Artificial Disc Replacement Surgery: From Start to Finish
What happens when a chronic back pain patient's disc degenerates so much that it needs to be replaced? Artificial Disc Replacement (ADR) surgery is a potential option.
Lumbar Artificial Disc Replacement (ADR) surgery, also known as Total Disc Replacement (TDR), is an alternative to spinal fusion surgery, a common procedure performed on an estimated 200,000 lumbar degenerative disc disease patients annually.
As we age, the natural wear and tear on our discs can create degenerative disc disease. Artificial disc replacement relieves a patient's chronic back pain by removing damaged discs, restoring disc height, and increasing mobility using a device designed to mimic the function of a natural spine disc.
The end goal of artificial disc replacement surgery is decreased back pain without increased risk of problems occurring at adjacent levels of the patient's spine that can happen as a result of spinal fusion surgery. As with any surgery, it’s important to consult with your doctor first to understand your level of risk.
Every person with chronic back pain isn’t a candidate for artificial disc replacement surgery. Your doctor will help you determine the best treatment plan for you. When talking to your doctor, they will examine you for these conditions:
- Back pain triggered by damaged disks in the lumbar spine
- A healthy weight that can support spine surgery
- Extensive Facet joint disease, or spinal nerve compression
- Existing major spine surgery, such as spinal fusion
- Spine deformities, such as scoliosis
Depending on the severity of any of these conditions, your doctor may or may not be able to recommend artificial disc replacement. Your physician then may rely on additional tests to make their determination. These tests include:
- Magnetic resonance imaging scans (MRI) to confirm disc degeneration, and
- Discography, a procedure in which your doctor injects a dye into your disc to pinpoint the damage visibly via X-ray or computed tomography (CT) scan.
Before ADR Surgery
Like other surgeries, you want to ensure that you have the best available spine surgeon operating on your back. Once you’ve selected a surgeon and consulted with them, be sure to ask why they believe surgery is best for your situation.
In preparation for surgery, your spine specialists may recommend some lifestyle changes to increase the success rate of your surgery. These changes may include quitting smoking, changes to diet and exercise if weight is a concern, and a psychological evaluation to ensure mental preparedness. Since spine surgeries are more prevalent in the U.S. and the psychological impact of surgery are higher, evaluations help both the doctor and patient making them important for surgical success.
The Food and Drug Administration (FDA) has approved artificial disc replacement for use in the United States because they have judged this surgery to be safe and effective to relieve a patient’s lower back or neck pain.
In both traditional and artificial disc replacement (ADR) surgeries, the surgeries start by eliminating the diseased or damaged disc between the vertebrae to prepare it for the new disc.
The surgeon makes a small incision on the patient's stomach — normally directly below the belly button. Then, the surgeon shifts the intestinal organs gently to the side. This is done so the surgeon can firmly see the spine to protect the anatomic structures inside the patient's stomach.
A properly sized artificial disc is then inserted into the patient's spine, and then tapped into place replacing the damaged disc with an artificial one. The surgeon makes sure to restore the intervertebral disc height to restore the spine to its natural position.
Post Op: Recovery & Results
Recovery from artificial disc replacement (ADR) surgery and post-op care are similar to that of other approaches to lumbar spinal surgery. Often, recovery is faster than for a traditional spinal fusion surgery. There can be less pain from artificial disc replacement (ADR) surgery and fewer complications.
Many patients in their hospital recovery rooms have felt immediate pain relief or lower pain levels, which is the best-case scenario for this treatment. These are normally the results of cervical disc replacement surgery.
Other patients wake from surgery saying their back pain has been relieved but complain about new nerve and leg pain, which is common due to the nature of the procedure. Surgeons call this “distraction pain.” It normally resolves itself within six to eight weeks.
Most patients are out of bed and walking around the evening following artificial disc replacement (ADR) surgery. Patients may need to stay in the hospital for one to two days post-op for monitoring.
There are some restrictions on what activities the patient can do for the first month, but after that, the patient can often resume normal activities with the approval of their physician. Patients should request a complete list of activity restrictions from his or her surgeon. In most cases, the patient can return to regular activities within six to eight weeks of artificial disc replacement (ADR) surgery.
In most cases, a self-directed walking and stretching program is what the patient needs during the first four weeks after artificial disc replacement (ADR) surgery. Later, an abdominal strengthening program may aid those who were deconditioned prior to artificial disc replacement (ADR) surgery.
Regarding doctor follow-ups, patients are typically seen at four to six weeks, three months, six months, one year and once a year after the initial year. X-rays are also done to make sure the artificial disc hasn’t moved and that your bones have fused with the disc endplates. Additionally, during the X-ray testing, the patient will be asked to bend and move in different positions to ensure the disc is functional.
Many patients in their hospital recovery rooms have felt immediate pain relief or lower pain levels, which is the best-case scenario for this treatment.
Dynamic X-rays, performed with the patient bending at the spine, are performed after a patient's ADR surgery to allow the surgeon to determine if the motion of the new artificial disc will closely resemble normal motion of a healthy disc.
PROVEN EFFECTIVE IN STUDIES
Patients given the opportunity to choose artificial disc replacement over spine fusion surgery through informed consent are given a surgery that is motion-preserving to the spine and greatly reduces the chance of adjacent segment disease. Furthermore, it yields better functional outcomes, fewer negative effects, and fewer surgical revisions and re-operations than spinal fusion.
If you have been told you need a spinal fusion or have been suffering from chronic low back pain from degenerative disc disease, you owe it to yourself to explore lumbar artificial disc replacement surgery to see if you are a candidate. It is a treatment option that can preserve motion, decrease the rate of adjacent segment disease, and avoid future surgeries.
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To assess the longevity, effectiveness, and safety of artificial disc replacement (ADR), a team of authors conducted a meta-analysis of the available randomized controlled trials with published five year outcomes comparing ADR to spinal fusion. The patients were those diagnosed with chronic lower back pain from single-level lumbar Degenerative Disc Disease (DDD). Here's what you need to know.