If you are among the thousands suffering from chronic pain and limited mobility caused by a degenerative and/or herniated disc, it may be time to consider a surgical alternative. Artificial disc replacement (ADR), also referred to as TDR (total disc replacement) is used to correct pain, tingling, and loss of mobility resulting from a degenerative or herniated disc.
However, there are certain considerations you and your doctor should discuss before moving forward with surgery. Here, we’ll share five things to consider about artificial disc surgery.
1. Is Surgery the Best Option?
The first consideration is whether surgery is your best option. Treatment will depend on the severity of your condition, so let's explore two of the more common disorders that may require artificial disc surgery.
Degenerative Disc Disease: As we age, the discs between our vertebrae, which normally provide cushion, support, and range of motion, naturally degenerate. For many people, this happens simply as a consequence of aging and causes no pain or loss of mobility, but for others, the degeneration of discs in the cervical or neck region can lead to numbness and tingling in the arms, pain radiating down the arms, and even loss of function.
Disc degeneration can result from dehydration within the disc, traumatic injury, a loss of collagen, or arthritis, and can lead to our next condition, herniation.
Disc Herniation: If the disc degenerates or is injured, it can leak its contents into the surrounding space, putting pressure on nerves, or the spinal cord, resulting in many of the same symptoms as a degenerative disc, namely pain, numbness, and tingling in the limbs. Because the bones of the neck are smaller than those of the chest and lower back, and have smaller openings for nerves to pass through, leakage from cervical discs results in more severe symptoms than leakage in the thoracic or lumbar regions.
Whether you suffer from disc degeneration, herniation, or both, there are many non-surgical treatment options to consider before resorting to surgery. Many cases resolve on their own and can be managed with pain and anti-inflammatory medications. Non-surgical modalities such as epidurals and facet blacks may be considered. Physical therapy is also an option, as is the use of hot/cold therapy, but for cases that don't respond to treatment, surgery becomes the natural option.
2. Artificial Disc Replacement vs. Fusion
There are two primary surgical procedures to correct disc degeneration or herniation:
- Disc removal and replacement, using a synthetic product that mimics the original disc.
- ACDF surgery (anterior cervical discectomy and fusion), where the disc is removed and replaced using a bone graft. The graft can come from the patient (autograft), from a cadaver donor (allograft), or be a synthetic replacement (plastic, ceramic, titanium, or bioresorbable compounds).
Artificial disc replacement has several advantages over ACDF. First, it preserves mobility of the neck, which is lost when the bones are fused during ACDF. And because the discs want to move with artificials disc replacement you are not required to wear a collar or a brace which may be required after a fusion operation. One of the most devastating complications of ACDF is failure of the graft to heal properly resulting in non-union of the bone and potentially requiring further surgery. Because the bones do not have to heal, artificial discs do not produce complications. Also, in the case of allografts, patients can suffer from pain and soreness in the graft area (typically the hip). Your doctor will decide which procedure is best for your condition.
Risks involved with ADR are typical of any surgical procedure: infection, which is why you should choose a facility with a reputation for exceptional cleanliness; pain at the site of operation; and the possible need to replace the synthetic disc over time (similar to hip or knee replacements).
3. What Results Can You Expect?
Artificial disc replacement will not improve mobility, but should restore it to what it was prior to surgery. Replacing the damaged disc will relieve associated pressure on surrounding nerves, thus eliminating pain, tingling, and numbness, and improving quality of life.
4. What Is the Recovery Process after ADR?
When ADR is conducted via a minimally invasive procedure, you can expect to be up and walking the day of surgery. However, you must follow doctor's orders concerning activity to reduce the risk of complications, wound not healing properly, and re-injuring the surgical site.
A physical therapist will guide your recovery, helping you restore activity while educating you on the proper ways to lift and perform daily activities.
5. Choosing Your Surgeon
Probably the most important consideration concerning artificial disc surgery is what you need in a surgeon. You want someone who specializes in ADR, someone who has the background, experience, and training to afford you the best possible outcome. Board certification and fellowship trained is a must, as is an integrative facility. A facility that offers a full range of surgical, therapeutic, and rehabilitative services will guarantee continuity of care throughout your treatment and recovery period.
As you prepare for artificial disc surgery, consider all of your options, educate yourself so you know what to expect, and choose a qualified surgeon who provides cutting-edge treatment in a state-of-the-art facility.
About the author
Robert S. Bray, Jr., M.D. Nicknamed “Dr. Fix-It” by The Red Bulletin, Robert S. Bray, Jr., M.D. makes an art of helping the world’s most elite athletes return to push the boundaries of performance. The neurological spine surgeon, recognized globally for his thorough diagnoses and pioneering minimally invasive approach, is quickly redefining sports medicine, one champion at a time. Dr. Bray founded the state-of-the-art, multi-disciplinary DISC Sports & Spine Center (DISC) in 2006 located in Los Angeles, CA. Read more articles by Robert S. Bray, Jr., M.D..