Disc replacement surgery, also known as artificial disc replacement or total disc arthroplasty, is a procedure where a damaged intervertebral disc in the spine is removed and replaced with an artificial disc. This surgery aims to maintain motion at the disc space, unlike spinal fusion, which eliminates motion.

Common Reasons for Disc Replacement

• Degenerative Disc Disease (DDD): Severe disc degeneration causing chronic pain and disability.
• Herniated Disc: When other treatments have failed to provide relief.
• Spinal stenosis: Narrowing of the spinal canal that compresses the spinal cord or nerves.
• Failed previous spinal surgery: Persistent pain after other types of surgery.

Candidates for Surgery

Ideal candidates for disc replacement surgery typically:

• Have disc degeneration confined to one or two discs in the lumbar or cervical spine.
• Do not have significant arthritis of the facet joints.
• Are not significantly overweight.
• Do not have a spinal deformity, such as scoliosis.
• Have not had a previous spinal fusion at the same level.

Diagnosis

• Medical history and physical examination: Assessment of symptoms, lifestyle, and physical condition.
• Imaging tests:
  • X-rays: To identify disc space narrowing and alignment.
  • MRI: To visualize disc health, herniation, and nerve involvement.
  • CT scan: Detailed images of the spine.
  • Discography: Injecting dye into the disc to pinpoint the source of pain.

Surgery

Preoperative Preparation

• Medical evaluation: Comprehensive health assessment to ensure the patient is fit for surgery.
• Medications: Review of current medications; certain medications may need to be stopped prior to surgery.
• Lifestyle changes: Patients may be advised to stop smoking and lose weight if necessary.

Surgical Steps

• Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
• Incision: An incision is made in the front (anterior) of the neck for cervical discs or the abdomen for lumbar discs.
• Removal of the damaged disc: The surgeon removes the damaged disc and prepares the disc space.
• Placement of the artificial disc: The artificial disc, typically made of metal and plastic, is inserted into the disc space.
• Closure: The incision is closed with sutures or staples, and a bandage is applied.

Types of Artificial Discs

• Cervical artificial discs: Designed for replacement in the neck region.
• Lumbar artificial discs: Designed for replacement in the lower back.

Rehabilitation

• Hospital stay: Usually 1-3 days post-surgery.
• Initial recovery: Rest and limited activity immediately after surgery.
• Physical therapy: Begins within a few weeks to restore strength and flexibility.
• Activity restrictions: Avoiding heavy lifting, twisting, and high-impact activities for several months.
• Full recovery: Typically takes several months, with gradual return to normal activities.

Complications

• Infection: Risk at the surgical site.
• Implant issues: Movement, dislocation, or wear of the artificial disc.
• Nerve damage: Potential injury to nearby nerves.
• Pain: Persistent pain or new pain.
• Adjacent segment disease: Increased stress on adjacent discs leading to degeneration.

Prognosis

• Success rate: Generally high, with many patients experiencing significant pain relief and improved function.
• Longevity of artificial discs: Designed to last for many years, but long-term outcomes are still being studied.
• Improved quality of life: Many patients return to normal activities with reduced pain and better mobility.

FAQ’s

How does disc replacement surgery differ from spinal fusion?
Disc replacement surgery maintains motion at the treated segment, while spinal fusion eliminates motion by fusing the vertebrae together.

What is the recovery time for disc replacement surgery?
Recovery time varies but typically ranges from several weeks to a few months. Full recovery can take up to six months.

Are there any activities I should avoid after disc replacement surgery?
Initially, heavy lifting, twisting, and high-impact activities should be avoided. Your surgeon will provide specific guidelines based on your recovery progress.

What are the risks of disc replacement surgery?
Risks include infection, implant issues, nerve damage, and persistent or new pain. Discussing these risks with your surgeon can help you make an informed decision.

How long do artificial discs last?
Artificial discs are designed to last for many years, but their longevity can vary. Long-term studies are ongoing to determine their durability.

Can I have an MRI after disc replacement surgery?
Most modern artificial discs are MRI-compatible, but you should always inform your healthcare provider about any implants before undergoing an MRI.