Considering disc replacement surgery (also sometimes called total disc replacement, artificial disc replacement, or ADR) at the advice of your physician? If you’re taking the time to research it, that’s an excellent first step. The most successful back surgeries usually involve patients who are proactive about their health: They educate themselves about their condition and treatment options, and gather information from lots of sources, not just their physician. In the end, they can make a more informed decision about why they’re undergoing a particular procedure and how it will help.
As you continue to read more from this website and other sources about disc replacement surgery, you’ll find that, while it works well for a small number of people, it’s not necessarily the right treatment for all back pain issues.1
In this article, we’ll describe the “ideal candidate” for disc replacement—what exactly is the medical condition that is addressed by total disc replacement surgery? If that doesn’t describe you, continue reading to find out about another option that could be more effective: BalancedBack Total Joint Replacement.
The Ideal Candidate For Total Disc Replacement
Essentially, there are three reasons for low back and leg pain:
- An abnormal disc
- Facet joint arthritis or degeneration
- Nerve compression
The ideal candidate for a disc replacement is someone who has only #1: some early disc abnormality.
Why? Because total disc replacement does not address problems #2 and #3. And if your disc abnormality is not in the early stages, it’s likely that problem #2 is already developing.
Here’s some background to explain further:
In the spine, the disc and facet joints work together as a unit.
Discs are usually the first to break down. Starting as early as the late teens or early 20s, human cells experience apoptosis—genetically programmed “cell death.” Cells contained in the center of the disc, the nucleus pulposus, begin to die off.
That cell death, along with repetitive mechanical loading from your daily movements, starts to cause an abnormal distribution of forces across the disc, pushing some of the mechanical load from the inner disc into the outer portion of the disc, known as the annulus fibrosus. As that area takes on larger amounts of load, nerve fibers in the annulus become stimulated and can become painful. The same mechanical process—cell death and mechanical loading—can also result in the annulus actually bulging, so that the load is no longer carried evenly across the disc.
Usually, if the disc begins to experience problems, the facet joints are likely to follow.2 That’s because the abnormal loading across the disc starts to affect the facet joints. In a normal 18-year old, for example, the proportion of disc load to facet load should be 80%–20%. But as the disc becomes increasingly abnormal that load gradually shifts, to 70–30, then 60–40. Ultimately, the cartilage in the facet joints begins to break down and the joints become a source of pain.
At that point, total disc replacement surgery won’t be enough to relieve your pain, because it only replaces the disc, not the facets.
As for problem #3—nerve compression—that is a condition that cannot be addressed with ADR. ADR surgeons approach your spine from the front (through the belly) to replace the worn-out disc, which does not allow them access to pinched nerves.
That’s why the number of people who benefit from disc replacement surgery is very small—because a degenerated disc is rarely the only problem they are experiencing. If you have leg pain, or the beginnings of arthritis in the facet joints, pinched nerves, spinal stenosis, or any amount of spine instability, you’ll still be in pain after the procedure.
So what if you aren’t the ideal candidate for disc replacement surgery? Keep reading for another option: BalancedBack Total Joint Replacement.
Improve the odds that your back surgery is a success. Find out if total joint replacement could be right for your condition.
The Ideal Candidate For BalancedBack Total Joint Replacement
If your back or leg pain is caused by more than one of the above-listed problems, BalancedBack Total Joint Replacement is more likely to relieve your pain than total disc replacement. Why? Because it addresses all three issues.
Rather than just replacing a disc, the BalancedBack device replaces the function of the entire joint, both facet joints and the disc. So if you have a worn-out disc and the beginnings of facet joint arthritis or degeneration, both problems will be solved with the new implant. This procedure also allows surgeons to treat pinched nerves causing leg pain, because it uses a posterior approach, from the back.
The root cause of pain for BalancedBack patients varies, but many suffer from one of the following conditions: spinal stenosis, recurrent disc herniations, subtle spondylolisthesis, or a previous failed fusion.
4 More Characteristics Of The Ideal BalancedBack Patient
Choosing the right treatment for your condition is the most important consideration for a successful surgery. Beyond that, the presence of certain other factors usually improves the outcome. In my experience, the people who are likely to benefit most from the BalancedBack procedure typically have the following characteristics in common:
1. They are highly motivated to recover.
Patients who live an active lifestyle no matter their age are anxious to get back to whatever they enjoy doing the most. (In my home state of Alaska that tends to be hiking, hunting, and snowshoeing, among other things!) That means they’re motivated to follow post-surgical instructions to a T and follow through with physical therapy as prescribed.
2. They practice healthy living habits.
Patients who see the best results from a total disc replacement and the BalancedBack procedure don’t smoke, they eat well, and they are generally fairly active. (Smoking, in particular, slows down the bone healing and ingrowth process mentioned above.) They also don’t have other high-risk factors such as diabetes or obesity.
3. They have healthy bones.
Unfortunately, patients with cancer present in the bones of the spine or who have osteoporosis are less likely to have success with any kind of spine surgery. The new implant requires time to integrate and bond with the surrounding bone, a process that is hindered if the bones aren’t healthy. It’s also important that the new implant doesn’t shift position before it’s fully integrated; very porous bones increase the risk of abnormal settling or shifting during the bone healing recovery stage.
4. They have a strong support system.
All medical procedures go more smoothly if you have family and friends around you to help out. These individuals are crucial during the recovery phase and with everything leading up to the surgery, like research and scheduling details, and traveling for the procedure itself.
Which procedure makes the most sense for you?
Choosing the right treatment begins with learning more about the cause of your back and/or leg pain. Talk to your doctor about all the options you’ve researched to determine which one will best address your condition—and help you avoid additional back surgery in the near future.
1 Huang, R. C., Lim, M. R., Girardi, F. P., & Cammisa Jr, F. P. (2004). The prevalence of contraindications to total disc replacement in a cohort of lumbar surgical patients. Spine, 29(22), 2538-2541.
2 Kalichman, L., & Hunter, D. J. (2007, October). Lumbar facet joint osteoarthritis: a review. In Seminars in arthritis and rheumatism (Vol. 37, No. 2, pp. 69-80). WB Saunders.