion, at Custom Physical Therapy I have the priviledge of working with a variety of wonderful people all of whom have different needs.  Everyday, there are people who can make small changes in lifestyle and thus have large gains in health.  However, such lifestyle changes do not come easy and require motivation.  With this post, I am suggesting we use the cost of healthcare as motivation to make the needed changes to become healthier.  You will save on  healthcare costs down the road as we will only use the expensive healthcare system when we truly need to.  Prevention is the word.

YOUR TO DO LIST:

  1. What one aspect of your lifestyle will you change today to start on the road to a healthier you? 
  2. Post your idea on this blog – I would love to read about it.
  3. Send this post to someone you would like to join with on the quest to save $$$ by becoming a healthier you.
  4. Schedule a wellness checkup with your primary care physician – let the doc know your desire to become healthier.
  5. Be happy and get healthy!