In a previous article, we mentioned anterior disc replacement as an alternative to spinal fusion—with the caveat that it isn’t ideal for most patients.
That leaves things a little unclear, which isn’t surprising for a procedure that goes by multiple names, including anterior disc replacement, spinal disc replacement, total disc replacement, and even occasionally lumbar (lower back) disc replacement. Confused yet? Let’s dig deeper into what artificial disc replacement surgery actually entails and the results we’ve seen in patients since it was first performed in the U.S. more than 15 years ago.
First, a little background on how your back works to help clarify the information to come.
How Your Back Works
To fully understand the concept of a spinal disc replacement, it’s important to know about the parts of your spine and their roles in whole body mechanics.
Our back pain dictionary defines the spine as a series of stacked vertebrae or vertebral bodies, each containing a disc and two facet joints, connected by ligaments and muscles and mechanically involved in your every movement. The disc and the facet joints work together as a unit, similar to the ball and socket of your hip. Every move you make depends on the seamless functioning of a series of these units. A problem anywhere along the line will eventually lead to back and/or leg pain.
An important feature of your back is its natural curve. If you look at someone (or yourself in a mirror) from the side, you’ll notice a curve shaped like an “S” in the back—there’s a curve at the top of the neck, the opposite curve mid-back, and another curve in the lower back, like the one at the top of the neck. Each time you change position throughout the course of a day—from standing to sitting and back again—so does the curve of your spine. A seated position, for example, lessens the curve in your lower back. These changes are a natural part of movement and help keep us balanced in every position.
What is anterior disc replacement surgery?
In artificial disc replacement surgery, a surgeon replaces a degenerated or worn disc in the spine with a new, artificial one. The facet joints are left alone, and only the disc itself is replaced. (That’s why the term “total disc replacement” isn’t accurate at all—you’re actually only replacing a portion of the motion unit, not the whole thing.) Patients with healthy facet joints may continue to retain a natural range of movement for several years after surgery, once the degenerated disc is replaced.
Benefits Of Artificial Disc Replacement Surgery
This type of surgery can be a good solution for isolated disc problems if the related facet joints are healthy at the time of surgery, because:
- It alleviates the pain associated with the problematic disc.
- It enables patients to retain range of movement because the facet joints remain intact (as opposed to fusion surgery, which eliminates the joint completely). Retaining movement also protects the adjacent motion units (above and below the surgical location) from additional stress that would have been placed on them had the joint been removed and fused.
But although it sounds like this procedure would be effective in relieving back pain (and it is, to some degree), it isn’t a perfect solution. Here’s why:
Disadvantages Of Artificial Disc Replacement Surgery
While the surgery may, in some cases, be successful at the outset, artificial disc replacement surgery overall has had mixed results.1 There are three main reasons why:
It only works for a very small percentage of people.2 It doesn’t address the most common cause of pain: pinched nerves. Nerves become pinched in the lower back for a variety of reasons, such as a ruptured disc, bone spurs, or thickened ligaments. For a surgery to be successful, then, it would need to unpinch the nerves—something that artificial disc replacement surgery does not do. It also won’t relieve your pain if you have arthritis of the spine (see reason #2). So in reality, the procedure only works for a small percentage of people—about 2% to 5% of patients overall.
It only replaces a portion of the functional spinal unit (just the disc)—which fixes only one third of the problem. You’re not a good candidate for this surgery if you have any signs of arthritis of the spine (facet arthritis), because your facet joints are not being replaced. Artificial disc patients receive a new disc during surgery, but as time goes on they are likely to experience continued facet degeneration and arthritic, stiff joints (as many people do). The weakened joints eventually cause pain, stenosis, and reduced range of motion. Ultimately this loss of natural movement creates more stress in other segments of your spine and will result in more back pain and even leg pain over time. Some patients even go on to fuse entirely, growing bone around the artificial disc and/or facets.
In fact, arthritic facet joints have often caused some patients to undergo additional surgery after the original disc replacement procedure. At that point, fusion is the only solution. So while you may experience several or even many years of relief as a result of the surgery, unless you are an ideal candidate with very isolated pathology, you’re likely to incur pain once again.
Looking for a solution that addresses back pain more fully? Find out about an innovative total joint replacement procedure called BalancedBack.
It uses an anterior approach—through the stomach—which is riskier than a posterior approach (through the back). To reach the damaged disc, surgeons must work around vital internal structures—the bladder, kidneys, ureters, part of the colon, and some major blood vessels. It’s possible to damage these organs during surgery, which could result in additional surgery or a prolonged hospital stay. In men, the anterior approach also carries the risk of retrograde ejaculation, a type of sexual dysfunction caused by cutting through small nerves in the stomach to access the spine.
The anterior approach presents an even greater challenge should a patient need revision surgery later to address a worn-out disc or arthritic facet joints.3 The second time around, those same blood vessels are scarred and less movable as a result of the first surgery, which increases the likelihood of injuring them. Studies show there’s a 10% chance of injury to the vessels, which can literally be life-threatening. As a result, most anterior surgeries are completed by a team, including both a spine surgeon and a vascular surgeon, to help in the event of a vessel injury.
A New Alternative: Total Joint Replacement
Up until now, people with debilitating lower back pain had no choice but to try artificial disc replacement surgery and/or fusion and hope that these procedures would work.
Today, there’s another alternative: BalancedBack Total Joint Replacement. This innovative form of lumbar disc replacement has one important difference—it replaces the function of the facet joints as well as the disc. Because it replaces the whole joint, your spine can regain its natural range of movement and retains its natural “S” curve, allowing you to find comfort in any position.
- It alleviates the pain associated with a problematic disc. Just like an anterior disc replacement, the BalancedBack procedure allows the surgeon to replace the damaged disc completely. But unlike anterior discs, BalancedBack also addresses back pain from arthritic or degenerated facet joints, which in many patients is the major source of back pain.
- It can address not only disc pain but also a broad range of other problems—such as pinched nerves, spinal stenosis, or arthritis in the facet joints—because it uses a posterior approach and addresses all three structures. As a result, a BalancedBack Total Joint Replacement procedure may be appropriate for as much as 75% of patients as opposed to an estimated 5% for artificial disc replacement surgery. Simply put, BalancedBack Total Joint Replacement addresses both leg and back pain—something not possible with anterior disc replacement.
- It enables patients to retain full range of movement because, just like a hip or knee prosthesis, it replaces the function of the total joint and allows the structure to keep on moving. This type of joint replacement procedure helps replicate your natural range of movement and spinal balance, while minimizing stress on adjacent motion levels.
So how does artificial disc surgery compare to BalancedBack Total Joint Replacement in terms of surgical recovery?
Recovering From Surgery: Artificial Disc Replacement & BalancedBack
Long-term recovery expectations for disc replacement come from a combination of science and experience. From a scientific perspective, lumbar disc replacement recovery time partly depends on the time it takes for the bone to grow onto the implant, bonding the two together for stability. With anterior disc replacements, forming a complete bond takes about three months. At that point, most patients have no further restrictions on activity. (Note that cervical artificial disc replacement surgery recovery time tends to be faster than lumbar disc replacement surgery recovery.)
As with disc replacement recovery, ingrowth of the new BalancedBack Total Joint Replacement occurs when the bone has integrated and bonded to the BalancedBack implant surfaces. But although bone healing is similar, BalancedBack patients generally recover much faster than anterior disc replacement patients simply due to the surgical approach. The posterior approach used for BalancedBack is much less invasive than an anterior surgery, resulting in less pain, shorter hospital stays (most BalancedBack procedures are outpatient surgeries), and faster recovery from the surgical exposure.
BalancedBack patients also recover much faster than fusion patients even when the same posterior surgical approach is used. Why? Because BalancedBack patients can move naturally after their surgery, preventing the body from stiffening into a protective move post-op. Whereas fusion patients often feel their screws and the changes in their mobility, particularly when sitting, BalancedBack patients often comment that they have not stood up as straight and unrestricted in years. They generally do not experience pain when changing from standing to sitting, and are generally less hesitant that fusion patients to begin rehabilitation.
Looking for an alternative to spinal fusion? Find out more about an innovative new procedure that might be right for you.
BalancedBack Recovery Timetable
The typical recovery timetable for BalancedBack procedures is as follows:
Day of Surgery—Patients begin ambulating as soon as possible. We typically have people walk up and down the hallways at the hospital 2-3 hours after surgery. Early mobility is encouraged. In most cases, patients are discharged home the same day to begin their full recovery in a positive, comfortable, non-hospital environment.
Day 3/Day 4—Patients begin a walking program. Walking is the best type of exercise after motion surgery because it puts a low amount of stress on the back while aiding the healing process and building muscle strength and balance.
Two weeks after surgery—Patients can get in a swimming pool, do aerobic activities, use light hand weights, or do a stationary bike. At this point, most patients can also do a small amount of stretching (about 25 to 30 degrees)—enough to bend forward slightly as needed, take a shower, etc. The majority of patients can also drive short distances at this point.
Six weeks after surgery—In this stage, patients are usually able to bend further—45 to 50 degrees—as needed, and can continue to do the activities listed above. Many people return to work at this point.
Three months after surgery—On average, most patients have no further restrictions on their activities three months after their procedure.
Is BalancedBack the right solution for you?
That’s a decision for you and your doctor to make together. If you’d like to find out more about the BalancedBack Total Joint Replacement procedure, visit our website or schedule an evaluation of your case with our clinical coordinator. Getting the information you need is the first step on the path to recovery.
1 Salzmann, S. N., Plais, N., Shue, J., & Girardi, F. P. (2017). Lumbar disc replacement surgery—successes and obstacles to widespread adoption. Current reviews in musculoskeletal medicine, 10(2), 153-159.
2 Gelalis, I. D., Papadopoulos, D. V., Giannoulis, D. K., Tsantes, A. G., & Korompilias, A. V. (2018). Spinal motion preservation surgery: indications and applications. European Journal of Orthopaedic Surgery & Traumatology, 28(3), 335-342.
3 McAfee, P. C. (2004). The indications for lumbar and cervical disc replacement. The Spine Journal, 4(6), S177-S181.