Dr. Lim Recognized as a 2018 Best Doctor by Northern Virginia Magazine
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Artificial Disc Replacement Surgery
A spinal fusion is not the only option for your neck pain.
Artificial disc replacement surgery, also known as total disc replacement, is a procedure that removes a severely damaged or degenerated disc and replaces it with a mechanical, man-made disc, to restore normal motion to the spine.
On the surface, having a disc replacement surgery recommended by your neurosurgeon can seem intimidating. However, the procedure is quickly emerging as an alternative to spinal fusions in an effort to relieve both neck and lower back pain caused by an injury, deformity, disease or natural degeneration.
In the past, these types of conditions were typically treated through what is known as a spinal fusion. A fusion, just like it sounds, involving the spine surgeon completely removing the damaged disc that separates two vertebrae and “welding” the two bones together so that they heal into a single bone.
While spinal fusion rates continue to rise throughout the United States, more and more research is beginning to show that the procedure is typically unnecessary, has varying results, requires a long recovery period, can limit motion and, in some cases, even have no effect on neck pain whatsoever. As a matter of fact, studies have found that only 75-80% of spinal fusions are successful; the other patients continue to experience symptoms after their recovery, even if the procedure was performed properly and everything healed as it should.
A 20-25% failure rate may not seem like a lot on paper, but when you consider that approximately 352,000 spinal fusions are performed in the United States each year it means that at least 88,000 people will experience little to no change in their symptoms. That’s not a number to sneeze at, especially in the medical community.
This isn’t to say that spinal fusions don’t have their place in the medical field. Sometimes they are medically necessary in cases of traumatic accidents and diseases; and fortunately, advances in minimally invasive technology have allowed them to become safer, more accurate and more successful than they’ve been in the past.
That said, no surgery, especially spinal fusions should be undertaken lightly. Most of the time the pain can be treated using conservative treatment or a less invasive form of surgery.
This is one of the reasons why researchers and neurosurgeons have invested so much time and effort into identifying whether or not disc replacement is a viable solution to spinal fusion.
Disc replacement surgery, on the other hand, aims to preserve the motion of the spine by inserting a man-made device that mimics the functionality of your natural discs.
Artificial disc replacement serves as an alternative to spinal fusions by replacing a diseased or damaged disc with a mechanical, man-made disc, to restore natural motion to the spine.
When compared to spinal fusion, one of the biggest benefits of disc replacement surgery is that it allows a patient to have more flexibility and natural range of motion in their spine. Additionally, because motion has been preserved in the spine there is less risk for increased level degeneration above or below the spinal fusion; an occasional occurrence in spinal fusions.
Disc replacement surgeries can be performed using minimally invasive techniques, meaning that there is less damage to the muscles, blood vessels, tendons and other tissues that surround the spine. This reduces the amount of bleeding that occurs during the surgery, reduces the risk of surgical complications, increases accuracy dramatically and helps patients recover more quickly and fully.
Finally, research is continuing to show that disc replacement surgery has better outcomes, for specifically selected patients, than a traditional spinal fusion.
In a 5-year randomized, multicenter study, researchers found that:
82.5% of patients who had a disc replacement surgery would have the procedure performed again
Only 68% of fusion patients would say the same.
When compared to spinal fusion, disc replacement surgeries have consistently better outcomes because they allow patients to maintain natural movement in their necks, which helps avoid increased level degeneration.
Unlike spinal fusions, which fuse two vertebrae together, in a disc replacement, surgeons will remove a diseased, degenerated or damaged disc completely and replace it with a man-made implant which was created to operate just like a natural disc; providing maneuverability and cushioning.
Before explaining how the procedure works, it’s helpful to have an understanding of how discs are supposed to function naturally and why surgery needs to occur at all.
Your spine is made up of 26 different bones, known as vertebrae which serve as the body’s central support structure and house the spinal cord. If you think of the human body like a tree, the spine would be the trunk.
Now, unlike a tree, our bodies our spines are able to bend, twist and absorb shock thanks, in part, to the thin cartilage inserts that separate each of our vertebrae. These are known as spinal discs.
Spinal discs are primarily made up of two parts:
As a normal part of the aging process, spinal discs start to degenerate. Years of wear and tear can take their toll, causing these discs to flatten out and shrink in size. This is known medically as degenerative disc disease.
In most instances, this degeneration is completely asymptomatic. However, in some instances, the outer part of the disc can grow so weak and flattened that it cracks, allowing the jelly-like substance inside to leak out and press against the sensitive nerve roots that exit the spine. This is known as a herniated disc and is one of the most common reasons for daily neck pain.
This is typically the progression for neck pain that occurs somewhat naturally, but discs can also be damaged by a traumatic accident (like a fall, accident or injury), deformation (like scoliosis), disease or tumors.
In some instances, the disc has become so degenerated that it is beyond repair and needs to be removed in order to help alleviate the neck pain that it’s causing. This is where disc replacement comes in and it typically becomes an option after conservative treatments have been exhausted.
Before recommending a disc replacement surgery, your neurosurgeon needs to look at your specific spine and the vertebrae that make it up to determine whether or not you are a candidate for the surgery. We’ll talk in depth about this process a little further below.
Once you have gone through this process and your spine surgeon recommends you for the surgery, you can undergo the procedure.
Typically, disc replacement surgery takes about 2-3 hours and your neurosurgeon will take what is known as an anterior approach to the spine, which means that he’ll enter through your abdomen or throat in order to access your affected disc.
The reason surgeons often take an anterior approach is because it allows them to work around the spine without having to move any of the sensitive nerve roots that exit from the spinal column. It also allows them to make smaller incisions and induce less muscle trauma which causes the surgery to be safer and allows you to recover more quickly.
Once a neurosurgeon has gained access to the spine, they will typically go about removing the affected disc completely. They will then size the gap between your vertebrae and insert an artificial disk that fits the location perfectly. If necessary, they will drill out certain portions of the vertebrae to make sure the disc is as secure as possible and will not shift during daily wear and tear.
An artificial disc is an implant that surgeons use to replace a degenerated or diseased spinal disc, helping relieve neck pain while restoring normal motion to the spine.
Artificial discs come in many different shapes and sizes and their functionality varies depending on the spine surgeon performing the operation and the research that’s currently available.
While the idea of artificial replacements isn’t new, Sir John Charley invented the artificial hip replacement in 1960, their use in a structure as complicated and intricate as the spine is relatively groundbreaking. This being the case, there are consistently new studies coming out about the best way to replace a disc, the best type of artificial disc that will easily and naturally bind to the vertebrae around it and more.
The technology continues to advance, along with the disc designs, each attempting to better reproduce the size and functionality of a natural spinal disc. The way they do this, the material they’re made out of and the way that they bind to the spine is what can vary.
Some discs are made of metal, while others are a combination of metal and plastic, some discs require total removal of the natural disc, others leave the rigid outer ring and just replace the nucleus pulposus.
Talk with your spine surgeon to decide which artificial disc design is best for you and your specific condition.
At Atlantic Brain and Spine, we typically use the Mobi-C Cervical Disc, created by Zimmer Biomet.
Mobi-C is the first FDA approved cervical disc for both one and two level procedures. Its patented mobile bearing technology allows the Mobi-C disc to self-adjust and move with the spine, facilitating movement similar to the natural cervical spine. The top and bottom plates have teeth that allow for placement without cutting the vertebrae, eliminating operative steps and preserving the bone as a stable surface for multiple implantations.
Artificial discs come in many shapes, sizes and materials. Your spine surgeon will be able to make an educated decision on which implant is right for you based on your specific spine and condition.
Careful patient selection by a neurosurgeon for disc replacement surgery is critical in helping ensure a positive outcome. Typically patients are good candidates if they are adults who are experiencing one level symptomatic degenerative disc disease.
On the other hand, patients who have soft or brittle bones caused by an injury or genetic disorder will likely not be good candidates because settling an implant in soft bone will typically cause it to slip or dislodge entirely.
Additionally, patients who are suffering from spondylolisthesis, a condition where one vertebra slips forward relative to the vertebra below it are not optimal candidates for a disc replacement because there can be movement of the implants.
In order to determine whether or not you are a candidate for disc replacement surgery, your neurosurgeon will likely perform a couple of tests including:
The results of these tests will help your spine surgeon determine the extent of the damage to your discs and whether or not inserting an artificial disc would help improve your daily neck pain.
It's incredibly important to make sure that you're a good candidate for an artificial disc replacement surgery. Your spinal specialist will perform a number of tests to make sure you don't have soft or brittle bones caused by an injury or genetic disorder.
The exact recovery time from any surgery depends almost entirely on the patient and the success of the surgery, however, people undergoing disc replacement surgery should expect to stay in the hospital for 1-3 days following their surgery.
These days of rest will give the body a chance to heal from the surgery and ensure that no complications have arisen.
Patients should expect to be able to stand and walk after the first day of surgery and, unlike a spinal fusion, there is no bone healing required in a disc replacement surgery meaning that you’ll be encouraged to get up and move around, specifically in the area where the disc was implanted, which can help foster quicker rehabilitation and recovery.
In the weeks after surgery, you will also be encouraged to stay active and perform basic exercises to help strengthen and heal the area around the implant. Your neurosurgeon will provide you with specific details of what you should do during the recovery phase of your surgery.
In general, patients undergoing disc replacement surgery should expect to stay in the hospital for 1-3 days following their surgery and several weeks or months of rehabilitation after the operation.
Daily neck pain is not normal. If you are experiencing consistent pain as a result of a degenerated disc and would like to learn more about disc replacement surgery, please don’t hesitate to reach out to our office.
Dr. Lim has been named a 2018 Best Doctor by Northern Virginia Magazine.Read more
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