Disc Replacement

Common treatments for degenerated discs include discectomy (removal of a damaged or degenerated disc) and spinal fusion where the vertebrae are fused to reduce painful spinal movements. Discectomy and spinal fusion are a safe and effective treatment for degenerative disc disease that causes pain. However, fusion alters normal spine movements and creates stress and strain on adjacent vertebrae and can lead to accelerated degeneration.

Modern technological advances provide a cutting-edge option – disc replacement which avoids the issues related to spinal fusion. Disc replacement is an alternative to discectomy and fusion for the surgical treatment of degenerative disc disease. It preserves spinal motion and avoids degeneration of adjacent vertebrae. Moreover, a patient who had a disc replacement can have spinal fusion in the future if indicated.

What is disc replacement surgery?

Disc replacement surgery involves a discectomy, removal of a worn or deteriorated disc that is impinging on spinal nerves and replacing it with an artificial disc to relieve back or neck and arm pain while maintaining as much normal movement as possible, and more than can be achieved with spinal fusion. It is available to treat cervical and lumbar disc degeneration.

Total disc replacement is indicated for people with pain from a pinched nerve in the spine due to a diseased or damaged disc. Lumbar degenerative disc disease is among the most common adult spinal diseases.

Spinal anatomy

The spine is composed of 24 vertebrae. There are seven cervical vertebrae, C1-7, beginning at the base of the skull. These vertebrae protect the spine and allow us to turn, rotate and tilt the head. There are 12 thoracic vertebrae in the mid back, T1-T12, that attach the ribs to the spine. There are 5 lumbar vertebrae L1- L5 that support the upper spine and connect the pelvis to the spine. The lumbar vertebrae support and stabilizes the upper body, bear the body weight to allow lifting and carrying, and control leg movements and sensations. Between each vertebra is a spinal disc.

What is a spinal disc?

A natural intervertebral disc is flexible with a high-water content that sits between the vertebrae. It is made of a tough outer shell that encases a soft inner core which provides shock absorption and can support pressure, rotation, and shearing forces. It is acts as a spacer and functions to allow movement in every dimension while providing stability and shock absorption.

What is a herniated disc?

A herniated disc occurs when the tough outer shell tears and the soft inner core spills out into vertebral space and impinges on the spinal nerves. It can occur anywhere along the spine but is commonly found in the cervical and lumbar vertebral discs.

What is degenerative disc disease?

Degenerative disc disease is caused by age-related wear and tear on the discs. With age the discs dehydrate, shrink, and become brittle which makes them prone to tears and cracks. The discs have no ability to heal themselves. A herniated disc is a common cause of low back pain, leg pain and sciatica. Most people with low back pain will not need back surgery to find relief and some are pain free.

Who is a good candidate?

Good candidates for disc replacement are people with chronic, disabling low back or neck pain due to impingement on spinal nerves caused by degeneration of one or two degenerated vertebral discs, that is not alleviated with nonsurgical management. The results of imaging studies and physical exam will determine candidacy.

People who have any of these conditions are not good candidates.

• prior major spine surgery
• severe spinal osteoarthritis
• osteoporosis
• vertebral fracture
• facet joint disease (osteoarthritis)
• segmental instability
• severe spinal stenosis
• spinal tumors

There are various disc designs. All are intended to replicate the size and function of a natural intervertebral disc. All have been FDA cleared for use. Most are a combination of metal and plastic. Studies report that outcomes are satisfactory in carefully chosen patients. Disc replacement is as safe and effective as fusion in improving pain and function and offers a faster recovery than fusion.

Disc replacement is a thoroughly studied approach to treating chronic neck and low back pain. Studies report that an artificial disc replacement provides long-lasting relief with low failure rates. Recovery is quicker than with spinal fusion.

Dr. Federico Girardi specializes in the surgical treatment of spine disorders and has extensive experience in minimally invasive spine surgery. Dr. Girardi is internationally renowned, trains spine surgeons world-wide in advanced surgical skills including minimally invasive spine surgery and has extensive clinical research experience.

Contact Dr. Girardi’s office to schedule a consultation at the Hospital for Special Surgery (HSS) in Manhattan. HSS is the number one US hospital in Orthopedics.