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    • Larry L. Teuber, M.D.
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Artificial Disc Options

The arrival of the artificial disc is perhaps the most anticipated advance in spine surgery in the past 20 years. On October 26, 2004, the artificial disc received formal approval by the Food and Drug Administration (FDA) for wide-range use in the United States.

It is anticipated that the artificial disc will have an extraordinary impact on the field of spine, similar to the introduction of the artificial joint for those with damaged knee or hip joints. Prior to the introduction of the artificial knee or artificial hip, these joints often had to be fused. Thankfully, thousands of people each year regain the ability to walk due to artificial joint implants. At last, this new technology is launched in the field of spine.

An Alternative to Fusion Surgery

The artificial disc is currently the best alternative to spinal fusion surgery. Yearly estimates indicate that more than 200,000 spinal fusion surgeries are performed to relieve severe pain caused by damaged discs in the low back and neck areas.

The fusion procedure involves the replacement of the damaged disc with bone from a patient's hip or from a bone bank. During fusion surgery, two vertebrae become locked in place; this increases stress on the discs above and below the fusion site. Disc herniation may result due to the added stress and movement restrictions. In contrast, an artificial disc replacement is designed to mimic the function level of a normal, healthy disc and keep motion in the spine.

Expert estimates show that in the next 10 years, greater than 50% of patients who would otherwise receive a fusion will receive an artificial disc instead. Nationwide, well-informed consumers are expected to migrate towards regional spine centers of excellence for access to this latest technological advance in spine care.

Why the Artificial Disc is Big News

Occurrence of degenerative disc disease is widespread, due to this fact; the artificial disc is remarkable news. A natural consequence of aging is the loss of resiliency in spinal discs and a greater propensity toward a herniated disc, especially when placed under a heavy load, like when we lift objects. Moreover, there is a correlation between family history of degenerative disc disease and an increased risk in developing the disease.

When a natural disc herniates or becomes badly degenerated, it loses its shock-absorbing ability, which can narrow the space between vertebrae. A common aspect of all artificial discs is that they are designed to retain the natural movement in the spine by duplicating the shock absorbing and rotational function of the discs attained at birth.

Most artificial disc designs have plates that attach to the vertebrae and a rotational component that fits between these fixation plates. These components are typically designed to withstand stress and rotational forces over long periods of time. Still, like any manmade material, they can be affected by wear and tear.

Manufacturers of artificial discs aim to design discs that are not only resistant to wearing out but that are easily replaced if revision surgery is needed. While artificial disc surgery is still relatively new, the potential benefits are very encouraging for those with degenerative disc disease.

Benefits

In general, those who receive artificial disc replacements return to activity sooner than traditional fusion patients. Because there is no need to harvest bone from the patient's hip, there is no discomfort or recovery associated with a second incision site. Some of the overall benefits of artificial disc surgery include:

• Retains movement and stability of the spine
• Prevents degeneration of surrounding segments
• No bone graft required
• Faster recovery and return to work
• Less invasive and painful than a fusion
• Reduced pain associated with disc disease
  
  

Drawbacks

Artificial joints typically last anywhere from 15 to 20 years, orthopedic surgeons who perform knee and hip replacement try to postpone the implantation of an artificial joint until a patient is at least 50 years old so that they do not outlive the implant. Revision surgery, which may be necessary to replace a worn-out artificial joint, can be complex.

This is also a concern with the artificial disc. Unlike knee and hip replacement patients who are typically in their 50s or 60s, many patients can benefit from artificial disc technology at a much younger age in their 20s or 30s. Therefore, the implantation of an artificial disc in younger patients can raise a surgeon's concern about the potential life span of the artificial disc in the spine and the need for revision surgery to replace a worn-out artificial disc, which can be also be complex.

Lumbar vs. Cervical Artificial Discs

Artificial disc for the low back

Because the weight of the trunk is placed on the artificial disc, the disc material must withstand the wear and tear of walking, bending and lifting. Due to the weight of the body and the rotational stress that the trunk places on discs in the low back (lumbar) area, more stress is placed on artificial discs in the lumbar area than in the neck (cervical) area, which only supports the weight of the head.

Artificial disc for the neck

The Prestige disc for the neck represents a significant advance because it retains crucial natural movement in the neck, replicating the normal disc. As the surgeon must access the front of the spine, an incision is made in the abdomen for lumbar discs and in the front of the neck for cervical discs. Typically, access to the cervical discs can be easier than the lumbar discs.