Getting an Artificial Disc Replacement (ADR) is a big decision. When it is done properly and for the right reasons, it can dramatically improve your life. However, deciding to get ADR takes careful thought and planning. Here is everything you should know, do, or ask before having an artificial disc replacement procedure.
Many cases of neck and back pain will go away on their own or with conservative treatments, so ADR is not needed. To be a candidate for Artificial Disc Replacement, a person usually has to have lower back or neck pain for at least 6 months. Also, conservative treatments such as rest, heat, pain medications, physical therapy or injections have not fully relieved the pain over that time. Lumbar artificial disc replacement treats the lower back, whereas cervical disc replacement provides relief to the neck.
ADR is only intended to treat certain kinds of back or neck problems. You should make sure that either CT or MRI shows degenerative disc disease. Simply put, is a bad intervertebral disc the likely cause of your pain or disability? If so, ADR may be an option. Lastly, make sure there isn’t anything that would make ADR a bad choice, i.e., a contraindication. Contraindications to ADR include poor bone quality, ankylosing spondylitis, rheumatoid arthritis, and severe facet joint degeneration, among others. Ask your spine surgeon if you actually need Artificial Disc Replacement and if you have any contraindications to the procedure.
It can be difficult to get a straight answer to the question: How long does an Artificial Disc Replacement last? Depending on where you get your information, various sources quote vastly different times. Today, modern artificial discs last an exceedingly long time. Engineering tests show that artificial discs can last over 50 + years. To make sure, tell your doctor about your level of activity and ask your spine surgeon how long you can expect your particular artificial disc to last. This information can help you decide if ADR is right for you.
Once you have determined that spine surgery is right for you, it is important to determine which cervical spine surgery is right for you. Fortunately, there are really only two options: Artificial Disc Replacement or Spinal Fusion. In ADR, the diseased disc is removed and replaced with an artificial disc. In the spinal fusion, the diseased disc is removed and the spinal bones are fused together to become one larger bone. As you can imagine, ADR provides greater mobility and flexibility of the spine than spinal fusion, which is an important advantage for most active people. On the other hand, spinal fusion can be performed in cases in which ADR cannot, e.g., people with osteoporosis or ankylosing spondylitis. Ask your surgeon if disc replacement or spinal fusion is your best option.
Artificial Disc Replacement is a technically challenging procedure that requires skilled hands and extensive experience. While all spine surgeons can perform spinal fusion surgery, not all of them are skilled in disc replacement. Therefore, it is best to seek out someone who has extensive experience in ADR and ACDF so they can help you decide between ADR, ACDF, or no surgery at all.
Will your surgery be performed under general anesthesia? Most Artificial Disc Replacements are performed under general anesthesia unless it poses too great of a health risk. Patients who cannot tolerate general anesthesia may not be good candidates for ADR, so talk to your surgeon about this. While you are on the topic, ask your surgeon about pain control after the procedure. Will opioids be prescribed? If so, when can they be stopped and non-opioid pain medications started?
Make sure you are prepared for recovery from Artificial Disc Replacement, which can take several weeks to months. You will likely be observed at the surgery center or hospital for observation for 6 to 23 hours after surgery. Also, if you are a heavy laborer you will likely not be able to work for at least 2 weeks after surgery, though people with desk jobs find they can get back to work a little earlier than someone who must stand or lift as part of their job. Remember to ask your spine surgeon how recovery differs between ADR and ACDF.
All spine surgeries can be expensive, so if you are expecting health insurance to cover part of the cost, it is critical to find out what portion your insurer will pay and how much you will need to pay as a deductible. Consider that there may be costs for radiology studies like CT and MRI, a pre-op physical, bloodwork, and time spent in the hospital after the procedure. Then there is the facility cost of the surgical procedure itself, which includes operating room (OR) time, the surgeon’s fee and the anesthesiologist’ fee (these may be billed separately or together). There may also be a cost for follow-up appointments with a physical therapist. Lastly, consider how you will manage if you must take time off of work to recover from ADR. Do you have someone in your home to support you physically and financially, if needed?
No reputable surgeon should feel threatened if you get a second opinion. It is only prudent to ask more than one spine surgeon the questions in this article. The surgeons will likely give you the same information, but if they do not, consider reaching out to other qualified surgeons to help you make sense of all the information. Again, getting Artificial Disc Replacement is a big decision. Make sure you trust the person you choose to do this important work.