Thailand Medical Agency
Spine surgery in Thailand is one of good choice destination and very popular in Asia with the modern technologies and highly qualified surgeon which perform under international standard. And the cost of treatment is cheaper and affordable.
Back Surgery
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Our Services>>
- First consultation about the overall of your personal conditions and the treatment programs available in Thailand.
- Recommendation the professional Spine specialists, surgoen and team with highly experienced and international standard qualified.
- Offer the health assistant service to co-operate with hospital and make your personal arrangement.
- Planing your personal program, expected the date(treatment period), estimate budgeting.
- Arrange the accommodations , living place/hotel up to the treatment expected date.
On your coming
- Arrange the transportation to pick up you at Airport and send to the hotel we've prepared.
- Assist for any necessary needed during your long staying.
- On the hospital appointment day, take you to hospital and be your health secretary, assist you to manage your plan details from doctor.
- Visiting during the recovery period
- Recommend and guide you the attraction trips in Bangkok, Thailand or some nearby, so that you can relax and enjoy during the treatment vacation.
Normal structure of spine
The spine is made of 33 individual bones stacked one on top of the other. Ligaments and muscles connect the bones together and keep them aligned.The spinal column provides the main support for your body, allowing you to stand upright, bend, and twist. Protected deep inside the bones, the spinal cord connects your body to the brain, allowing movement of your arms and legs. Strong muscles and bones, flexible tendons and ligaments, and sensitive nerves contribute to a healthy spine.
The spine is divided into
1. Cervical spine
2. Thoracic spine
3. Lumber spine
4. Sacral and Coccygeal spine
The spinal column (or vertebral column) extends from the skull to the pelvis and it is made up of 33 individual bones termed vertebrae. The vertebrae are stacked on top of each other group into four regions; Cervical Vertebrae (C1 – C7), Thoracic Vertebrae (T1 – T12), Lumbar Vertebrae (L1 – L5), Sacral Spine.
Purpose of the Vertebrae
Although vertebrae range in size; cervical the smallest, lumbar the largest, vertebral bodies are the weight bearing structures of the spinal column. Upper body weight is distributed through the spine to the sacrum and pelvis. The natural curves in the spine, kyphotic and lordotic, provide resistance and elasticity in distributing body weight and axial loads sustained during movement.
The vertebrae are composed of many elements that are critical to the overall function of the spine, which include the intervertebral discs and facet joints.
>> Cervical: The 7 vertebrae in the neck form the cervical region of the spine. Cervical vertebrae are the thinnest and most delicate vertebrae in the spine but offer great flexibility to the neck. The first cervical vertebra, C1, supports the skull and is named “atlas” after the Greek titan who held the Earth on his shoulders. The skull pivots on the atlas when moving up and down. The second cervical vertebra, C2, is also known as the “axis” because it allows the skull and atlas to rotate to the left and right.
>>Thoracic: The 12 vertebrae in the chest region form the spine’s thoracic region. Thoracic vertebrae are larger and stronger than cervical vertebrae but are much less flexible. The spinous processes of the thoracic vertebrae point inferiorly to help lock the vertebrae together. A unique feature of the thoracic vertebrae is that each one forms joints with a pair of ribs to form the sturdy rib cage that protects the organs of the chest.
>>Lumbar: The 5 vertebrae in the lower back form the lumbar region of the spine. Lumbar vertebrae are even larger and stronger than thoracic vertebrae, but are more flexible due to the lack of ribs in the lumbar region. All of the upper body’s weight bears down on the lumbar vertebrae, leading to many back problems in this region despite the size and strength of the vertebrae.
>>Sacral Spine: The Sacrum is located behind the pelvis. Five bones (abbreviated S1 through S5) fused into a triangular shape, form the sacrum. The sacrum fits between the two hipbones connecting the spine to the pelvis. The last lumbar vertebra (L5) articulates (moves) with the sacrum. Immediately below the sacrum are five additional bones, fused together to form the Coccyx (tailbone).
>>Coccygeal: The spine’s coccygeal region contains only the coccyx, a single bone in the adult skeleton that is formed by the fusion of 4 tiny vertebrae during adolescence. The coccyx is often referred to as the human tailbone, as this region is homologous to the tail bones of animals that have tails. In humans, the coccyx bears our body weight when sitting down and provides attachment points for muscles of the pelvic and gluteal regions. While most people have a coccyx made of 4 fused vertebrae, the coccyx may consist of as few as 3 or as many as 5 vertebrae. The length of the coccyx has no effect on the body’s function.
The spinal cord is a tube-like structure filled with a bundle of nerves and cerebrospinal fluid, which protects and nourishes the cord. Other protectors of the spinal cord include linings called meninges and vertebral bones. The spinal cord is about an inch across at its widest point and about 18 inches long.
Nerves exit the spinal column in pairs and branch out like a delicate web throughout the rest of the body. Each area of the body is controlled by specific spinal nerves. The placement is fairly logical. For example, nerves in the cervical spine (neck area) branch out into your arms, which is why sometimes a neck issue can lead to pain radiating down your arms. Nerves in the thoracic govern the middle of the body, those in lumbar spine extend into the outer legs, and the sacral nerves control the middle of legs and organ functions of the pelvis.
Spinal Discs or Intervertebral Discs
The vertebral disc in the spine is an interesting and unique structure. Its primary purpose is to act as a shock absorber between adjacent vertebrae. Spinal discs also act as ligaments that hold the vertebrae of the spine together and as cartilaginous joints that allow for slight mobility in the spine.
There are a total of twenty-three vertebral discs in the spinal column. Specific problems with any of these discs may prompt different symptoms, including back pain, neck pain, and sciatica.
Discs are made from collagen; technically speaking, they are fibrocartilage, which means they consist of strong fibers with some elasticity. The outer layer of the disc is called the annulus fibrosis. Its main job is to attach to the vertebra above and below, although it also provides some cushion. The fibers are crisscrossed, making the connections super strong. Repetitive stress can sometimes cause this outer layer to bulge. If the bulge pushes on a nerve, the result is pain. The nucleus pulposus is the gel-like center of the disc designed to absorb shock and provide lubrication. It's mostly made of water. As we age, it can dry up a bit, making the discs thinner and less shock absorbent. There is some evidence that inversion therapy or lumbar traction can help the discs rehydrate, but the long-term benefits have yet to be demonstrated.
Back pain is one of the most common reasons people self-treat and seek medical care. It will affect approximately three in four adults during their lifetime. When we speak about “back pain” we mean pain that originates in the spine anywhere between the upper and lower back.
There are many different types of pain. Acute back pain is defined as severe but lasting a short period of time. Chronic back pain usually occurs every day. It can be severe, but may be characterized as mild, deep, achy, burning, or electric-like. Back pain that travels into another part of the body, such as the leg may be consider radicular pain, particularly when it radiates below the knee.
Degenerative disc disease
Degenerative disc disease is one of the most common causes of low back pain and neck pain. It describes the symptoms of pain and possibly radiating weakness or numbness stemming from a degenerated disc in the spine.
Disc degeneration is actually a natural part of aging and over time all people will exhibit changes in their discs consistent with a greater or lesser degree of degeneration. However, not all people will develop symptoms. In fact, degenerative disc disease is quite variable in its nature and severity.
Risk factors include:
- genetic predisposition
- history of heavy work (eg, repetitive lifting that may wear out your spine and lead more quickly to these degenerative changes)
- poor body mechanics
- traumatic injury
- being overweight
- smoking
Herniated disc
Herniated disc is a relatively common condition that can occur anywhere along the spine, but most often affects the lower back or neck region. Also known as a slipped disc or ruptured disc, a herniated disc develops when one of the cushion-like pads between the vertebrae moves out of position and presses on adjacent nerves.
Herniated discs are typically caused by overuse injuries or trauma to the spine; however, disc conditions can also develop as a result of the normal aging process. It is also known that there is a genetic factor that contributes to the development of disc degeneration and herniated disc. In most cases, a herniated disc in the lower back will heal within six months, as the size of herniation shrinks with time via resorption. Surgery may be needed if medication, physical therapy and other treatments fail.
Osteoporosis
Osteoporosis is a generalized skeletal disorder of low bone mass (thinning of the bone) and deterioration in its architecture, causing susceptibility to fracture.
There are two types of osteoporosis:
Type I osteoporosis (postmenopausal osteoporosis) generally develops in women after menopause when the amount of estrogen in the body greatly decreases. This process leads to an increase in the resorption of bone (the bones loses substance). Type 1 osteoporosis is typically develops between the ages of 50 and 70. The process usually results in a decrease in the amount of trabecular bone (the spongy bone inside of the hard cortical bone). The decrease in the overall strength of the bone leads primarily to wrist and vertebral body (in the spine) fractures.
Type II osteoporosis (senile osteoporosis) typically happens after the age of 70 and affects women twice as frequently as men. Type II osteoporosis involves a thinning of both the trabecular bone (the spongy bone inside of the hard cortical bone) and the hard cortical bone. This process often leads to hip and vertebral body fractures.
Spondylolisthesis
The bones in your spine come together at several small joints that keep the bones lined up while still allowing them to move. Spondylolisthesis is caused by a problem with one or more of these small joints that allows one bone to move out of line. The causes of spondylolisthesis may include;
- A defective joint that you've had since birth (congenital).
- A joint damaged by an accident or other trauma.
- A spinal bone with a stress fracture caused from overuse of the joint.
- A spinal bone become degenerative.
- A joint damaged by an infection or arthritis.
Spondylolisthesis affects children and teens involved in sports. Some sports, such as gymnastics or weight lifting, can overuse back bones to the point of causing stress fractures in vertebrae, which can result in spondylolisthesis.
Older adults can develop spondylolisthesis, because wear and tear on the back leads to stress fractures. It can also occur without stress fractures when the disc and joints are worn down and slip out of place.
Spondylolisthesis would be divided in to 2 types;
1. Degenerative spondylolisthesis is the condition occurs as a consequence of the general aging process in which the bones, joints, and ligaments in the spine become weak and less able to hold the spinal column in alignment. Degenerative spondylolisthesis is more common in people over age 50, and far more common in individuals older than 65. It is also more common in females than males by a 3:1 margin.
2. Isthmic spondylolisthesis occurs when one vertebral body slips forward on the one below it because of a small fracture in a piece of bone that connects the two joints on the back side of the spinal segment.
Symptoms of spondylolisthesis may include:
- Back or buttock pain.
- Pain that runs from the lower back down one or both legs.
- Numbness or weakness in one or both legs.
- Difficulty walking.
- Leg, back, or buttock pain that gets worse when you bend over or twist.
- Loss of bladder or bowel control, in rare cases.
- Sometimes spondylolisthesis causes no symptoms at all.
Spinal stenosis
Spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord. If the stenosis is located on the lower part of the spinal cord it is called lumbar spinal stenosis. Stenosis in the upper part of the spinal cord is called cervical spinal stenosis. While spinal stenosis can be found in any part of the spine, the lumbar and cervical areas are the most commonly affected.
What Causes Spinal Stenosis?
Some patients are born with this narrowing, but most often spinal stenosis is seen in patients over the age of 50. As people age, the ligaments of the spine can thicken and harden (called calcification). Bones and joints may also enlarge, and bone spurs (called osteophytes) may form. Bulging or herniated discs are also common. Spondylolisthesis (the slipping of one vertebra onto another) also occurs and leads to compression. When these conditions occur in the spinal area, they can cause the spinal canal to narrow, creating pressure on the spinal nerve.
Symptoms of Spinal Stenosis
The narrowing of the spinal canal itself does not usually cause any spinal stenosis symptoms. It is when inflammation of the nerves occurs at the level of increased pressure that patients begin to experience problems. Patients with lumbar spinal stenosis may feel pain, weakness, or numbness in the legs, or buttocks. In the lumbar spine, symptoms often increase when walking short distances and decrease when the patient sits, bends forward or lies down. Cervical spinal stenosis may cause similar symptoms in the shoulders, arms, and legs; hand clumsiness and gait and balance disturbances can also occur. The pain may radiate like sciatica or may be a cramping pain. In severe cases, the pain can be constant. Severe cases of stenosis can also cause bladder and bowel problems, but this rarely occurs.
Spinal Deformities
The most 2 common of spinal deformities are Scoliosis and kyphosis;
What is Scoliosis?
Scoliosis describes an abnormal, side-to-side, curvature of the spine. The spinal curve may develop as a single curve (shaped like the letter C) or as two curves (shaped like the letter S). In children and teenagers, scoliosis often does not have any noticeable symptoms and may not be noticeable until the curve has progressed significantly. The two most common forms of scoliosis are degenerative scoliosis and idiopathic scoliosis (adolescent).
Scoliosis is not a disease, but rather it is a term used to describe any abnormal, sideways curvature of the spine. Viewed from the back, a typical spine is straight. When scoliosis occurs, the spine can curve in one of three ways:
-The spine curves to the side as a single curve to the left (shaped like the letter C), called levoscoliosis
-The spine curves to the side as a single curve to the right (shaped like a backwards letter C), called dextroscoliosis
-The spine has two curves (shaped like the letter S).
What Is Kyphosis?
Kyphosis is a progressive spinal disorder that can affect children or adults. This disorder may cause a deformity described as humpback or hunchback. Abnormal kyphotic curves are more commonly found in the thoracic or thoracolumbar spine, although they can be cervical.
The thoracic (rib cage) portion of the spine has a normal forward curvature called "kyphosis," which has a normal range (20 to 50 degrees). This forward curvature is matched by reverse curvatures (called "lordosis") in the cervical spine (the neck) and the lumbar spine (the low back). This combination of forward and reverse curves in the spine allows people to sit and stand upright.
Technically, any exaggerated rounding of the forward curvature in the upper back is called hyperkyphosis (meaning too much kyphosis), but the term "kyphosis" is commonly used to refer to the clinical condition of excess curvature of the upper back (greater than 50 degrees), leading to a stooped forward posture.
Spinal Surgery and Treatment
Total Artificial Disc Replacement (TADR)
Artificial disc (also called a disc replacement, disc prosthesis or spine arthroplasty device) is a device that is implanted into the spine to imitate the functions of a normal disc (carry load and allow motion).
Artificial discs are usually made of metal or plastic-like (biopolymer) materials, or a combination of the two. These materials have been used in the body for many years. The most commonly used total disc replacement designs have two plates. One attaches to the vertebrae above the disc being replaced and the other to the vertebrae below. Some devices have a soft, compressible plastic-like piece between these plates. The devices allow motion by smooth, usually curved, surfaces sliding across each other.
During the operation
A longitudinal section of the skin of approximately 2 - 4 cm.first exposes the cervical spine. The intervertebral disc is then removed and the intervertebral disc space is expanded to about 5 – 7 cm using special instruments to decompress the nerve root and to create space for the artificial disc. Following measurement of the appropriate size and precise preparation of the implant area , the implant is inserted centrally under X - ray control.
What happens after the operation ?
You will remain in the hospital after the operation . Since the artificial disc is immediately stable under movement and pressure , you may begin ambulating one day after the operation. If necessary, as advised by your surgeon, you may be asked to wear a cervical collar for a few weeks after the operation to support your spine. You will undergo special post – operative treatment ( physiotherapy , mobilization , muscle build –up , etc. ) After some months, significant ingrowth of the artificial disc in to the bone has occurred. This can be verified by X ray during the follow- up examination. Follow –up examinations are performed at regular intervals to guarantee the greatest possible safety and care in this surgical method.
Vertebroplasty vs. Kyphoplasty
There are two common general approaches for vertebral surgery, a category of minimally invasive surgical procedures designed to immediately stabilize a vertebral fracture to treat the patient's pain and prevent progressive spinal deformity.
These procedures, vertebroplasty and kyphoplasty, are most commonly used in cases of severe, functionally disabling pain caused by a vertebral fracture that does not improve over a number of weeks with pain medication and treatment with brace immobilization. Both vertebroplasty and kyphoplasty procedures involve the placement of cement into the fractured vertebra through small, minimally invasive incisions in the skin under X-ray guidance using fluoroscopy.
>>Vertebroplasty
Vertebroplasty is considered a minimally invasive surgical procedure because the procedure is done through a small puncture in the patient's skin (as opposed to an open incision). A vertebroplasty procedure usually use to treat and stabilize a spinal fracture. For the procedure, a biopsy needle is guided into the fractured vertebra under X-ray guidance through a small puncture in the patient's skin. Then, the special formulated acrylic bone cement is injected under pressure directly into the fractured vertebra, filling the spaces within the bone to stabilize the vertebral bone. The needle is removed then and the cement become harden quickly (about 10 minutes), congealing the pieces of the fractured vertebra and stabilizing the bone. The small skin puncture is covered with a bandage.
>>Kyphoplasty
Kyphoplasty is a minimally invasive surgical procedure used for treating a compression fracture resulting from osteoporosis.
During kyphoplasty surgery, a small incision is made in the back through which the doctor places a narrow tube. Using fluoroscopy to guide it to the correct position, the tube creates a path through the back into the fractured area through the pedicle of the involved vertebrae.
Then, the doctor inserts a special balloon through the tube and into the vertebrae, then gently and carefully inflates it. As the balloon inflates, it elevates the fracture, returning the pieces to a normal position. It also compacts the soft inner bone to create a space inside the vertebrae.
The balloon is removed and the doctor uses specially instruments under low pressure to fill the space with a cement-like material. After being injected, the material would be harden quickly and stabilize the bone.
Both vertebroplasty and kyphoplasty are successful about 90% of the time in significantly relieving the pain of fractured vertebrae. Kyphoplasty procedures are considered to be potentially more helpful in correcting vertebral collapse and wedging if it is done within six weeks of when the fracture is sustained.
Laminectomy|Laminotomy|Spinal decompression
The lamina is a bony part of your spine, and it makes up part of your spinal canal. You can think of it as the "roof" of your spine.
Laminectomy is the removal of the entire bony lamina, a portion of the enlarged facet joints, and the thickened ligaments overlying the spinal cord and nerves. Laminotomy is the removal of a small portion of the lamina and ligaments, usually on one side. Using this method the natural support of the lamina is left in place, decreasing the chance of postoperative spinal instability. Sometimes an endoscope may be used, allowing for a smaller, less invasive incision.
A laminectomy (the total removal of the lamina) or a laminotomy (removing part of the lamina) is used for 2 reasons:
- To relieve nerve or spinal cord compression caused by your lamina.
- To gain better access to other parts of your spine: Parts of your lamina may need to be removed so that your surgeon can reach your disc, for example. Then he or she can do a microdiscectomy.
Below are some spinal conditions that may be treated with laminectomy:
- Degenerative disc disease
- Herniated disc
- Sciatica
- Spinal stenosis
- Spondylosis (also known as spinal osteoarthritis)
If an intervertebral disc has herniated, the surgeon may need to remove pieces of the disc compressing nerve roots. The lamina may obstruct the surgeon's view of an intervertebral disc, so with part or all of the lamina removed, the surgeon has a better view of the disc. These spinal decompression procedures also provide greater access to the spinal canal and other parts of the spinal anatomy.
Fusion(if necessary)
If you have spinal instability or have laminectomies to multiple vertebrae, a fusion may be performed. Fusion is the joining of two vertebrae with a bone graft held together with hardware such as plates, rods, hooks, pedicle screws, or cages. The goal of the bone graft is to join the vertebrae above and below to form one solid piece of bone.There are several ways to create a fusion. The right one for you depends on your own choice and your doctor’s recommendation.
Anterior Cervical Discectomy and Fusion (ACDF)
An anterior cervical discectomy and fusion is an anterior approach (through the front of the neck) to removing a cervical herniated disc in order to relieve spinal cord or root pressure and alleviate corresponding pain, weakness, numbness and tingling.
This procedure is called an anterior cervical discectomy and allows the offending disc to be surgically removed. A discectomy is a form of surgical decompression, so the procedure may also be called an anterior cervical decompression. A fusion surgery is almost always done at the same time as the discectomy in order to stabilize the cervical segment. Together, the combined surgery is commonly referred to as an ACDF surgery, which stands for Anterior Cervical Discectomy and Fusion. While this surgery is most commonly done to treat a symptomatic cervical herniated disc, it may also be done for cervical degenerative disc disease. And also be able to do for more than one level of the cervical spine.
The advantage for anterior cervical surgery approach is to be better access to the spine. The anterior approach can provide access to almost the entire cervical spine, from the C2 segment at the top of the neck down to the cervico-thoracic junction, which is where the cervical spine joins with the thoracic spine. This would be less postoperative pain because it provides good access to the spine through a relatively uncomplicated pathway. The patient tends to have less incisional pain from this approach than from a posterior operation.
Minimally invasive spine surgery (MISS)
Minimally invasive spine surgery (MISS) is the using of advanced technology and innovative techniques to treat back pain and neck pain caused by a variety of spinal disorders. Numerous spine conditions can be treated using minimally invasive spine surgery such as;
- Degenerative disc disease
- Herniated discs
- Spinal stenosis
- Scoliosis or other spinal deformities
- Spondylolisthesis
- Spinal fractures
Through computer-assisted technology and highly specialized tools, minimally invasive surgery is an attractive option for patients who want a quicker recovery after surgery, less post-operative pain, and smaller incisions. MISS may be a less risky, less invasive option compared to traditional open spine surgery. The goals of MISS procedures are the same as open traditional procedures.
The 2 main goals of minimally invasive spine surgery are;
Decompression: This is used to take pressure off (to decompress) your spinal cord or nerve roots. That pressure can cause pinched nerves and pain. So that, the procedure will relieve the pressure and reduce your pain.
Stabilization: Sometimes a mobile segment or abnormal movement can be the source of pain. When this happens, a stabilizing surgery may be needed. This is typically a fusion, often done with instrumentation.
There are 3 main minimally invasive spine surgery techniques;
Mini-open: This is similar to an open procedure, but has fewer risks, such as less blood loss during surgery and less risk of infection because the incision is much smaller. Advances in visualization have made mini-open procedures possible.
Tubular: This surgery involves a tubular retractor, which acts as a tunnel that passes through your back muscles to access your spine. Compared to open spine surgery, there is less muscle damage and less blood loss when using a tubular retractor.
Endoscopic: This spine surgery uses a tiny video camera called an endoscope to pass through small surgical incisions (usually less than 2 cm) to access your spine. An endoscope guides surgeons by showing them an internal view of your body on screens in the operating room.
Minimally invasive spine surgery (MISS) seems like an attractive option, but that doesn't mean that everyone is a good candidate for MISS. For example, in rare cases, if you have a certain spinal infection, sometimes it cannot be treated minimally invasively. However, MISS may be a good choice for older patients or other patients who are considered poor candidates for traditional open spine surgery.
Treatments Options | Methods
1. Assessment : Monitor symptoms without treatment. The majority of back pain improves or disappears within 2-4 weeks. If the pain is mild, symptoms should just be monitored and if they tend to improve and finally disappear, it is not necessary to take any further action.
2. Alternative treatment :
Medication; - A patient who is suffering increasing back pain which interferes with their daily life are generally prescribed medication such as a normal analgesic and anti-inflammatory that aims to reduce pain and inflammation. However, this kind of medication should be taken only for a short period of 1-2 weeks or stopped if symptoms improve earlier, as this group of medication may irritate the stomach.
Physical therapy used;
- Ultrasound or electrical stimulation to reduce muscle contraction, which decreases pain
- Traction can help stretching bone joints and discs to reduce direct pressure on nerves
- Chiropractic is an alternative medical treatment. According to research, it can be successful for reducing acute back pain; however results for chronic and deformed bones are unsubstantiated.
- Acupuncture is another alternative medical treatment that can reduce back pain and especially back pain caused from muscle tension (myofacial pain syndrome).
3. Injection Treatments : Epidural steroid injection to the effected area in spinal canal. Epidural steroid injection is used only for patients with spreading pain from nerves such as arm or leg pain caused from nerve compression by disc herniation.
Problems and risks from epidural steroid injection;
- 20-30% of symptoms do not improve.
- 60-70% of symptoms are improved only temporarily since steroid injection, but does not return the disc into place, however it reduces inflammation from nerve compression.
- 2-4% of patients develop headaches after the injection. In rare cases the needle that pierces into the spine canal causes spinal fluid to leak a little which may cause headache.
- Infection (found in less than 1%).
- Injury to nerves (found in less than 1%).
- Allergy to injected medication (found in less than 1%).
4. Surgical Options : These can be categorized in 2 types which are Decompression surgery and Fusion surgery.
4.1 Decompression surgery is performed to correct nerve compression.
When nerves are compressed, increasing pressure results in pain or tingling and numbness in extremities. The surgery is performed to decrease pressure on the compressed nerves which reduces the pain.
4.2 Fusion surgery is performed to connect bones and spine joints.
Spine discs separate vertebrae and buffer the body weight. When the disc has been removed, there will be a gap between the upper and lower vertebrae spine bones, which will be refilled using one of these 3 methods
4.2.1 Fill it with the patient’s own bone (from the hip bone). At the end, the bones will completely connect as one piece (fusion). The advantages are fast bone connection and economical but the downside is that the patient will endure pain at the point where the bone from the hip is taken out.
4.2.2 Connect the joint with an artificial disc, which is available in metal and polymer material (PEEK). The aim is to connect bones into one piece as in option 1 but the patient need not suffer pain from another wound at the hip. Metal plates and screws can be used to enhance bone connection and stability.
4.2.3 Total disc replacement (TDR) is a surgical procedure that replaces degenerative discs of the lumbar or cervical spine with artificial discs that are designed to imitate the functions of a natural disc and allow as normal as possible motion after surgery. It is a piece of metal which enables the joint to be movable, in much the same way as a normal disc.