What is a Disc Replacement?

Disc replacement surgery or artificial disc replacement surgery involves replacing a painful disc with a synthetic or artificial disc. During this surgery, neurosurgeons remove the worn or damaged disc material between the vertebrae in the spine. This replacement helps patients to relieve their existing back pain. This also maintains more normal motion than spinal fusion surgery. Neurosurgeons usually perform this operation at the neck (cervical spine) or lower back (lumbar spine). Neurosurgeons use this operation as an alternative to spinal fusion surgery. Spinal fusion procedure uses as a traditional approach to treat pain or disability from degenerative disc disease. Spinal fusion surgery permanently joins 2 vertebrae together.

Disc ReplacementUsually, a series of bones called vertebrae make up a spinal column. Discs between the vertebrae act as a cushion that helps in vertebral rotation and movement without the bones rubbing against each other. Lumbar vertebrae and their disc usually present at the bottom of the spine, while cervical vertebrae with their disc present at the top of the spine. The lumbar disc replacement procedure involves the replacement of a damaged disc in the lumbar region of the spine.

Conditions for Disc Replacement

To determine the patient’s ability for disc replacement, the neurosurgeon will perform a few tests, such as magnetic resonance imaging (MRI) scans, discography, computed tomography (CT) scans, or X-rays. Information from these tests will help the neurosurgeon to determine the source of the back pain. Not all patients with low back pain considered a perfect candidate for artificial disc replacement. Patients with excessively overweight will not recommend for this surgery. Usually, neurosurgeons recommend patients for disc replacement with these below characteristics 2:

  • Back pain due to one or more problematic intervertebral discs in the spine
  • Patients with no prior major surgery on the spine
  • Patients with deformity of the spine (scoliosis)
  • Patients with osteoporosis can’t support disc replacement
  • Patients with no significant facet joint disease or bony compression on spinal nerves

Approximately 65 million people each year experience low back pain due to degenerative disc disease (DDD) in the United States. This DDD refers to a disorder of the spine and intervertebral discs.

Different Types of Disc Replacement

Based on the location of operation, neurosurgeons classify disc replacement into 2 major types: cervical disc replacement, and lumbar disc replacement. Neurosurgeons perform cervical disc replacement when the problem occurs in the cervical regions. Similarly, lumbar disc replacement performs when this spinal disorder involves the compression of the lumbar vertebral disc.

Risks of Disc Replacement

All surgical operations have some risk. Like any surgery involving general anesthesia, risks associated with artificial disc replacement include the following:

  • Excessive bleeding
  • Blood clot
  • Possible paralysis due to nerve or spinal cord injury
  • Local or systemic bacterial infection
  • Reactions to the anesthesia
  • Swelling of the tissue
  • Bending, breaking, loosening, or dislocation of the implant
  • Allergic reaction to the artificial disc’s materials
  • Damage to the vertebra during disc replacement
  • Death

Besides these complications, neck and/or arm pain, difficulty swallowing, changes of speech, etc. may occur in the case of a cervical disc replacement procedure. Neurosurgeons need to discuss these risks with the patient before surgery.

How should a patient prepare for a Disc Replacement procedure?

Patients need to discuss with neurosurgeons about their qualifications for artificial disc replacement. Neurosurgeons recommend patients between the ages of 18 and 60 with degenerative disc disease who tried non-surgical therapy for at least 6 months 2. Patients need to stop taking certain drugs like blood thinner before the operation and also need to avoid eating, drinking, and smoking for several hours before the operation. Prior to the surgery, neurosurgeons will check the patient by performing additional tests like X-rays, magnetic resonance imaging (MRI), etc. to get more information regarding the spinal column.

How does a Spinal Surgeon perform Disc Replacement?

Artificial disc replacement surgery requires a well-trained neurosurgeon, an anesthesiologist, and an assistant to perform successfully. The overall process includes 1:

  • Anesthesiologists will administer general anesthesia to the patient to fall asleep so that patient may not feel any sensation.
  • Nurses will prepare the incision site and monitor the vital signs of the patient’s body such as heart rate, respiration, etc.
  • Neurosurgeons will approach the lower back from the front through an incision in the patient’s abdomen. This helps the neurosurgeon to access the patient’s spine without moving the nerves.
  • Then neurosurgeons will move the abdominal organs and blood vessels allow access to the spine.
  • Neurosurgeons will remove the problematic disc and put the artificial disc in place of it.
  • Finally, the neurosurgeon will put back the abdominal organ and blood vessels in place and close the incision.

How long does a Disc Replacement procedure typically take?

Usually, an artificial disc surgery requires 2 to 3 hours to complete successfully 3. Throughout the operation, nurses will monitor the vital signs like heart rate, respiration, blood oxygen level, etc. of the patients. Neurosurgeons need to be careful about the potential risks of this surgery.

What does recovery from Disc Replacement look like?

Usually, a patient requires a 1 to 3 days stay in the hospital following disc replacement surgery 4. The duration of hospital stay depends upon post-operative care. Since artificial disc replacement does not require bone healing, that’s why most patients can expect to stand and walk one day after surgery. Early motion enhances the rehabilitation process and helps the patient to recover quickly. Studies show that disc replacement may improve the condition, but can’t eliminate pain permanently.

Most patients can return to their normal activities between 6 to 8 weeks after surgery. The rehabilitation process after this surgery may include self-directed exercise programs like walking, stretching, etc. for a few weeks after surgery. After then, neurosurgeons suggest the strengthening program. Neurosurgeons recommend patients shower 5 to 7 days after the surgery. Usually, an artificial disc replacement lasts for an average of 70 years without a second replacement. Typically, neurosurgeons observe patients with an artificial disc at four to six weeks following surgery and then at 3, 6, and 12 months 5.

References

  1. Zhu, Z. & Shen, Q. The Research of Artificial Cervical Disc Replacement. J. Nanjing Med. Univ. 22, 335–337 (2008).
  2. Pham, M. H., Mehta, V. A., Tuchman, A. & Hsieh, P. C. Material Science in Cervical Total Disc Replacement. Biomed Res. Int. 2015, (2015).
  3. Kitzen, J. et al. Long-term clinical outcome of the Charité III total lumbar disc replacement. Eur. Spine J. 29, 1527–1535 (2020).
  4. Wang, X. F., Meng, Y., Liu, H., Wang, B. Y. & Hong, Y. The impact of different artificial disc heights during total cervical disc replacement: an in vitro biomechanical study. J. Orthop. Surg. Res. 16, 1–10 (2021).
  5. Othman, Y. A., Verma, R. & Qureshi, S. A. Artificial disc replacement in spine surgery. Ann. Transl. Med. 7, S170–S170 (2019).

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