Disc replacement surgery involves removing the damaged disc tissue and implanting an artificial disc. This procedure can be performed in the cervical (neck) and lumbar (lower back) regions. The artificial disc maintains the spine's natural motion while securely attaching to the surrounding vertebral bones.
Although total disc replacement is a newer procedure and is performed less frequently than traditional spinal decompression and fusion surgeries, it is becoming increasingly popular. This is due to its ability to preserve spinal motion while effectively treating neck or back pain. Additionally, as more long-term outcome studies demonstrate its effectiveness, the procedure continues to gain acceptance.
The following are the conditions that lead to the need for a disc replacement surgery:
- Discitis (Inflammation of the intervertebral disc)
- Scoliosis (abnormal spinal curve laterally)
- A herniated disc in the back (slipping of the cartilaginous disc into surrounding tissue)
- Disc degeneration and disc rupture (infection of the intervertebral disc causing its degeneration.
- myelopathy
Who is the best candidate for spinal disc replacement surgery?
The best candidates for spinal disc replacement surgery are patients with diseased discs in the cervical or lumbar spine who still have good spinal motion and minimal or no arthritis. One of the primary goals of this surgery is to preserve spinal motion. According to research from HSS, patients with greater disc height may be better suited for this procedure than those with less disc height.
The following signs and symptoms may indicate a need for cervical or lumbar disc replacement:
- Chronic Neck pain persists
- Radiculopathy(Pain radiates from the neck to the shoulders, arms, and hands.)
- Numbness or tingling in the arms and hands.
- Weakness in the shoulders, arms, or hands.
- Myelopathy causes difficulty with coordination and fine motor abilities in the hands.
- Trouble with balance and walking.
- Sciatica (pain that radiates from the lower back to the buttocks, legs, and foot.)
- Numbness or tingling in the legs and feet.
- Weakness in leg muscles.
The cervical or lumbar disc replacement diagnosis generally involves a combination of patient history, physical examination, and imaging studies. The process includes:
- A Detailed discussion of symptoms, including the location, duration, and intensity of pain.Review of any previous treatments and their effectiveness.Assessment of lifestyle, activity level, and overall health.
- A thorough evaluation of Physical Examination of neck or lower back movement and flexibility.
- Neurological function, including strength, sensation, and reflexes in the arms (for cervical issues) or legs (for lumbar issues) are also assessed.
- Imaging Tests such as X-rays, MRI, and CT scans are performed to get detailed images of bone in the spine, a detailed view of soft tissues, including discs, nerves, etc, and also check the detailed cross-sectional image of the spine.
- Discography is also performed to evaluate the integrity and the source of pain by using a specific contrasting dye in the disc.
Patients can generally expect to spend at least one night in the hospital after disc replacement surgery and may be discharged after two to four days, after a thorough evaluation by the physical therapists. the patient should avoid bending or twisting for the first two to four weeks to avoid straining the surgical site. Patients are advised to use braces if their condition requires support in the lower back.
The patient may recover and get back to normal activities within three weeks after disc replacement surgery. Studies reveal that patients who successfully undergo total disc replacement surgery remain asymptomatic and free from chronic back pain for an average of 8.7 years.
The recovery time after total disc replacement is significantly less than that of spinal fusion surgery. The mobility is not compromised, and the prognosis is good. The success rate of the disc replacement surgery is around 98 percent. Rigorous or high-impact activity is restricted until the surgical site is well healed, usually just a few weeks. Some patients may benefit from a short course of physical therapy afterward. In general, patients can expect to return to normal activities three months post-surgery.
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