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Choosing Between an Artificial Disc and Fusion
Anterior cervical discectomy and fusion (ACDF) surgery has long been considered the gold standard for treating pain and/or neurologic deficits stemming from nerve root inflammation and/or spinal cord compression in the cervical spine. While both ACDF and cervical ADR aim to remove a problematic disc and restore normal disc height, they differ in that ACDF fuses the adjacent vertebrae so motion is lost at that spinal level.
- Maintaining more natural neck motion
- Reducing the risk for adjacent segments of the cervical spine to develop degenerative disc disease
- Eliminating potential complications and issues associated with the need for a bone graft and spinal instrumentation for spinal fusion
- Allowing quicker return to neck movement after surgery
In cases when both ACDF and cervical ADR are viable options, some potential benefits of choosing an artificial disc may include:
There are also some considerations that could make ACDF a better option for some people. For example, there is more data available to back up the long-term safety and effectiveness of ACDF because it has been around for decades longer. Also, there are many cases where ACDF is an option but an artificial disc is not, such as when advanced spinal degeneration, bone weakness, or other serious underlying medical conditions are present.
Efficacy of Cervical Artificial Disc Replacement Surgery
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While cervical artificial disc replacement surgery is still considered a newer procedure, the data collected thus far have shown it to be relatively safe and effective for reducing neck and arm pain resulting from a compressed nerve root or spinal cord. Several randomized controlled trial studies, ranging from 2 to 10 years, have shown clinical success rates for cervical ADR to be similar or even better than ACDF clinical success rates. However, there is currently a lack of data on the success or failure of cervical ADR in the long run, such as over 15 or 20 years, which presents its own unknown risk and must be taken into consideration when deciding on the surgery. Current studies do demonstrate that the symptom relief achieved within the first few months after cervical ADR can last for many years.
Who Makes a Good Candidate for Cervical ADR?
- Confirmed cervical disc disease. An MRI or CT scan with myelography can show soft tissues—such as discs, nerve roots, and the spinal cord—in addition to bones. If imaging shows degeneration of one or more discs, the next step is to determine if any of the degenerating discs correlate to the pain or other symptoms experienced by the patient.
- Radicular pain and/or neurological deficits caused by a problematic disc. Most commonly, an inflamed cervical nerve root corresponds to problems with pain, tingling, numbness, and/or weakness that radiate down into the arm and/or hand. If the spinal cord is compressed within the cervical spine, cervical myelopathic symptoms and/or myelopathy may be experienced anywhere below the level of compression, such as pain that goes into both hands and/or legs, hand weakness/numbness, leg weakness/numbness, trouble with coordination or walking, or difficulty with bladder/bowel control.
- Nonsurgical treatments have been tried. Cervical degenerative disc disease symptoms typically can be managed with nonsurgical treatments, such as rest, ice, heat, medications, physical therapy, and/or therapeutic injections. If the symptoms persist at least 4 to 6 weeks despite nonsurgical treatments, a surgical solution is more likely to be needed for pain relief.
- Surgery would be well tolerated. Candidates for cervical ADR must be in generally good health and capable of recovering well from the surgery. The candidate needs to have reached full skeletal maturity (with no more bone growth left) but still be in good enough health for the procedure’s benefits to outweigh the risks. Candidates for cervical ADR are typically between ages 20 and 70.
Good candidates for cervical artificial disc replacement surgery typically have the following indications:
What is a lumbar disk replacement?
A lumbar disk replacement is a type of back or spine surgery. Your spine is made up of bones called vertebrae that are stacked on top of each other. Disks between the vertebrae work like cushions to allow the vertebrae to rotate and move without the bones rubbing against each other. The lumbar vertebrae and disks are at the bottom of your spine. Lumbar disk replacement involves replacing a worn or degenerated disk in the lower part of your spine with an artificial disk made of metal or a combination of metal and plastic.
Lumbar disk replacement is generally seen as an alternative to the more common spinal fusion surgery. Fusion permanently joins 2 vertebrae together. Lumbar disk replacement is a major surgery that requires general anesthesia and a hospital stay.
Why might I need a lumbar disk replacement?
The main reason you would need a lumbar disk replacement is to treat low back pain. Still, not everyone with low back pain is a good candidate for a lumbar disk replacement surgery. Your doctor will need to do some tests to see if it’s the right procedure for you.
In general, lumbar disk replacement surgery might be recommended if:
- Your back pain mostly comes from only 1 or 2 disks in your lower spine
- You have no significant joint disease or compression on the nerves of your spine
- You are not excessively overweight
- You haven’t previously had spinal surgery
- You don’t have scoliosis or another spinal deformity
What are the risks of a lumbar disk replacement?
Like all surgeries, lumbar disk replacement poses some risks. A disk replacement requires greater access to the spine than standard lumber fusion surgery. This also makes it a riskier procedure.
Some of the potential risks of this surgery include:
- Infection of the artificial disk or the area around it
- Dislocation or dislodging of the artificial disk
- Implant failure or fracture (break)
- Implant loosening or wear
- Narrowing of the spine (stenosis) because of the breakdown of spinal bones
- Problems due to a poorly positioned implant
- Stiffness or rigidity of the spine
- Blood clots in your legs due to decreased activity
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How do I get ready for a lumbar disk replacement?
Along with a physical exam and medical history, you may need X-rays, an MRI or CT scan, and blood tests. These help the doctor identify the true nature and extent of your back pain and spinal damage. They may also be needed to get a better view of the spine and decide whether the surgery is right for you.
You may be asked to stop smoking as part of getting ready for spine surgery.
Tell your doctor about all prescription and over-the-counter medicines and any vitamins, herbs, and supplements that you are taking. Some of these may affect things like healing and blood clotting, so you may need to stop taking them before the procedure.
You may be told to not eat or drink anything for several hours before the surgery. You will probably have to stay in the hospital for a few days. You may not be allowed to drive for some time after surgery. For a short time after surgery, you may need some help at home with things like bathing, dressing, cleaning, and shopping. You may want to arrange this ahead of time.
Talk to your healthcare provider so you know exactly what you need to do before your procedure.
What happens during a lumbar disk replacement?
You will have an IV line put into a vein in your hand or arm through which an anesthetic is given. The medicine will put you into a deep sleep and keep you from feeling pain during the surgery. You will be lying on your back for this surgery.
A team of surgeons (usually a vascular surgeon and an orthopedic or neurosurgeon) will do the procedure together. The surgeon will make an incision in your abdomen. Your organs and blood vessels will be moved to the side to allow access to your spine.
The surgeon will remove the damaged disk and put the new artificial disk in place. Your organs and blood vessels are put back in place and the incision will be closed.
You will be taken to a recovery area for close monitoring until you are awake from the anesthesia. You will still have an IV line and may also have a catheter in your bladder to make urination easier. When you are fully awake and alert, you will be taken to your hospital room.
Talk with your healthcare provider about what you can expect your lumbar disk replacement procedure to be like.
There may be other risks, depending on your specific medical condition. Be sure you understand the risks and benefits of lumbar disk replacement and discuss any concerns with your surgeon before the procedure.
What happens after a lumbar disk replacement?
You will probably need to stay in the hospital for a few days after your surgery. Because a lumbar disk replacement doesn’t require bone to heal, the recovery period may be faster than with other back surgeries. You’ll be given pain medicines if you need them, and may be encouraged to stand and walk within the first day after surgery. Your IV and bladder catheter will be removed within a few days of surgery.
You will be shown how to move properly and how to do exercises, such as gentle trunk twists. This will keep your spine limber and help you have a quicker rehabilitation and recovery. As your recovery progresses, you’ll be encouraged to walk and stretch. You’ll need to avoid any jarring activities or motions for quite a while. Your recovery may take from a few weeks to a few months.
A lumbar disk replacement generally improves pain, but it does not eliminate it completely. Talk with your doctor to get a realistic idea about what you can expect after this surgery. Also talk to your healthcare provider about instructions you need to follow after surgery, what you can and cannot do, how to care for your incision, signs of problems you need to watch for, and when you need to follow-up with the doctor.
