30 million Americans will suffer from a back problem this year, with low back pain second in frequency only to the common cold. Facet joint disorders are among the most common of all the recurrent disabling low back problems that cause serious symptoms. The American Academy of Orthopaedic Surgeons reports that the most commonly performed operation for back pain has been spinal fusion. Approximately 2 million fusion procedures have been performed since 1990, and according to National Institutes of Health statistics, about a million lumbar fusions were performed in 2005 in the United States alone.
While facet fusion has been employed since the 1950s, TruFUSE is the latest solution offered to patients. TruFUSE, which is an allograft design improvement, is a cortical allograft with the same properties as other allograft configurations that have been used in spine surgery for over a century. TruFUSE was developed in partnership with the University of South Florida, which conducted extensive biomechanical testing, and LifeLink Tissue Bank, one of the largest not-for-profit tissue banks in the United States. It has been used on selected patients since January of 2005 and has proven to be highly effective with no notable postoperative complications. It was formally introduced to the market on March 9, 2006.
TruFUSE represents the only allograft solution for facet fusion. It may be used for treatment of degenerative disc disease, degenerative joint disease, osteoarthritis and other indications for spinal fusion. It may be used for any location from C1-C2 to L4-L5. Compared to methods that use metal screws, TruFUSE is less invasive, less destructive, less complicated, less expensive and subjects the patient to minimal risk.
An increasing number of orthopaedists in the Birmingham metropolitan area are adopting this procedure as a part of their armamentarium for treating instability of the spine. Dr. Mark A. Prevost of Jasper has performed more than 50 TruFUSE surgeries and has been pleased with the results. "The TruFUSE technique can be used alone," Dr. Prevost said, "or in place of posterior pedicle based rod systems, and to augment anterior fusion techniques with minimally invasive posterior fixation. It reduces operating, hospital and recovery time dramatically."
This author had the opportunity to observe Dr. James Stanford Faulkner Jr. perform the surgery at Medical Center East. One is impressed by the simplicity of the procedure and the fact that such a small dowel is able to provide such rigid fixation of the facet joint. Dr. Faulkner's experience has been positive based on the ease of the procedure with the provided guide, drill and compaction bit and with the lack of complications. He said, "I like the prospect of superior long-term benefits, and with this procedure, you are not burning any bridges in the event additional surgery is required."
TruFUSE grafts are most often used in place of rod and screw systems and bone growth stimulators. The entire TruFUSE technique can be performed using any dilating or retraction system or in open surgery. Elegantly simple, the TruFUSE technique uses a precision machined, Morse taper allograft cortical bone dowel and a compaction bit. A self-aligning drill guide is used to drill a tunnel in the plane of the facet joint between the inferior and superior surfaces to achieve a secure press fit for posterior fixation and permanent fusion. The TruFUSE bone dowel is inserted into the tunnel using a loaded inserter and tamp. The instrumentation and tapered dowel design insure that the dowel does not penetrate the foramen or migrate posteriorly out of the joint and into the paraspinous soft tissue.
Whether facet fusion alone is indicated or whether appropriately used in place of rods and screws, TruFUSE improves the rate of successful outcomes with a very favorable risk-benefit profile and lower complexity relative to its alternatives. Compared to other methods, TruFUSE offers less risk, surgical time, cost, hospitalization and rehabilitation. These improvements, combined with consistently positive outcomes and a good prospect of a beneficial long-term solution, have propelled TruFUSE to the orthopaedic limelight. Dozens of orthopaedic spine and neurospine surgeons have been trained and more are scheduled for training. Those numbers are sure to grow at a rapid rate as the news spreads.
