What is Artificial Disc Replacement?

Is Artificial Disc Replacement a good option for me?

Author: Attorney Lonnie Roach

Is Artificial Disc Replacement a good option for me? Good candidates have back pain caused by one or two vertebral discs in the spine, no degenerative arthritis that affects the facet joints in between individual vertebrae, no previous surgery and no spinal deformity such as scoliosis.

Approximately 70-80% of people will experience some back pain during their lifetime. Treatment depends on both the cause and severity of the pain. Though most patients will not require surgery, spinal fusion and artificial disc replacement may be considered when nonsurgical care such as medication, injections, chiropractic and physical therapy do not provide sufficient relief.

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Spinal fusion is the traditional surgical approach to treating back pain caused by degenerative discs.

This procedure removes disc tissue and replaces it with bone, fusing the vertebra around the disc that is causing pain. But a normal spine allows motion at the discs and while spinal fusion reduces pain, it also eliminates movement. Artificial disc replacement (ADR) is a surgical procedure where damaged disc tissue is removed and a synthetic disc is placed in the spine. The goal of ADRA is to restore motion as well as relieve back pain.

Lumbar and cervical discs are made of cartilage-like tissue and form the cushioning between the small bones of the spine called vertebrae.

Worn or injured discs can cause severe back pain. A disc has an outer portion called an annulus and an inner portion called a nucleus; the disc is usually flexible, allowing the spine to bend. Artificial discs can be made of metal or biopolymer (plastic-like) materials or a combination of metal and plastic. Devices that are commonly used have 2 plates, one attaching to the vertebra above the disc being replaced and the other attaching to the vertebra below. Some artificial discs have a soft piece between the plates that can be compressed. These discs allow motion by their smooth surfaces sliding across each other.

There are several artificial disc designs used in disc replacement:

•    Total disc replacement removes all or most of the damaged disc tissue and an artificial disc is implanted in between the vertebra.
•   Disc nucleus replacement removes the center of the disc (nucleus) and replaces only the nucleus. The outer portion of the disc (annulus) remains.
•   Cervical disc replacement involves removing a disc in the cervical spine and replacing it with an artificial disc.

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The type of artificial disc replacement implemented depends on the cause of back pain and its severity.

Cervical disc replacement has only been used a short time in the United States and is undergoing evaluation in FDA studies. Though nucleus replacement may be a good option for patients in the early stages of disc degeneration where the annulus is in good condition, no nucleus replacement devices are currently in use in the United States, not even in FDA studies.

Who might benefit from a disc replacement? Good candidates have the following characteristics:

•   Back pain caused by one or two vertebral discs in the spine
•   No degenerative arthritis that affects the facet joints in between individual vertebrae
•    No previous surgery
•   No spinal deformity such as scoliosis
•   Not excessively overweight

Additionally, some conditions may exclude artificial disc replacement:

•   Spondylolisthesis (slipping of one vertebral body across a lower one)
•   Spinal tumor or spinal infection
•   Vertebral fracture
•   Pregnancy
•   Chronic steroid use
•   Autoimmune disease
•   Allergy to device materials
•    Osteoporosis

In order to determine whether a patient might benefit from ADR, a doctor will perform an MRI, a discography (a procedure where dye is injected into the disc), X-rays and a CT Scan to identify which disc is causing pain.

Surgery takes between 2 and 3 hours. The orthopedic surgeon approaches the spine through an incision in the abdomen and organs to reach the spine without moving the nerves. The damaged disc is removed and the artificial disc is implanted. Typically, a patient will remain in the hospital for 1 to 3 days and is encouraged to stand and walk the first day after surgery. During the first weeks after surgery, patients perform basic exercises, walking and stretching, but avoid hyperextending the back.

Most patients experience a reduction in pain and a more rapid return to activity, but artificial disc replacement does not eliminate pain completely.

While spinal fusion has a long record of success, there have been no long-term studies on artificial disc replacement and future research will need to focus on advancement in disc design and tools for diagnosing pain.