Tyler Neurosurgeon Jon T. Ledlie, MD, Introduces Bone Dowel Procedures for East Texas-Area Back Pain Sufferers

A new spinal fusion procedure using human allograft bone tissue as opposed to conventional metal-based bone-grafting devices may help bring long-term relief to thousands of chronic back-pain sufferers throughout East Texas.

Introduced in May by Tyler-based neurosurgeon Jon. T. Ledlie, MD, at East Texas Medical Center Tyler, the anterior lumbar interbody fusion (ALIF) procedure features human allograft donor bone tissue which is connected with a hollow, thimble-size cylindrical dowel into the patient's spine, replacing metallic instrumentation to enhance the bone fusion process.

The ALIF procedure was developed in the early 1990's by surgeons and researchers in Memphis, Tenn., and at the University of Florida Medical School as a means of eliminating the use of metal instrumentation, simplifying the back surgery procedure and reducing patient hospital stays, which have been reduced to an average of two-three days, compared with the four-five days associated with previous preferred spinal fusion techniques at other centers, Dr. Ledlie said.

Patients with primary back pain who have not responded favorably to three-six months of aggressive forms of non-surgical management may be considered candidates for the ALIF surgical procedure, he said.

"We are very excited about this advance in technique," Dr. Ledlie said. "We now have something that should give us great fusion rates without depending on metal screws, bolts, rods and cages. All spinal fusion procedures should be performed only as a last resort to treat and hopefully, decrease chronic back pain.

In many patients the space between two vertebral bodies can begin to collapse, thereby reducing the height of the space and causing nerve compression and back pain. By restoring and maintaining the disk space to its original height, the pain can, in many cases, be either reduced or eliminated altogether, Dr. Ledlie said.

Traditionally, surgeons have attempted to restore the space between the vertebrae by using wedges or blocks made from bone.

Using a wedge, the surgeon then returns the space between the vertebrae to its normal height. A portion of the disk is removed, thereby reducing the pressure on nerves between the vertebrae, which in many cases provides significant relief or even eliminates pain caused by spinal nerve compression.

The new threaded cortical bone dowels offer significant benefits over conventional bone wedges and blocks by placing two threaded bone dowels side-by-side in the previously collapsed disk space, he said.

Dr. Ledlie said the ALIF procedure hopefully will eliminate the use of metal devices, which are a subject of controversy within the medical and lay communities.

While stainless steel and titanium-based devices are considered structurally sound and effective for reconstruction purposes, the long-term effects of placing metal in the human spine will remain a subject of study for years to come.

"Most of the patients requiring back surgery are in their 40s and 50s and have a lot of active years ahead of them," Dr. Ledlie said. "some concerns have been raised about the long-term effects of metal instruments in the body. Until we know about it, this ALIF procedure provides us with a sensible, feasible and cost-effective alternative."

Dr. Ledlie said every individual is subject to degenerative changes in the spine as part of the natural aging process. The severity of that deterioration is determined by one's overall physical condition, the type of work the individual has performed and related physical considerations, he said.

In addition, Dr. Ledlie said, the influx of women into the general work force, particularly in labor-intensive jobs traditionally held by men, has accelerated the spinal degeneration process among women.

"Equality in the workplace has led to more equality in (spinal) degeneration," Dr. Ledlie said.

Studies show about 25 percent of the population will at some time suffer from debilitating back pain, leading to an average of more than 250,000 back surgeries in the United States on an annual basis.

Taken from "MEDSTAFF", a publication for physicians on staff at East Texas Medical Center, Tyler