Can an implant that swells like cooked spaghetti really ease your back pain? The unusual procedure lowers the risk of paralysis after surgery

  • Jamil took a serious fall while hiking last year, damaging two discs in his back
  • In March his damaged disks left him with in agony, unable to stand up straight
  • After having the new procedure, Jamil can finally play with his children again

For patients with back pain linked to damaged discs, there may be a new surgical option. 

Jamil Hussain, 40, an IT consultant from Birmingham, underwent the procedure, as he tells ADRIAN MONTI.

THE PATIENT

Last year, while climbing Ben Nevis for charity, I had a serious fall and was taken to hospital.

Scans showed I had significant bruising under the skin on my back (a haematoma). 

But, more worryingly, the doctor said I had signs of damage to the discs in my spine which was a result of everyday wear and not related to my fall. 

Last year, while climbing Ben Nevis for charity, Jamil Hussain had a serious fall and was taken to hospital. Scans showed he had damage to the disks in his spine

Last year, while climbing Ben Nevis for charity, Jamil Hussain had a serious fall and was taken to hospital. Scans showed he had damage to the disks in his spine

I'd never had any back problems so this came as a surprise.

I went home to my wife Seama the next day feeling very groggy and had two weeks off work recovering. 

After that I had almost constant severe lower back pain. It was sharp, came in waves and spread down my buttocks and legs, which made everyday life very difficult.

Playing with our four children was almost impossible, as was my usual cycle to work, so I had to start driving in — but even getting in and out of my car was a struggle.

I'm normally very active, playing football and cricket, but over the following months I wasn't flexible enough to do anything, which got me down.

I went back to my GP several times, but she said it could take eight months for the haematoma, which we believed was causing my pain, to heal properly.

Then, in March, the muscles in my back started going into spasm and I was in agony. I asked to be referred to a specialist through my firm's private health insurance.

By the time I saw the consultant, Mushtaque Ishaque, a week later, I couldn't stand up straight and was limping badly.

Scans, to my surprise, showed my haematoma had healed; the pain was actually the result of the wear and tear to my discs. One had essentially worn away.

Mr Ishaque gave me a steroid injection to reduce inflammation, which took away the shooting pain immediately, but the soreness in my lower back continued.

I went to see him again six weeks later for another steroid injection. But that didn't work, nor did six weeks of physiotherapy.

After the operation Jamil took strong painkillers for two days, but after a week he felt noticeably more mobile. Soon after, he was cycling to work again.

After the operation Jamil took strong painkillers for two days, but after a week he felt noticeably more mobile. Soon after, he was cycling to work again.

Mr Ishaque briefly mentioned spinal fusion as an option, where the bones around the damaged disc are locked in place. But it's a drastic measure and he felt I was too young.

So he told me about an implant which makes the disc 'swell' back to its normal size. It's very new, but I was keen to try it as everything else had failed.

I had it fitted in June, under general anaesthetic, in half an hour. I woke up very sore and had to lie still for two hours as my legs recovered from the anaesthetic, but went home later that day.

I took strong painkillers for two days, but after a week I felt noticeably more mobile. I was 90 per cent back to my normal self within a month and back cycling to work, which felt fantastic. 

I can now run around with my children again. The implant has given me back my old life. I even plan to return to Ben Nevis at some point.

THE SURGEON

Mushtaque Ishaque is a consultant spinal surgeon at BMI The Priory in Birmingham. He says:

Around 25 per cent of back pain cases are caused by degenerative disc disease.

The discs act as shock absorbers between the bones that make up our spine — they start out as flexible and spongy, but as we get older they can become stiffer as they dry out.

The discs act as shock absorbers between the bones that make up our spine ¿ they start out as flexible and spongy, but as we get older they can become stiffer as they dry out

The discs act as shock absorbers between the bones that make up our spine — they start out as flexible and spongy, but as we get older they can become stiffer as they dry out

This means we can't move as easily as we're less flexible and usually suffer with a dull pain.

The first treatment option is painkillers such as paracetamol, and then anti-inflammatory pills or injections.

Some patients also see a physiotherapist or chiropractor for spinal manipulation — we don't exactly know why this works, but it does benefit some. 

These treatments will work for most people, but some require surgery — traditionally spinal fusion, where the damaged disc is removed and the two vertebrae are fused to stop them moving.

This is often a last resort because it's irreversible and carries the risk of paralysis or incontinence. It can also take up to nine months for a patient to recover.

But in the past three years, a new type of treatment has been developed in Germany — the FehrFix intradiscal implant, which is made from a special gel that swells up when it's inside the damaged disc, bulking it up again almost to its normal size.

WHAT ARE THE RISKS? 

How well it will work over a longer period is unknown until more procedures are done.

As with any implant, there is a small risk of infection.

Traditionally, damaged discs are treated by spinal fusion - surgically removing the disk and fusing the two vertebrae

Traditionally, damaged discs are treated by spinal fusion - surgically removing the disk and fusing the two vertebrae

Bob Chatterjee, a consultant spinal surgeon at Highgate Private Hospital and the Royal Free NHS Trust, says the implant will need to undergo more robust scrutiny before it's used in the mainstream.

'It's much too early to say whether this implant is a success as results are variable and there are few studies. The greatest fear with any implant is that it simply won't work.

'There are concerns about their long-term stability because they could move out of position and the structure could deteriorate after years of use. Only long-term studies will determine this.'

The procedure costs between £7,000 and £8,000.

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This makes it easier for the spine to bend and move as normal, and so reduces pain.

To insert the implant, patients are first given a general anaesthetic and an additional local anaesthetic where the needle is inserted in the lower back.

I use two sets of X-rays to locate exactly where to put the needle into the back and where the damaged disc is. Then a 3mm incision is made to feed the implants into the disc.

Usually, around four or five implants — they're 1cm long and the same diameter as a strand of dry spaghetti — are inserted to bulk the disc up. Once inside the disc, they act just like strands of spaghetti in water, swelling up to double their size as they absorb the fluid inside the disc. This makes the disc squidgy once again.

Surgeons have previously tried other types of implants to replace the disk, such as gel balls. But they don't expand three-dimensionally like these ones so don't cushion the damaged disc very well.

The entire procedure takes about 30 minutes. Patients go home the same day and are told not to over-exert themselves in the early weeks but to still keep moving, not sitting still for longer than 40 minutes.

I discharged Jamil after three months because he was doing so well; he said he'd been playing football, so I knew it had worked.

I've implanted the FehrFix in around ten patients and the results have been very encouraging.

At the moment, the 'spaghetti' implant is only used at a handful of private hospitals, including some in London and Manchester.

Though it is very early days, the beauty of this procedure is that it's minimally invasive and doesn't create any scar tissue as it restores movement very quickly. 

 

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