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Artificial Disc Replacement

What is an artificial disc?

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. The consistency of the nucleus is very similar to crab meat, and the annulus is similar to several layers of canvas wrapping around the nucleus. In most cases, the disc is flexible enough to allow the spine to bend. An artificial disc is a device that is implanted into the spine to replace the disc and then imitate the functions of a normal disc, therefore preserving motion.

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.

Cervical Artificial Disc Replacement has been FDA-approved since 2007.

Who needs an artificial disc?

The indications for disc replacement may vary for each patient. 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 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 normal functioning, which may lead to pain, 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 you have a CT scan performed to verify the bony architecture of the joints and vertebrae. Dr. Lanman will correlate the results of these tests with findings from your history and physical examination to help determine the source of your pain.

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.

Who Can Benefit?

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.

Traditional Spinal Fusion

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 PRESTIGE® Cervical Disc

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.

The BRYAN (R) Cervical Disc

The Bryan Cervical disc is a composite device with articulating polyurethane ring with a saline-filled chamber. It attaches to the bone via ingrowth of the vertebral bone into the porous-coated end plates for final fixation. The fixation process of healing takes 2 months.

Prodisc-C® Cervical Disc

The Prodisc-C is a chrome cobalt metal device, which is secured into the host vertebrae by a keel as well as by bony ingrowth. It features a semi-constrained design with an ultra-high density polyurethane dome articulating in an oval-shaped metal cup.

Secure-C® Cervical Disc

The Secure-C cervical artificial disc is a cobalt-chrome metal device, which is secured into the host vertebrae by a keel as well as bony ingrowth through a plasma spray coating. It features an unconstrained design with an ultra-high density polyurethane core articulating in an oval-shaped metal cup on the top and a trough on the bottom. This allows for a more natural physiologic motion of the cervical spine.

PCM® Cervical Disc

The PCM cervical artificial disc is composed of two alloy metal endplates, one with a spacer. The endplate surfaces that face the bone have ridges and are coated to enhance post-operative fixation to the bone. The Porous Coated Motion (PCM) cervical artificial disc is designed to preserve flexibility and motion by keeping the normal cervical spacing intact.

Mobi-C® Cervical Disc LDR

The Mobi-C® Cervical Disc Prosthesis consists of two metal (cobalt-chrome alloy) endplates and a plastic (ultra-high molecular weight polyethylene) insert. It has a hydroxyapatite coating over the metal plates to provide fixation to the vertebrae.

Lumbar Artificial Disc Replacement

Approximately 80% of Americans experience significant back pain at least once in their lifetime, and for many people, spinal disorders are a lifelong problem. The personal and monetary costs associated with this widespread problem are staggering. One of the main causes of back pain and spinal disorders is the degeneration of spinal discs. Disc degeneration is painful and often difficult to treat. One of the most promising surgical advancements that has been developed and FDA-approved since 2005 is lumbar artificial disc replacement.

What is a Spinal Disc?

The spaces between each vertebra in your spine (spinal discs) serve as areas of motion for your spine. As we age, these discs can deteriorate. When this happens, they lose their functional motion abilities and cause pain and wear and tear on the vertebra. To treat this condition, alternatives to disc replacement include fusion, nonoperative care or no treatment. Typically, surgery is not considered for disc-related pain unless the pain has been severe for a prolonged period (typically over six months) and the patient has gone through nonoperative treatments (such as active physical therapy, medication, injections, activity modification and/or spinal manipulation).

With the introduction of total disc replacement (TDR) surgery, surgeons can offer their patients an alternative to spinal fusion surgery for the treatment of degenerative disc disease (DDD) in the lumbar spine, or the treatment of symptomatic cervical disc disease (SCDD) in the cervical spine. The TDR procedure is intended to relieve pain and preserve motion in the spine. During both TDR surgery and spinal fusion surgery, the pain-generating disc is removed and the disc height is restored. During a fusion surgery, the spinal segment is stabilized with an implant and plate and/or rods and screws. Bone graft may be used to promote osseous fusion of the vertebrae. Conversely, during a TDR surgery, an implant that allows the potential for motion is inserted into the disc space. There are two FDA approved Lumbar Disc Replacement devices available, these include the PRODISC®-L and CHARITÉ ®.

PRODISC®-L What is it?

The PRODISC®-L Total Disc Replacement is an artificial intervertebral disc made from metal and plastic that is used to treat pain associated with degenerative disc disease (DDD). DDD is defined as discogenic back pain (pain resulting from a degenerated intervertebral disc) with degeneration of the disc confirmed by patient history and radiographic studies. The PRODISC®-L Total Disc Replacement is implanted to replace a diseased or damaged intervertebral disc during a surgical procedure called spinal arthroplasty.

How does it work?

The PRODISC®-L Total Disc Replacement consists of three parts:

  • Two metal (cobalt-chrome alloy) endplates that are anchored to the top and bottom surfaces of the spinal bones (vertebrae)
  • A plastic (ultra-high molecular weight polyethylene, or UHMWPE) inlay that fits between the two endplates
  • The plastic inlay and endplates help restore the natural distance between the two vertebrae (disc height). The top (superior) endplate can slide over the domed part of the inlay, which can allow movement at the level where it is implanted.

When is it used?

The PRODISC®-L Total Disc Replacement is indicated for spinal arthroplasty in patients who:

  • are skeletally mature
  • have degenerative disc disease (DDD) at one level in the lumbar spine (from L3-S1)
  • have no more than Grade 1 spondylolisthesis at the involved level
  • have had no relief from pain after at least six months of non-surgical treatment

What will it accomplish?

The PRODISC®-L Total Disc Replacement is used to replace a damaged intervertebral disc. The device may restore disc height, may reduce pain, and may allow movement at the level where it is implanted.

When should it not be used?

The PRODISC®-L Total Disc Replacement should not be used in patients who have any of the following:

  • Active systemic infection or infection localized to the site of implantation
  • Osteopenia or osteoporosis defined as DEXA bone density measured T-score < -1.0
  • Bony lumbar spinal stenosis
  • Allergy or sensitivity to implant materials (cobalt, chromium, molybdenum, polyethylene, titanium)
  • Isolated radicular compression syndromes, especially due to disc herniation
  • Pars defect
  • Involved vertebral endplate dimensionally smaller than 34.5mm in the medial-lateral and/or 27mm in the anterior-posterior directions
  • Clinically compromised vertebral bodies at affected level due to current or past trauma
  • Lytic spondylolisthesis or degenerative spondylolisthesis of Grade > 1

CHARITÉ® What is the CHARITÉ® Artificial Disc?

The CHARITÉ® Artificial Disc is a three-piece articulating medical device consisting of a sliding core sandwiched between two metal endplates. The sliding core is made from a medical grade plastic and the endplates are made from medical grade cobalt chromium alloy. These materials usually do not harm the human body and are used in many other medical implants such as total knee replacement implants.

The endplates support the core and have small teeth which secure them to the vertebrae above and below the disc space. The sliding core fits in between.

Laboratory testing shows that the CHARITÉ® Artificial Disc design allows your spine to move. In the clinical study, patients were observed to have motion between 0 and 21 degrees while bending forward and backward.

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