Almost every bone in the spine rests on a spinal disc. The spinal disc gives the spine height, absorbs shock, and allows the spine to flex and bend. Unfortunately, spinal discs can wear out and rupture, causing pain and other debilitating symptoms. When conservative treatments fail, diseased spinal discs are surgically removed to relieve these symptoms. However, the space between the discs needs to be filled either with a bone fusion or an artificial disc. An artificial disc is a medical device that replaces a damaged or diseased spinal disc.
An artificial disc mimics the size, shape, and function of the natural disc to provide height, absorb shock, and restore spine mobility.
Artificial disc replacement can be performed in two places along the spine: in the cervical spine (neck) and the lumbar spine (lower back).
Cervical artificial disc replacement
Cervical artificial disc replacement is a spine surgery procedure to remove a problematic spinal disc in the cervical spine (neck) and replace it with an artificial cervical disc. The cervical spine has seven bones, referred to as C1 through C7, but the discs are between these spaces. Artificial disc replacement is named by the two spinal bones that “sandwich” the treated disc. Thus, cervical artificial disc replacement can be performed at C2-C3, C3-C4, C4-C5, C5-C6, C6-C7, C7-T1. Artificial disc replacement cannot be performed above C2, and C2-C3 replacements are rare. The “T” in T1 is the first spinal bone in the thoracic part of the spinal column.
Lumbar artificial disc replacement
Lumbar artificial disc replacement is a spine surgery procedure to remove a symptom-causing spinal disc in the lumbar spine (lower back) and replace it with an artificial lumbar disc. The lumbar spine has five bones referred to as L1 through L5. Artificial lumbar disc replacement can be performed at L1-L2, L2-L3, L3-L4, L4-L5, L5-S1. The “S” in S1 is the top of the sacrum, which makes up part of the pelvis.
Artificial disc replacement surgery relieves pain
The first part of artificial disc replacement surgery is to remove the spinal disc that is impinging on surrounding nerves, nerve roots, and spinal cord. Thus, artificial disc replacement surgery relieves chronic pain by removing the source of the problem.
Artificial disc replacement restores spinal mobility
The second part of artificial disc replacement surgery is to place an artificial disc in space between the spinal bones where the natural, damaged disc just was. The artificial disc is held firmly in place by the spinal bones, but the device itself is an artificial joint of sorts, allowing movement of the upper and lower spinal bones. As you can imagine, having movement between spinal bones allows for much more spinal mobility than fusing that space together with artificial bone, which is what happens after spinal fusion surgery.
Artificial disc replacement is easier on surrounding bones than fusion.
The spine is made up of many spinal bones (vertebrae) and discs that work together to support the body’s weight but also allow the neck and low back to bend, stretch, and twist. Fusing two spinal bones together is not normal, and the bones above and especially below the treated area do not like it. Spinal fusion causes considerable stress on the facet joints and ultimately leads to breakdown of other spinal bones and discs. Artificial disc replacement is much closer to the original, natural anatomy. Artificial disc replacement puts far less stress on the surrounding facet joints and discs and thus reduces the risk of needed a second spine surgery down the road.
Artificial disc replacement is performed under general anesthesia. This means you will be asleep during the surgery and will not experience any pain or other sensation. Anesthesia also ensures that you will not have any memory of the procedure. You will lie face-up on the operating table, and your body will be covered in sterile drapes. The surgical area will be sterilized.
If you are having cervical artificial disc replacement surgery, the surgeon will make a small incision in the front side of the neck. If you are having lumbar artificial disc replacement surgery, the surgeon will make an incision in your abdomen. In both cases, the structures under the skin will be safely moved to the side and protected.
Your spine surgeon will verify that they are treating the correct level with a special kind of X-Ray called fluoroscopy. The space between the two spinal bones is exposed and carefully held apart with surgical instruments. The entire spinal disc is then removed, including any areas that may have escaped the spinal disc’s natural space. If necessary, your surgeon will remove small edges or pieces of spinal bone to give the nerves additional room. Once the nerves are completely freed and mobile, the artificial disc is inserted.
Your spine surgeon places the artificial disc into the space between the two spinal bones. Correct placement is absolutely crucial—it must be centered with the space and in perfect alignment with the rest of the spine. Additional X-rays may be taken to assure correct placement. Once your surgeon is satisfied with the artificial disc placement, the spinal bones are released, and the surgical wound is then closed.
You will awaken in the post-anesthesia care unit and you will spend several hours recovering. Most artificial disc replacement surgeries are now same-day surgery. Thus, once you meet certain milestones, e.g., being able to swallow after cervical spine surgery, you will be permitted to go home.
Dr. Todd H. Lanman is a pioneer of artificial disc replacement surgery, serving as an investigator on several artificial disc clinical trials. The spinal neurosurgeon has performed scores of artificial disc replacements over the better part of two decades. If you are looking for the most trusted spine surgeon in Texas, those who know him would say it is Dr. Lanman.
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