The Challenge of Artificial Disc Replacement Surgery

What is Artificial Disc Replacement Surgery?

Artificial disc replacement surgery is a technique performed for treatment of low back pain caused by degenerative disc disease. There are several theoretical advantages of artificial disc replacement surgery. When comparing them to a spinal fusion procedure these advantages are listed below:

  • Preservation or even restoration of segmental motion in the affected area of the spine
  • Preservation or restoration of the intervertebral architecture and foraminal height
  • Adjacent structures are spared the additional stress that would be placed on them from the fusion of a spinal segment
  • Restoration of normal biomechanics across the lumbar spine

For patients who have undergone six or more months of conservative treatment of degenerative disc disease and not seen results disc replacement surgery may be an option. In the United States, to be considered a candidate for an investigative trial on intervertebral disc replacement the patient must meet the following conditions:

  • Must be diagnosed with one or two adjacent levels of disc degeneration between L3 and S1
  • Must fall within the age demographic of 18 – 60
  • Has undergone at least six months of conservative therapy without result

The challenge faced with artificial disc replacement surgery involves developing a suitable replacement for an intervertebral spinal disc. Replacing a spinal disc is a very complicated matter, not only does the material involved need to be safe, reliable, and long lasting, it must also accurately mimic the complex range of movement required of the disc. The efforts to find a suitable solution to all the above problems have been ongoing for more than forty years.

There are currently several types of spinal disc replacements for both the upper (cervical) and lower (lumbar) spine being offered to appropriate candidates in selected areas of the United States.

Artificial Disc Replacement Surgery – An Alternative to Traditional Open Spinal Fusion Surgery

A combination of factors including, age, genetics, and everyday wear and tear will eventually lead to damage and degeneration of the intervertebral discs that cushion the bones of our spine. The treatment of degenerative disc disease will almost always begin with conservative methods where results should be expected within the first three months. If these conservative treatments fail then others approaches including invasive and minimally invasive surgery can be considered.

Considered to be the gold standard surgery, a spinal fusion procedure can be performed for treatment of problematic degenerative disc disease. The goal of a spinal fusion procedure is to reduce pain caused by excessive motion in the affected spinal segment by permanently fusing two or more vertebrae into a locked position.

For all of the known advantages to spinal fusion there are also disadvantages associated with this procedure. They are listed below:

  • Loss of mobility and flexibility in the fused segment of the spine, this is more prominent in multi-level spinal fusions
  • Fusion of the spine is permanent. Biomechanics and characteristics of the spine are altered without the possibility of reversal
  • Because there will be more pressure on the spinal segments above and below the fusion, there is a chance that disc degeneration in this area may be accelerated.

The key differences between artificial disc replacement and spinal fusion surgery is that artificial disc replacement surgery offers the advantages of being reversible, and avoids the accepted shortfalls of the traditional spinal fusion surgery. With artificial disc replacement techniques there is no fusion of the motion segment in the spine.