Artificial disc replacement is a surgical procedure to remove the diseased or damaged intervertebral disc and replace it with an artificial joint. In most cases, artificial disc replacement reduces or eliminates pain, restores spinal movement, and improves quality of life.
Artificial disc replacement has emerged as one of the leading surgical procedures to treat chronic neck or back pain. It is also the next logical step in the evolution of neurosurgery. Just as hips and knees are now replaced instead of fused together, so too are the discs of the spine replaced instead of fused.
The spine in the neck and back is a collection of bones, one on top of the next. This configuration gives the spine both its strength and its flexibility. The stack of spinal bones (i.e. vertebra) holds the weight of the head, arms, and chest. At the same time, the bones can move relative to one another, allowing us to bend and twist. When the spine is healthy, it is a marvelous thing.
In between most pairs of vertebral bones is a vertebral disc. Vertebral discs are both sturdy and pliable. They act as shock absorbers and cushions for the bones of the spine. Again, when vertebral discs are healthy, they are marvelous things.
Dr. Todd H. Lanman is a board-certified and award-winning spinal neurosurgeon who has been practicing medicine for more than 30 years. He runs his private practice, the Advanced Disc Replacement Spinal Restoration Center, in Beverly Hills, California, and Palm Beach, Florida.
Dr. Lanman specializes in the treatment of spinal disorders and is a leading clinical advocate for artificial disc replacement surgery. He has been an associate clinical professor at UCLA for the past 20 years and is a fellow of both the American College of Surgeons and the American Association of Neurological Surgeons (FAANS).
As a leading innovator of artificial disc replacement surgery, as well as a media educator and contributor, Dr. Lanman has published more than ten peer-reviewed articles and book chapters on topics relating to neurological surgery. He has also presented more than two dozen papers at national and regional medical society meetings. Dr. Lanman has been tapped by colleagues to be the principal medical investigator on a wide swath of clinical trials for motion-preserving surgeries and artificial disc replacement devices. He most recently helped develop the Prestige LP and M6, along with Restorative Motion Surgery™.
Dr. Lanman is different from other surgeons because he has undergone spinal treatment himself. He has needed eleven spinal surgeries throughout his life – four cervical and seven lumbar. He has been through the recovery and rehabilitation process firsthand. This fuels his devotion to his patients and his commitment to providing better spinal solutions for them.
Unfortunately, almost everyone older than 40 eventually develops some degree of degenerative disc disease. Degenerative disc disease is a condition where the intervertebral discs break down. In some, degenerative disc disease causes debilitating pain, decreased range of motion, and diminished quality of life.
Unlike spinal fusion surgery—the other surgical approach to treating chronic neck or back pain—artificial disc replacement allows the vertebral bones to move, to twist, and to bend. Thus, artificial disc replacement preserves range of motion in the spine.
Many—but not all—people are candidates for artificial disc replacement surgery. The main indication for artificial disc replacement is degenerative disc disease that may or may not be accompanied by radicular pain. Radicular pain is caused by compression or inflammation of nerves in the spine. To be a candidate for artificial disc replacement, a person’s neck or back pain is usually severe enough to significantly interfere with their ability to work or pursue active hobbies or sports.
In general, most people must have experienced at least 6 months of chronic neck or back pain not relieved by nonsurgical interventions. In other words, a person must have neck or back pain that persists after treatment with heat, maximal tolerated activity, physical therapy, oral analgesics, and/or corticosteroids before being considered a candidate for artificial disc replacement.
While the procedure can be performed on patients of almost any age, younger people, i.e., age 18 to 60, have the best outcomes and derive the most benefit from artificial disc replacement. The surrounding vertebral bones must be healthy enough to support the artificial disc. Thus, people who have had failed spinal surgery, osteoporosis of the spine, (retro)vertebral compression, or ankylosing spondylitis are not candidates for artificial disc replacement.
Artificial Disc Replacement (ADR) surgery is a significant medical procedure aimed at relieving chronic neck or back pain. Proper preparation is key to ensure a smooth and successful surgery. Here are some essential steps and considerations when getting ready for ADR:
Dr. Lanman will walk you through each part of your particular operation so you feel comfortable about the procedure. However, there are a few common steps that occur with each operation to increase the chances of success while minimizing patient risk.
First, Dr. Lanman will place you under general anesthesia. This means you will be asleep throughout the procedure. Your anesthesia medication will either be administered through vapors that you breathe in via a mask or through an IV.
Once you are sedated, Dr. Lanman will either make an incision in your neck for cervical disc replacement or in your abdomen for lumbar displacement. These are typically done at the front of the body. This approach allows Dr. Lanman to avoid your nerve canal and spinal column while operating on your discs, which makes the procedure easier and safer.
Dr. Lanman will insert an endoscope, which is a medical device with a light attached, along with a tiny camera that sends a live feed to a computer monitor in the operating room. This allows him to operate on your spine while only utilizing an incision that is an inch or two long. From there, Dr. Lanman will identify your broken or damaged disc, remove it, and replace it with an artificial model.
There are multiple types of artificial discs used in these operations. Dr. Lanman will choose between four options to replace your damaged one: composite, hydraulic, elastic, and mechanical. These vary by materials used but all have the same effect: they should help you regain your range of motion while reducing your pain levels.
Once the artificial disc is placed, Dr. Lanman can run a few final checks on your spine and then end the operation. The procedure only takes a few hours and you should be able to return home on the same day as when you checked into Dr. Lanman’s clinic.
Dr. Lanman is a certified spine surgeon that offers Los Angeles artificial disc replacement and can answer all of your questions related to ADR. Only a qualified spine surgeon can help you decide if artificial disc replacement is right for you; however, you can review the pros and cons of the procedure.
Much like all surgical interventions, and especially in the realm of spinal surgery, patients are confronted with specific risks both during and following the procedure. These risks include bleeding, pain, infection, reactions to anesthesia, and more. However, Dr. Lanman and his team do the best they can to mitigate these risks and ensure the safety of their patients. Nonetheless, individuals considering ADR as a treatment option should remain well-informed about the potential challenges that may arise during the course of this procedure.
The recovery process after disc replacement surgery involves a gradual return to normal activities, pain management, and close monitoring by your medical team. Adhering to your surgeon’s instructions (and allowing your body the time it needs to heal) is key to a successful recovery and the best possible outcome. Here’s more about what to expect following an artificial disc replacement:
The artificial disc replacement recovery time varies from one patient to the next. It depends on your health, the intensity of the operation, and your dedication to your physical therapy exercises. However, most patients recover from the procedure within 3-5 weeks. You can expect to resume light activities within one week but it could take up to three months for you to reach your full activity levels.
Dr. Lanman does his best to reduce patient downtime. He tries to make the operation as minimally invasive as possible and recommends quality physical therapists to help patients recover. If you are still in pain a few weeks after the operation, Dr. Lanman will do his best to figure out why.
If you are considering artificial disc replacement, here are seven points you should understand:
The future of artificial disc replacement (ADR) technology and surgical approaches holds significant promise, with ongoing advancements aimed at improving patient outcomes and expanding the scope of ADR. Here are some advancements to be aware of in the future:
Additionally, disc replacement will continue to replace spinal fusion as a more effective operation that reduces pain levels while also preserving the range of motion.
Spine.MD has compiled everything you need to know about artificial disc replacement. Whether you need to know more about what it is, the procedure, or if artificial disc replacement is right for you, our ADR resources can help you make the right decision. Learn directly from a real spine surgeon, Dr. Lanman, that performs artificial disc replacement and is an ADR Lead Investigator regularly comparing artificial disc replacement surgery vs. fusion:
Simulated wear studies indicate artificial discs last a minimum of 40 years, with a range of 50 to 100 years.
Maybe. Each surgeon has different in-and out- of network preferences. It does typically cover facility expenses.
Medicare does not currently cover the cost of artificial disc replacement in people 60 years of age or older. However, the Centers for Medicare and Medicaid Services does permit local Medicare Administrative Contractors to cover artificial disc replacement in some Medicare patients under the age of 60.
Importantly, the CMS decision was made in 2007. We now have considerably more clinical data about the safety, efficacy, and durability of artificial disc replacement—so this coverage determination may change.
Several major health insurance companies cover a substantial portion of the cost of artificial disc replacement. Some health insurance companies that cover artificial disc replacement include Anthem, Cigna, Humana, and UnitedHealthcare. In all cases, however, patients must meet certain requirements to be eligible for coverage. People who are considering artificial disc replacement surgery should speak with their spine surgeon and/or health insurer to find out if and what artificial disc replacement surgery costs are covered.
Pricing for artificial disc replacement surgery will vary depending on your location. Contact your doctor to discuss cost of the procedure and insurance coverage
Patient satisfaction rates with artificial disc replacement surgery are higher than 95%. At least 75% of people who have had artificial disc replacement surgery achieve overall clinical success. This means that 3 out of every 4 patients who suffered from severe neck or lower back pain for at least six months that did not respond to medical treatment had a successful artificial disc replacement surgery. Success rates with some artificial discs (e.g., Prestige) are even higher (>80%).
The US Food and Drug Administration (FDA) considers whether to approve an artificial disc. The FDA examines the safety and efficacy of artificial discs in device trials to make this determination. Currently, 8 cervical and 3 lumbar total disc replacement devices are FDA-approved, though most surgeons use devices that have been approved by the FDA more recently.
If an artificial disc fails, it can be replaced under certain circumstances. However, the likelihood that an artificial disc fails is very small. In fact, artificial discs may be more durable than fusion surgeries.
In some cases, a spinal fusion can be reversed, and an artificial disc inserted at that spinal level. Patients may regret their decision to have spinal fusion surgery because it limits their spinal range of motion. Some spine surgeons offer spinal fusion revision surgery or Restorative Motion Surgery® to convert an old spinal fusion to an artificial disc.
Physical exercise is limited after any surgery, of course, but once a person heals, they can resume normal physical activities. Perhaps more importantly, artificial disc replacement surgery often restores spinal mobility and flexibility. This means patients may be able to return to a level of physical activity they enjoyed before neck or lower back pain started. Even professional athletes have disc replacements that are fully functional during sporting activities.