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Disc Replacement Surgery

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Artificial Disc Replacement can be a scary topic for those considering the surgery. The goal of the procedure is to restore the intervertebral disc height while restoring physiologic motion one would have with a healthy disc. This is done by the complete removal of the unhealthy disc in order to implant the new artificial disc. Recovery from this procedure can be tough and often requires physical therapy, but with time, it can reduce or eliminate a person’s back pain.

Before discussing how the disc can cause back pain, it is useful to first understand the role of a healthy disc in the spine and the anatomy.

The intervertebral disc has several important functions, including functioning as a spacer, as a shock absorber, and as a motion unit.

Spacer - The height of the disc maintains the separation distance between the adjacent boney vertebral bodies. This allows biomechanics of motion to occur, with the cumulative effect of each spinal segment yielding the total range of motion of the spine in any of several directions. Proper spacing is also important because it allows the intervertebral foramen to maintain its height, which in allows the segmental nerve roots room to exit each spinal level without compression (e.g. a pinched nerve).

Shock absorber - Shock absorption allows the spine to compress and rebound when the spine is axially loaded during such activities as jumping and running. Importantly, it also resists the downward pull of gravity on the head and trunk during prolonged sitting and standing.

Motion unit - The elasticity of the disc allows motion coupling, so that the spinal segment may flex, rotate, and bend to the side all at the same time during a particular activity. This would be impossible if each spinal segment were locked into a single axis of motion.

The gelatinous central portion of the disc is called the Nucleus Pulposus. It is composed of 80 90% water. The solid portion of the nucleus is Type II collagen and non aggregated proteoglycans.

As the inner nucleus dehydrates, the disc space narrows, and redundant annular ligaments bulge. With progressive nuclear dehydration, the annular fibers can crack and tear.

Loss of normal soft tissue tension may allow the spinal segment to sublux (e.g. partial dislocation of the joint), leading to osteophyte formation (bone spurs), foraminal narrowing, mechanical instability, and pain.

The following is a brief history of early evolution of artificial disc technologies:

• Early attempts at disc replacement were all nuclear replacements, based on the need to prevent disc space collapse following discectomy.
• David Cleveland published the first study in 1955, when he injected methyl acrylic into the disc space at the time of discectomy in 14 patients.
• James Gardner who had “replaced hundreds of damaged lumbar discs with 8x22 mm Lucite pegs, yielding excellent results.”
• Hamby reported his reproduction of Cleveland’s work in another 14 patients, reported in 1957 at the American Association of Neurological Surgeons meeting.
• In 1959, Harmon implanted Vitallium Spheres, inserted through an anterior retroperitonael approach, but never reported his results.
• Nicholson injected silicon rubber inserts into cadaveric discs in 1962. He never proceeded to clinical trials since the implants did poorly in mechanical testing.
• In 1964, Fernstrom published his results of replacing lumbar discs with a metal ball bearing, under local anesthesia. At 30 months, he stated that his results were better than discectomy alone, and comparable to fusion.
• Similarly, Reitz and Joubert implanted 19 steel balls into 12 patients, and at 8 month follow up concluded that results were superior to fusion.

Theoretically, the artificial disc is designed to take the place of the real intervertebral disc and be placed between two vertebral bodies where the disc has been surgically removed in order to decompress the spinal cord or nerve root in the neck. Ideally the artificial disc acts like a normal disc, providing motion while acting as a shock absorber in the spine (unlike a fusion, which eliminates both motion and shock absorption in the fused segment of the spine).

here are a variety of artificial discs that are in various stages of the process of seeking approval by the United States Food and Drug Administration (FDA) through clinical trials.All technologies share similar goals of replacing the original disc, but differ in their designs and materials.