Arthroplasty (Artificial Disc Replacement)

Artificial disc replacement, also known as arthroplasty, is the replacement of a damaged spinal disc with an artificial (manufactured) disc.

An artificial disc is designed to support the vertebrae while still allowing backward and forward bending, side-to-side bending, and turning. Many artificial discs have been approved for use by the Food and Drug Administration (FDA). In general, they are composed of two endplates that move and slide on a central core. They are composed of metals like titanium or cobalt and sometimes a plastic such as polyethylene or polyurethane.

The vertebral column (backbone) is made up of 33 vertebrae. Between each set of vertebrae is a “cushion” called a disc. Age, genetics, and everyday wear and tear can contribute to disc damage and degeneration or herniation. Disc degeneration or herniation may cause pain, weakness, and numbness that radiate (spread) into the shoulders and arms.

Many patients with degenerated or herniated discs respond well to nonoperative treatment, such as physical therapy, injections, and neck braces. These measures are often effective in relieving symptoms, and they avoid the risks that come with any kind of surgery. However, if patients are experiencing severe neck and/or arm pain, and/or if nonoperative measures do not provide symptom relief, arthroplasty may be considered.

The best candidates for arthroplasty are younger patients who have a single disc herniation and normal spinal motion at the level of the disc. In some patients, replacement of more than one disc is possible. Older patients who have significant arthritis, bone spurs and limited mobility at the disc level are generally not good candidates for arthroplasty.

The neurosurgeons at The Spine Hospital at the Neurological Institute of New York are experienced in forming treatment plans that best suit individual patients and cases.

This procedure is performed under general anesthesia.
The surgeon makes an incision in the front of the neck and carefully exposes the front of the spine. X-ray imaging helps the surgeon verify the correct level of surgery.
Using an operating microscope, the surgeon removes the herniated or damaged disc, a procedure called a discectomy. An artificial disc of the appropriate size is then inserted into the disc space. Another X-ray confirms the positions of the plates. Then the surgeon closes the incision with sutures.
The surgery typically lasts one to two hours.

Make sure to tell your doctor about any medications that you’re taking, including over the counter medication and supplements, especially medications that can thin your blood such as aspirin. Your doctor may recommend you stop taking these medications before your procedure. To make it easier, write all of your medications down before the day of surgery and share them with your doctor.

Be sure to tell your doctor if you have an allergy to any medications, food or latex (some surgical gloves are made of latex).

On the day of surgery, remove any nail polish or acrylic nails, do not wear makeup and remove all jewelry. If staying overnight, bring items that may be needed, such as a toothbrush, toothpaste, and dentures.

Any type of surgery is like an injury, and an artificial disc replacement is no different. There will be some discomfort and limited motion for a few weeks. You may need some pain medication for a short period of time. Your activity may be limited for a few weeks, but in most cases you may increase your level of activity as you feel comfortable. Activities such as driving and returning to work depend on your own personal comfort and safety level.

Your surgeon will likely schedule a follow-up appointment 4-6 weeks after surgery. At this appointment, an X-ray will be taken to see how the bones are healing. At this appointment, you and your surgeon will discuss physical therapy and a return to more strenuous physical activity.

• Will I need to take any special medications?
  Many surgeons will prescribe one aspirin per day for the first two weeks following surgery. This regimen helps limit the possible growth of calcium around the artificial disc.
• Will I need to wear a collar?
  Strictly speaking, no collar is necessary. However, some patients like to wear a soft collar for comfort for a week or two after the procedure.
• When can I resume exercise?
  Low-impact and aerobic activities such as walking, elliptical, stationary or recumbent bikes may be instituted as soon as you are comfortable, often within a few weeks after surgery. More rigorous activities should be delayed until 4-6 weeks after surgery.
• Will I need rehabilitation or physical therapy?
  Physical therapy for the neck is usually recommended 4-6 weeks following surgery. This includes instruction for proper balance, mechanics, and posture; modalities such as heat, massage, and ultrasound to release the muscles; and stretching, strengthening, and training the muscles of the neck and upper back.
• Will I have any long-term limitations due to XX?
  There are no long-term limitations or disability due to this procedure.

Drs. Paul C. McCormick, Michael G. Kaiser and Patrick C. Reid are experts in artificial disc replacement.