disc substitute

  My name is Janet Fisher and I am a 37 year old mother of four. I am about to undergo my second laminectomy in two years. L5, S1 ruptured once as a result of a car accident and again due to my job. My neurosurgeon mentioned a material that can be used in place of disc material after a laminectomy. Could you please give me any and all available information on this new substance? I go in for surgery on January 14. Any response would be appreciated.
  Sincerely,
  Janet Fisher
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Dear Janet,
Spine surgeons have long thought that there may eventually be some substance that we would put in the disc space after simple discectomies.  The fact is that most patients do very well in the long run after a simple discectomy.  Surgeons differ on how much of the disc should be taken out when doing the first discectomy, but most agree that a fusion is not necessary after the first disc at a particular level.
When a patient has recurrent disc herniation at a certain level, there is increased risk of instability at that level.  Some advocate a fusion after a patient has had two or three recurrent discs.  Do know that this is rather uncommon.  It is, however, a real concern.  
The simplest and most sensible material to put in the disc space is a patient's own bone.  This has the best chance of fusion as shown in clinical studies.  The next best is allograft fusion or cadaveric bone.  
Beyond that researchers have been trying to come up with a whole host of different materials to put in the disc space.  Titanium, various alloys, different kinds of plastic derivatives have all been tried in the laboratory.  The most common ones in use are bone followed by the newer titanium cages (BAK, Ray etc...).  
Speak to your surgeon about his particular goals in your situation for a clear understanding of what he wants to do with you.  
Good luck.