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The disc is the soft cushioning structure located between the individual bones of the spine, called "vertebra." It is made of cartilage-like tissue and consists of an outer portion, called the annulus, and an inner portion, called the nucleus. In most cases, the disc is flexible enough to allow the spine to bend. An is a device that is implanted into the spine to imitate the functions of a normal disc (allow motion and carry weight).
Artificial discs are usually made of metal or plastic-like (biopolymer) materials, or a combination of the two. These materials have been used in the body for many years. Total disc replacements have been used in Europe since the late 1980s. The most commonly used total disc replacement designs have two plates. One attaches to the vertebrae above the disc being replaced and the other to the vertebrae below. Some devices have a soft, compressible plastic-like piece between these plates. The devices allow motion by smooth, usually curved, surfaces sliding across each other.
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Herniation |
The indications for disc replacement may vary for each type of implant. Some general indications are pain arising from the disc that has not been adequately reduced with non-operative care such as medication, injections, chiropractic care and/or physical therapy. Each vertebra in the spine is separated by a shock absorbing disc, which is made up largely of water. As discs lose water content because of disease, injury or age, they compress, or lose height, which causes the vertebrae to move closer together. This reduces the disc's shock absorbing qualities, which may lead to bone spurs and narrowing of the nerve openings. If a disc ruptures, it can place pressure on the surrounding nerve roots and the spinal cord, resulting in pain, numbness and/or weakness.
Typically, you will have had an MRI that shows disc degeneration. Often discography is performed to verify which disc(s), if any, is related to your pain. (Discography is a procedure in which dye is injected into the disc and X-rays and a CT scan are taken.) The surgeon will correlate the results of these tests with findings from your history and physical examination to help determine the source of your pain.
Your doctor may recommend surgery if non-surgical treatment fails to provide relief from these symptoms. Traditionally, a procedure called an anterior cervical discectomy with fusion (ACDF) has been the "gold standard" for surgically treating DDD in the cervical spine. Using bone grafts and instrumentation such as metal plates and screws, this procedure fuses, or creates a bond between, two or more adjacent vertebrae, ideally stabilizing the segment and providing relief. Many patients have achieved excellent results with ACDF; however, a potential disadvantage associated with spinal fusion is the loss of motion and flexibility in the treated vertebral segment.
A normal healthy spine allows motion at each of the discs throughout the spine. Ideally, your surgeon would like to restore your spine to this normal state. Currently the treatment for many painful spinal conditions is fusion, which eliminates motion of the painful spinal segment. Artificial discs are designed to allow motion after surgery that is as normal as possible.
With fusion there also is a possibility that the fusion of one part of the spine forces the discs and vertebra above and/or below to carry more load and motion. This may result in more wear and tear than normal. The artificial disc may significantly reduce this risk.
Another potential advantage of disc replacement is a more rapid return to activities than occurs after fusion surgery. Fusion patients have limited activities during the time required for the bone graft to grow into a solid mass. Because one of the goals of artificial discs is motion, patients are encouraged to return to motion early, although at a gradual progression. Although artificial discs offer several advantages over fusion, this is a relatively new technology with no long-term randomized, controlled clinical study results. Fusion has a long-standing record of success in permanently correcting problems in the fused motion segment. Discuss both options thoroughly with your health care provider before deciding which procedure is best for you.
The type of artificial disc to use, if any, depends on the cause of your back and/or leg pain, the severity of the problem and the training of your surgeon.
As with any surgery, there are risks associated with disc replacement. The complications when using artificial discs are similar to those associated with anterior spinal fusion. Possible complications include but are not limited to: infection, injury to blood vessels, nerve injury, dislodgement or breakage of the device, wear of the device materials, continued or increasing pain, and development of new pain. Discuss these risks with your surgeon before deciding to have an artificial disc implanted.
PRESTIGE® Cervical Disc
 The PRESTIGE® Cervical Disc is a stainless steel surgical implant indicated to treat patients suffering from degenerative disc disease (DDD) of the cervical (neck) spine. The patented ball-and-trough design allows for a variable center of rotation, meaning the disc is designed to better replicate the motion of a naturally functioning cervical spine.
» Click here to visit the PRESTIGE® Cervical Disc website.
It is estimated that more than 200,000 patients receive surgical treatment for cervical DDD. Patients suffering from single-level cervical DDD with problematic radiculopathy which is arm pain numbness, tingling, and/or weakness from a pinched nerve in the neck related to a herniated disc. Many patients will also have some element of neck pain going along with it. Patients may also have bone spurs causing irritation of the nerve root, with arm pain and/or neck pain.
Spinal fusion is the current standard of care for patients suffering from DDD. It is a widely used and successful therapy that shows a 95% success rate based on radiographic imaging. However, fusions restrict motion at treated levels and literature suggests that it may cause additional complications at adjacent levels of the spine. The PRESTIGE Cervical Disc design allows for preservation of motion at the treated level and is an effective and safe treatment for many patients. Spinal fusions will still be indicated for certain patients, but there now exists another option for patients suffering from DDD.
The disc was approved by the FDA after reviewing data from the largest completed clinical trial to date involving the cervical spine. Patients in the study showed superior overall success and superior neurological success which incorporated sensory, motor, and reflex functions. The PRESTIGE Disc is the first artificial disc approved by the FDA for use in the U.S.
 Click here for additional information on The PRESTIGE® Cervical Disc.
For more information on Cervical Artificial Disk Replacement, click here.
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