Artificial Disc Replacement (ADR)

Artificial disc replacement is a procedure that is considered an alternative to spinal fusion surgery. With an artificial disc, patients do not experience the accelerated degeneration of discs at adjacent levels of the spine like they sometimes do in spinal fusion surgery.

Before artificial discs were available, patients would traditionally receive an Anterior Cervical Discectomy and Fusion (ACDF) procedure to alleviate the pain from a herniated disc.

In a fusion surgery, the disc is removed and either a bone spacer or a plastic implant is placed in the disc space to restore disc height and remove pressure on the pinched nerves or spinal cord. A metal plate and screws can be placed on the front of the neck to hold the implant in place.

The result of the ACDR procedure is a spine segment that no longer moves, because it is “fused”. The potential downside of a fusion procedure, in addition to the loss of motion, is that it can create additional stress on the spinal levels above and below it. This can cause degeneration at those levels and potentially result in another future surgery.

ADR replaces the worn out disc while also preserving the spine’s motion. The result is reduced back pain and no increased risk of problems developing at an adjacent level of the spine.

Spinal discs are located between the bones or vertebrae of the spine and act as cushions or shock absorbers for the vertebrae. The discs also contribute to the flexibility and motion of the spinal column.

The discs consist of an inner portion made of a jelly-like material and an outer portion which is a stronger, fibrous material.

Similar to knee replacement, the artificial disc is inserted into the damaged joint space and preserves motion, whereas fusion eliminates motion.

During the aging process, discs can weaken and develop tears or cracks in the outer portion, resulting in degenerative disc disease. Additionally, the inner portion may bulge out and press against the outer portion, resulting in pain.

Artificial disc replacement (ADR) is a surgical procedure in which degenerated intervertebral discs in the spinal column are replaced with artificial devices in the lumbar (lower) or cervical (upper) spine.

The first artificial disc was approved by the FDA for use in the US. in October 2004 following a four-year clinical trial. There are five artificial discs available.

The procedure is used to treat chronic, severe low back pain and cervical pain resulting from degenerative disc disease. Cervical disc replacement is also an alternative intervention for symptomatic disc herniation associated with arm and hand pain.

The neurosurgeons at Semmes Murphey Clinic have specialized training in complex spine surgery. In fact, many of the surgeons at SMC have invented or perfected techniques and tools to help make spine surgery less intrusive and more successful.

ADR surgery begins with an incision made in the throat area to access the disc. The spine is actually more accessible from the front of the neck than from the back because the disc can be reached without disturbing the spinal cord, spinal nerves, and the strong neck muscles.

After the disc is removed, the space between the bony vertebrae is empty. To prevent the vertebrae from collapsing and rubbing together, a spacer is inserted to fill the open disc space.

Instead of the bone graft used in traditional disc replacement surgery, an artificial disc is inserted instead of grafted bone from the patient or a donor (cadaver).

Talk with your surgeon about whether artificial disc replacement is most appropriate for you.

Risks include:

• Infection
• Bleeding
• Spinal fluid leak
• decreased range of motion secondary to removal of the discs and fusion
• Dysphagia (difficulty swallowing-typically transient)
• Cosmetic scar visible on the front of the neck,
• hoarseness or voice changes (usually subsides)
• Failure of the bone graft space to incorporate with the adjacent vertebral bodies
• Injury to the nerve root and/or the spinal cord
• Instrumentation loosening

You may be scheduled for presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. An anesthesiologist will talk with you and explain the effects of anesthesia and its risks.

Before the day of your procedure, your doctor and surgical team will meet with you to thoroughly describe your specific surgery and tell you exactly what to do to prepare.

They will review your prescribed and over-the-counter medications along with your medical conditions. Some medications may need to be continued or stopped prior to your surgery.

You probably have answered these questions before, but it is important that this information is checked and rechecked to be certain no errors are made.

Please follow your specific instructions, but there are some general preparations:

• You should not eat or drink for six hours before the procedure.
• Your nurse or doctor will inform you which of your regular medications to take or avoid the day of your procedure.
• If this surgery is to be performed as an outpatient at Semmes Murphey’s Ambulatory Surgery Center, you must arrange to have someone remain at the surgery center until you are discharged and to drive you home afterward.
• The most important thing you can do to ensure the success of your spinal surgery is to quit smoking. Nicotine prevents bone growth and puts you at higher risk for a failed fusion. Smoking also decreases your blood circulation, resulting in slower wound healing and an increased risk of infection.

Morning of surgery:

• Shower using antibacterial soap.
• Dress in freshly washed, loose-fitting clothing.
• Wear flat-heeled shoes with closed backs.
• If you have instructions to take regular medication the morning of surgery, do so with small sips of water.
• Remove make-up, hairpins, contacts, body piercings, nail polish, etc.
• Leave all valuables and jewelry at home (including wedding bands).
• Bring a list of medications (prescriptions, over-the-counter, and herbal supplements) with dosages and the times of day usually taken.
• Bring a list of allergies to medication or foods.

You will awaken in the postoperative recovery area. Blood pressure, heart rate, and respiration will be monitored.

Because narcotic pain pills are addictive, they are used for a limited period. As their regular use can cause constipation, drink lots of water and eat high fiber foods. Laxatives (e.g., Dulcolax, Senokot, Milk of Magnesia) can be bought without a prescription. Thereafter, pain is managed with acetaminophen (e.g., Tylenol).

Most patients having a one- or two-level disc replacement are sent home the same day. However, if you have difficulty breathing or unstable blood pressure, you may need to stay overnight.

Hoarseness, sore throat, or difficulty swallowing may occur in some patients and should not be cause for alarm. These symptoms usually resolve in 1 to 4 weeks.

Your physician may recommend physical therapy to help you strengthen your back and gain more mobility. The SMC onsite physical therapy team will consult with your doctor and talk with you before developing a unique rehabilitation plan for you. This plan will be based on your situation and goals.

Restrictions:

• Do not use non-steroidal anti-inflammatory drugs (aspirin, ibuprofen, Advil, Motrin, Nuprin, naproxen sodium, Aleve) for 6 months after surgery. These may cause bleeding and interfere with bone healing.
• Do not smoke. Smoking delays healing by increasing the risk of infection and inhibits the bones' ability to fuse.
• Do not drive for two to four weeks after surgery or until discussed with your surgeon.
• Avoid sitting for long periods of time.
• Avoid bending your head forward or backward.
• Do not lift anything heavier than 5 pounds, like a gallon of milk.
• Housework and yard-work are not permitted until the first follow-up office visit. This includes gardening, mowing, vacuuming, ironing, and loading/unloading the dishwasher, washer, or dryer.
• Postpone sexual activity until your follow-up appointment unless your surgeon specifies otherwise.

Activity:

You may need help with daily activities (e.g., dressing, bathing), but most patients are able to care for themselves right away.

Gradually return to your normal activities. Walking is encouraged starting with a short distance and gradually increasing to one- to two-miles daily. A physical therapy program may be recommended.

If applicable, a cervical collar before leaving the hospital, and when walking or riding in a car.

You may shower one to four days after surgery. Follow your surgeon’s specific instructions. No tub baths, hot tubs, or swimming pools until your health care provider says it’s safe to do so.

Call your doctor if you run a temperature exceeding 101⁰ F, if the incision begins to separate, turn red, swell or drain.

Recurrences of neck or back pain are common. The key to avoiding this is prevention:

• Proper lifting techniques
• Good posture during sitting, standing, moving, and sleeping
• Appropriate exercise program
• An ergonomic work area
• Healthy weight and lean body mass
• A positive attitude and stress management
• No smoking

This information was provided by the specialists at Semmes Murphey Clinic. Readers are encouraged to research trustworthy organizations for information. Please talk with your physician for websites and sources that will enhance your knowledge and understanding of this issue and its treatments.