Disc Arthroplasty/Artificial Disc Replacement
Artificial disc replacement is a surgical procedure for relieving pain in the low back or neck, or pain, weakness or numbness in the arms. A disc replacement substitutes a mechanical device for an intervertebral disc in the spine that is damaged or diseased. The device is meant to restore motion to the spine by replacing the worn, degenerated disc.
An MRI is used to confirm damage to the disc and determine appropriateness of a disc replacement surgery.
This technology has been available in Europe for over a decade. Artificial disc replacement initially gained FDA approval for use in the U.S. in 2004.
Who Is a Candidate for Disc Replacement?
To determine who is a good candidate for disc arthroplasty, the surgeon may require a few tests. These may include magnetic resonance imaging (MRI), discography, computed tomography (CT or CAT scan), and x-rays. These tests will also help the surgeon determine the source of the pain.
Good candidates for disc replacement have the following:
- Back pain thought to be caused mostly from one or two intervertebral discs in the lumbar spine
- Symptomatic cervical disc causing arm pain, arm weakness, or numbness with some degree of neck pain
- No significant facet joint disease or bony compression on nerves
- Not excessively overweight
- No prior major surgery in the lumbar spine
- No deformity (scoliosis)
How does disc arthroplasty work?
For a lumbar disc replacement, the surgical implantation procedure is performed through an incision in the abdomen. With this approach, the organs and blood vessels must be moved to the side. This allows your surgeon to access the spine without moving the nerves.
In most cases, total artificial disc replacements substitute the annulus and nucleus with a mechanical device that will simulate spinal function.
Examples of total artificial disk replacements.
(A) CHARITÉ artificial disk. Reproduced with permission from DePuy Spine, Inc.
©2007 DePuy Spine, Inc. All rights reserved.
(B) ProDisc-L prostheses. Reproduced with permission from Synthes, West Chester, PA.
The standard surgical procedure for a cervical disc replacement is an anterior (from the front) approach to the cervical spine. The affected disc is completely removed including any impinging disc fragments or osteophytes (bone spurs). The disc space is distracted (jacked up) to its prior normal disc height to help decompress (relieve pressure) on the nerves. This is important because when a disc becomes worn out, it will typically shrink in its height, which can also contribute to the pinching on the nerves in the neck.
Sierra Neurosurgery Group Resources
Doctors Walker, Vacca, Morgan, Khosla, Leppla, and Demers are all trained in artificial disc replacement surgery.