Arthroplasty commonly known as Artificial Disc Replacement (ADR) or disc replacement surgery is a spine surgery to replace the damaged inter-vertebral disc in our spinal column with an artificial implant or device. Such replacement procedure is done in patients suffering from chronic severe lower back / cervical pain or ones who had met with an accident that had damaged their spinal disc. It is a not as prevalent as knee or hip replacement but is now increasingly being used around the world to treat patients with degenerative spine disc problems.
Artificial Disc replacement surgeries have proved to be successful alternative to spinal fusion as they not only eliminate pain but also allow movement throughout the spine. Studies have reported over 90% success rate for disc replacement procedures.
What is a disc replacement surgery?
Let us first understand briefly the structure of our back bone. Our spine or back bone is made up of 33 bones known as vertebrae stacked one above the other. In between these vertebrae are the flat round cushions called the inter-vertebral discs. These discs give us flexibility to bend our body. But with age the intervertebral discs get brittle and flat. They even start to degenerate due to diseases like osteoarthritis and osteoporosis. An accident or injury can also damage the disc, compressing the nerves causing acute back pain.
When this disc gets damaged causing severe back pain and preventing movement, your doctor may recommend disc replacement surgery, basing your other medical conditions.
During the replacement surgery an artificial disc, also called disc prosthesis would be implanted in your affected part of spine. The artificial disc has the capacity to function as a normal disc, bearing body weight and allowing motion and most important relives you from continuous severe pain.
There are two common types of disc replacements – Lumbar disc replacement and cervical disc replacement.
Lumbar disc replacement-
Lumbar Disc Replacement surgery involves replacing a worn out disc in the lumbar (lower) region of your spine with an artificial implant made of metal or a combination of metal and plastic.
Cervical disc replacement –
Who undergo disc replacement surgery?
Replacement surgeries would only be recommended when even the aggressive non-operative treatments fail to give relief from back pain and you are almost unable to move or perform daily activities. Doctors would also consider your other health/medical conditions before proposing the disc replacement. Generally, patients in the age group 18-60 years are eligible to undergo the procedure.
Possibly in any of the below conditions, disc replacement is recommended:
- Patients with degenerative disc disease
- Spinal disc herniation commonly known as slipped disc
- Severe chronic back pain
- Not responded at all for non-surgical treatment like medications, exercises etc.
It is also important to know that you CANNOT have the disc replacement surgery if you have any of the following condition:
- Spondylolisthesis (when one vertebrae slides forward over the one below it)
- Severe osteoporosis
- Vertebral body fracture
- Allergy to the materials in the device
- Spinal tumor
- Spinal infection
- Morbid obesity
- Chronic steroid use or autoimmune problems
- Previous history of abdominal surgery
Do disc replacement surgeries have any complications?
The complications are same as in any other surgical procedure. They include blood clotting, infection, blood vessels or nerve injury, and sexual dysfunction. But these are very rarely reported and as also your surgeon takes care of everything as when necessary.
Studies have shown life of disc implant is about 10-20 years and wearing of the artificial disc implant is also uncommon.
Whom to choose – Orthopedic or neurologist spine surgeon for the replacement?
Both orthopedic and neurosurgeon are trained enough to do surgeries. Since spine surgeries are complex and involve lot of intricacies, it is advisable your doctor has experience of doing spine disc replacement surgeries.
Recovery of disc replacement surgery
The recovery after disc replacement is an ongoing process. Most probably you will be discharged from the hospital within a week. Pain management and gentle exercises by your physiotherapist as essential part for recovery will continue for months.
Follow your physiotherapist techniques thoroughly after the replacement. He/she will teach you how to gradually do your exercises and move (walking, sitting etc.) around without stressing your back.
For the first two to four weeks, you will have to avoid bending and lifting. It takes over a month or two to make your back muscles strong and the pain to subside and return to normal activities. But make sure to consult your doctor before beginning any new physical activity like driving, cycling etc.
You may return to moderate work and light sports in about three months after the surgery when the pain has subsided. However, it would take over a year to experience the complete benefit of disc replacement surgery.
- Avoid heavy lifting and impact sports
- Follow regular exercises as prescribed by your physiotherapists
- Do not be in a hurry to do too much too quickly
- Control body weight
- Regular follow-up with doctor
Benefits of disc replacement surgery
- Relieve from severe back pain
- Corrects deformity
- Improves your mobility
- Life changing surgery
It is essential that you make an informed decision and discuss with your surgeon all your doubts including the benefits and risk factors. Also, since spine surgery is mostly elective, except for few cases when it is very essential. Always take the second opinion and outweigh all the possibilities before and after the procedure. And most important be positive as disc replacement has benefited thousands of patients around the world.