Disc Replacement Surgery: 5 Things You Need to Know
Chronic back pain is an unfortunate reality for millions of people in the United States, with evidence suggesting that Americans lose more than 80 million workdays per year due to debilitating pain restricting their mobility. In some cases, pain can be treated with over-the-counter or physician-prescribed medicine, while surgical intervention may be required for more severe cases.
There are several types of surgical treatments available for back and neck pain, each of which targets different areas of the spine. An anterior cervical discectomy, for instance, involves the removal of damaged discs via an incision in the front of the neck and helps alleviate pressure on the nerve roots or the spinal cord. Disc replacement, spinal fusion, and laminectomy are among the other common surgeries for chronic back pain and other spine-related injuries.
For disc replacement surgery, the surgeon removes degenerative or damaged discs and replaces them with artificial discs designed to mimic natural disc movement and improve spine stability. It is usually a viable option for patients with single-level disc pathology and average or better spinal stability. Those with facet joint disease, poor spinal stability, and multiple disc pathologies may need to look into alternative treatment options.
Issues That Disc Replacement Surgery Can Resolve
Assuming candidates meet the physical requirements, disc replacement surgery is a good option for addressing chronic back pain caused by herniated discs, degenerative disc disease, disc degeneration with spinal instability, and failed back surgery syndrome (FBSS). It is generally a last resort for herniated discs, which occurs when the soft inner core of an intervertebral disc pushes through the tough outer layer, either due to injury, repetitive strain, or age-related deterioration.
Degenerative disc disease is an age-related ailment that causes chronic back pain and can severely impact one’s quality of life. Affected discs become smaller, losing their elasticity and ability to protect the spine. Disc degeneration with spinal instability, meanwhile, occurs when there is too much movement between the vertebrae. Disc replacement surgery is also an option for cervical myelopathy and radiculopathy, as well as pain that may develop after other surgical treatments, such as FBSS.
Materials Used for Artificial Discs
The materials used to make artificial discs may differ based on the patient receiving them. The surgeon will ask you about any allergies or potential reactions to select materials and choose the best fit, although the majority of artificial discs are composed of durable, long-lasting metal (either titanium or cobalt chromium) and plastic (medical-grade polyethylene). Hydroxyapatite, a bone-forming material, is sprayed on the surface of the metal plates to help it stay in place and stimulate vertebral bone growth. Disc implants are typically the size of a thumbnail.
How Disc Replacement Surgery Compares to Spinal Fusion
As previously mentioned, disc replacement surgery is the preferred option for those with above average spinal stability. Spinal fusion, which involves removing damaged discs and fusing vulnerable vertebrae via metal rods, is typically reserved for patients with arthritis in the facet joints or small vertebrae cracks or fractures. In some cases, patients may require a hybrid solution involving both procedures to improve mobility and prevent further disc degeneration.
Artificial disc replacement is the preferred treatment option for those looking to preserve their mobility. Spinal fusion surgery has a longer recovery period and, even when successful, patients may not be able to move as easily as they did before experiencing chronic back pain. When replacing discs near the neck (cervical spine), recovery is about two months, whereas recovery from cervical fusion usually takes about three months. Moreover, patients who undergo artificial disc replacement can usually start doing intense strengthening exercises within two months. Those who have had a spinal fusion often have to wait three months before beginning low-intensity stretching.
Diagnosis and Surgery Prep
To determine whether or not artificial disc replacement is suitable, the surgeon will perform a series of physical exams to assess muscle strength and the severity of back pain. They'll then take X-rays and MRI/CT scans to identify the issue and see if the spine is in good enough shape for surgery—otherwise, they may recommend spinal fusion.
If necessary, the surgeon will also suggest that the patient make lifestyle changes, like not drinking or smoking before surgery. Patients may also need to stop taking certain medications and make dietary changes. In preparation for surgery, the patient is sedated via general anesthesia, after which the surgeon makes an incision in the neck or abdomen to remove and replace the damaged disc. The average procedure usually takes a couple of hours.
The Recovery Process
Unlike spinal fusion which typically require patients to stay overnight in the hospital for monitoring, those who undergo artificial disc replacement can usually go home almost immediately after the procedure. They should have minimal or no issues walking on their own and should return to normal mobility within three weeks. For non-physical jobs, most patients can return to work by this time, although those with physically demanding jobs may need to wait at least three months.
Rehabilitation and physical therapy are important components of the post-surgery recovery process. Doctors might also prescribe pain medication to reduce swelling from surgery.