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Disc Replacement Surgery

DEFINITION AND DESCRIPTION:

This is a major surgical procedure performed by a spine surgeon, replacing a worn out disk in the lower back or neck. The degenerated disc is first removed and replaced by a synthetic or "artificial" disk.  The goal of the procedure is to relieve back, neck, leg or arm pain while maintaining relative normal spinal motion as compared to alternate treatment with spinal fusion. Examples of total artificial disk replacements is shown below.

INDICATIONS

Disc replacement surgery is motion-preserving procedure developed as a substitute to fusion. It’s indicated in patients with severe degenerative disc disease, complaining of neck or back pain which is not responsive to non-operative treatments. As part of a normal aging process, the intervertebral disc loses its natural height and hydration, develops internal disc derangement and becomes prone to injury. Degenerative disc disease can cause back and leg pain or neck and arm pain, and result in declining function and poor quality of life. 

OUTCOME

In 2007, cervical disc replacement was approved by FDA. Longer-term, multicenter studies are required for a better evaluation of the long-term efficacy and safety of cervical disc replacement.  Current literature comparing cervical disc replacement to cervical fusion shows that patient with disc replacement have better functional outcomes, fewer adverse events, and fewer secondary surgical procedures as compared to fusion. The efficacy and safety of cervical total disc replacements are superior to those of fusion.  There seems to be less adjacent degenerative disc disease following disc replacement as compared to fusion. 

In 2004, lumbar disc replacement was approved by FDA. In lumbar spine, spinal fusion is still considered superior to disc replacement. An artificial disc is a mechanical device that resides in patient's back and is generally safe, but does not come with lifetime guarantees. Longer follow-up should still be necessary to study longevity of improvement, surgical outcome and to observe any late complications including wear-debris osteolysis and adjacent level degeneration. Fusion surgery must be still the mainstay of surgical management in lumbar disc disease.

COMPLICATIONS

As with any surgery, disc replacement surgery carries the potential risk of complications. Complications can be related to anesthesia (medical), surgery or the hardware. Complications can develop at the time of surgery or in the days, weeks or months following the surgery. A list of potential complications may include bleeding, infection, blood clot, injury to blood vessels, spinal nerves or spinal cord injury, poor wound healing (diabetics), chronic pain and difficulty with swallowing. Hardware complications include dislodgement of the artificial disk, implant failure or fracture, implant loosening or wear, iatrogenic spinal stenosis, problems due to  poorly positioned implant, spinal stiffness or rigidity, wear-debris osteolysis and adjacent level degeneration.

VIDEO DEMONSTRATION

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Lumber Disc Replacement 

Cervical Disc Replacement