Low back pain is incredibly common. At least half of all adults will experience low back pain, and one of every four adults have had back pain in the previous month. For the fortunate, their back pain will resolve with rest and conservative treatments. However, for countless Americans, low back surgery—spinal fusion surgery or artificial disc replacement surgery—is their only hope of relief. Spinal fusion surgery is the surgical fusing or melding of the spinal bones. Artificial disc replacement surgery is the replacement of a damaged or diseased natural disc with a synthetic disc device. The major difference: The artificial disc replacement procedure preserves and restores spinal motion.
The artificial disc replacement procedure is performed under general anesthesia. This means that you will not be awake during the procedure and you will have no memory of the process after the anesthesia is started. A spine surgeon—either a neurosurgeon or orthopedic surgeon—performs the artificial disc replacement procedure with the assistance of an anesthesiologist, other surgeons, scrub nurses and the rest of the surgical team.
Even though the operation will take place on your spine, you will be lying on your back during the artificial disc replacement procedure. The surgeon will make an incision in your abdomen and various devices will be used to gently retract your organs to make room for the spine surgeon to reach your spine. The vertebral bones are slightly spread apart to allow free access to the disc space. Indeed, careful preparation is a key part of artificial disc replacement surgery. Using this approach allows the surgeon to replace the damaged vertebral disc without damaging the spinal cord, nerves, or important muscles in your back.
The spine surgeon carefully removes the damaged vertebral disc including any segments that may be torn or damaged. Once complete, the bottom of one spinal bone and the top of the spinal bone below will be ready to accept the artificial disc. It is critical that the layer of cartilage on these endplates is fully removed.
Placing the artificial disc requires planning, preparation, and skill. The endplates are placed tightly on the vertebral bones so they will hold to the spinal bones and are in proper alignment with the rest of the spine. Some artificial discs are a single piece while others are in multiple pieces. The more pieces to the artificial disc, the more challenging the placement and alignment. Regardless of disc design, all types of artificial discs are designed to provide mobility and flexibility to the spine, in many ways mimicking the natural vertebral disc. A spine surgeon who has extensive experience with artificial disc replacement surgery will be able to help you decide what artificial disc is right for you.
The surgery usually takes between 1 to 2 hours for most single level, primary artificial disc replacement surgeries. After the artificial disc replacement procedure is complete, you will be moved to a post-anesthesia care unit (PACU) or similar area to wake from the anesthesia and receive supportive care. Once you are fully awake, alert, and able to talk to staff, you will be wheeled to a hospital room or sent home if in a surgery center as an outpatient.
Most people who have had artificial disc replacement surgery can expect to be in the hospital as little as 0, home same day, and as many as 2 days. During that time, you will be asked to perform certain exercises that help with recovery. A physical therapist may show you how to perform the exercises. Most of these exercises will be modest at first—simply walking and gentle stretching and twisting. One movement you should not do for the first several days to weeks after surgery is to hyperextend your back (e.g. lean back and look straight up; make the middle of your spine push farther forward than your shoulders and your waist).
Unlike spinal fusion surgery, no bones have to fuse after artificial disc replacement surgery. This means that recovery times tend to be shorter after the artificial disc replacement procedure. That said, you can expect a recovery period of several weeks before you can return to full activity. Your surgeon will monitor your recovery process through several post-surgical, follow-up appointments. While recovery from artificial disc replacement surgery may take up to a month or two (or perhaps a little longer), the long-term benefits of artificial disc replacement surgery are worth it. The overwhelming majority of people who have artificial disc replacement surgery are satisfied with the procedure.