ADR or Artificial Disc Replacement is a surgery to remove a diseased intervertebral disc and replace it with an artificial device. Spinal fusion surgery—the fusing together of two or more vertebrae—had long been the only surgical option for patients with intractable neck or lower back pain. Today, however, ADR is an attractive alternative to spinal fusion because both procedures substantially reduce neck or back pain, but ADR preserves far more spinal movement than spinal fusion surgery.
Like spinal fusion surgery, ADR can solve the problem of chronic neck or chronic lower back pain that has not responded to medical therapy. Specifically, ADR solves the problem of chronic neck/back pain caused by a diseased intervertebral disc. The diseased disc could be breaking down (degenerating) because of degenerative disc disease. Or perhaps the disc has “slipped,” which is a way of saying that the intervertebral disc has moved outside of its normal place nestled between two vertebral bones and is pinching a nerve in the surrounding area. During ADR, the spine surgeon removes all remnants of the diseased disc, thus fixing the problem that caused pain and/or neurological symptoms such as weakness, numbness, or tingling in the arms or legs.
As with surgery in general and spine surgery in particular, patients face certain risks during and after the procedure. Fortunately, the rate of complications from ADR is relatively low, but prospective patients should be aware of the potential problems with the ADR procedure.
You can minimize your risk for general surgical complications by preparing yourself before surgery and by following the standard cervical disc replacement recovery procedures. If you have ever had any sort of negative reaction to anesthesia, tell your surgeon or anesthesiologist prior to the procedure. Temporarily stop taking blood thinning medications for a certain time before surgery (your doctor will tell you how far in advance you need to pause the medication). Stop smoking as far in advance of the procedure as possible because smoking increases your risk of lung-related complications and blood clots. Smoking has been shown to decrease the benefit of many types of spine surgeries. If you have diabetes, it is important to get your blood sugars under control to minimize the risk of infection and other complications.
After surgery, take all medications you were prescribed, exactly as prescribed. This is especially important for pain medications and antibiotics. The risk of blood clots after surgery can be reduced by getting a certain amount of activity (i.e., getting the legs moving and the leg muscles squeezing). Your surgeon will place some restrictions on your activity after the ADR procedure, by you should also make sure you are getting enough activity within these limits. This not only reduces the risk of blood clots, but also helps you regain physical function after surgery.
The best way to reduce the risk of problems related to the ADR procedure or artificial disc is to choose the right spine surgeon. Spine surgeons who have extensive experience in ADR often have lower ADR complication rates. Experienced spine surgeons are also better at choosing the right artificial disc size and angulation based on the patient’s unique anatomy (determined from X-rays and MRIs and evaluations during the produce). Likewise, the risk of improper disc placement, disc migration or spinal stenosis is lower when ADR is performed by an experienced spine surgeon. Surgeons can essentially prevent infection by maintaining rigorous and meticulous sterile fields. If you have or suspect you may have an allergy to metal, tell your doctor. You may need to have formal allergy testing prior to the procedure or at the very least it could change the type and brand of artificial disc used for your ADR surgery. Lastly, implant wear or failure is very rare with new devices—they are designed and built to last for decades.
Once you have decided on surgery for neck or lower back pain, one of the most important decisions you can make is whether to choose disc replacement vs spinal fusion surgery. Both surgical procedures reduce pain and neurological symptoms and both procedures are relatively safe and long-lasting, but there are some important differences.
Spinal fusion surgery can be thought of as the default choice. Spinal fusion is available to most patients who need disc surgery; it is suitable for people with certain forms of spinal bone degeneration, low bone density, cancer, and advanced age. The spinal bones are fused together, so movement of the spine is limited in the treated area. Reduced mobility of the spine means reduced mobility of the body, in general.
Artificial disc replacement is only available to people who have relatively healthy spinal bones and are reasonably healthy. However, for those who are candidates for ADR, the procedure restores or preserves spinal motion in ways that spinal fusion cannot. People can eventually return to the activities they once enjoyed like tennis, golf, or yoga. It is this difference in spinal mobility that makes spinal fusion surgery the “default” choice and ADR the “preferable” choice for those who qualify.