What is Artificial Disk Replacement (ADR) or Arthroplasty Surgery?
What is Artificial Disk Replacement (ADR) or Arthroplasty surgery?
Artificial Disk Replacement (ADR) or arthroplasty is a spinal surgery intended for treatment of Degenerative Disk Disease (DDD) where a device is implanted in the space previously occupied by the damaged disk, between the vertebral bones. An artificial disc is intended to preserve natural motion in the neck or back as if the disc material was still present. This is a well-studied and proven minimally-invasive surgical treatment option for DDD versus the traditional spinal fusion surgery.
Let’s start with defining what DDD is and ways in which it can be treated. DDD is a very common spine degeneration process, progressive arthritis or an injury involving damage or erosion of disk material in your neck or back. These disks are located between each vertebrae and act as a cushion or shock absorber for the neck (cervical) and lower back (lumbar). We also need to introduce facet joints here which are joints at every level along our spine that play an integral part in motion. More on this in a bit. Non-surgical treatments for DDD typically include medication therapy, physical therapy and steroid injections.
Historically, surgical treatment for severe DDD was limited to cervical or lumbar decompression or fusion at the location of the damaged disc. Although still a feasible surgical option, spinal fusions often require a
longer recovery time, limit range of motion, and, in some cases, require further surgery down the road.
Artificial Disk Replacement or Arthroplasty, thanks to advancements in technology, is a newer, more progressive surgical treatment for DDD. Extensive medical research has shown ADR to be a more beneficial treatment versus a spinal fusion for the appropriate patient. Studies demonstrate many benefits of ADR including a shorter hospitalization, faster return to normal activities and thus, a quicker recovery following surgery.
I have completed over 100 ADR procedures and have found the outcomes to be as good, if not better than a spinal fusion when performed on the appropriate patient. A key advantage of an artificial disk replacement is the ability to maintain a natural range of motion of the affected cervical (neck) or lumbar (back) level(s). Spinal fusion surgery, by definition, is the process of stabilizing and preventing movement in order to relieve pain at the damaged vertebral disk. However, stabilization/fusion will decrease flexibility and the natural movement of your neck or lower back. This decrease motion at the affected level can put added stress and strain on the adjacent levels resulting in accelerated degeneration and the possibility of additional surgery. ADR preserves the natural motion and natural biomechanics of your neck or back which can decrease this added stress or strain at adjacent levels and potentially limit the need for further surgery in the future.
Who is an appropriate candidate for artificial disc replacement (ADR) or Arthroplasty? Patients with primarily radicular pain or pain in a specific pattern down your arm due to a compression of a nerve or isolated degeneration of a cervical or lumbar disc are the ideal candidates. We must also consider the facet joints mentioned above. These joints can often be part of the pain generator. If these joints are significantly arthritic or degenerated we worry that they may be part of the pain you are experiencing. Unfortunately we cannot replace these joints and thus, a fusion may one a more appropriate option if these joints are felt to be part of the problem. As always, I would be happy to discuss your case in person.
10 year followup up study showed overall success rate considerably higher for arthroplasty vs fusion in terms of additional surgery, pain scales and disability index.