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.
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.
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.
The short-terms risk profile of artificial disc replacement is similar to spinal fusion surgery. However, the rate of complications is relatively low. The risk of complications can be further reduced by choosing a surgeon with the skill and experience to successfully perform artificial disc replacement surgery.
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 the 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.