Disc replacements

1.       What are they?

Most people are familiar with the joint replacements we perform for hip and knee problems.  These have been around for many years, going back to the 1960’s.  When a joint wears out from arthritis, injury or wear and tear, it loses the cartilage or cushioning for the joint.   Joint replacements involve removing the worn surface and placing artificial surfaces, usually metal and plastic.

Disc replacements for the spine are relatively new compared to joint replacements for hips and knees.   When the discs in the spine are injured, they may bulge or rupture, causing pain and often nerve damage affecting the arms or legs.  Disc replacement involves removing the damaged disc and replacing it with an artificial disc made of metal or a combination of metal and plastic.

2.        What is the advantage of a disc replacement?

Before disc replacements the traditional treatment for disc problems was a fusion.  This  surgery involved removing the damaged disc and placing a spacer in the disc with bone graft often taken from the hip, to weld the bones together.  It makes that disc level stiff and transfers the stress to other areas of the spine. 

A disc replacement preserves some of the motion in the disc space and places less stress on the rest of the spine.  You also don’t have to use bone graft, reducing the amount of surgery involved.

3.       What are they used for?

In the normal spine, the bones provide protection for the spinal cord and nerves.  The disc provides cushioning and allows movement.  When a disc has ruptured or bulged, or develops wear and tear or bone spurs, it can cause irritation or pressure on nerves.   Pinched nerves can cause many symptoms, such as neck pain, headaches, arm and leg pain, numbness in the hands or feet, and weakness.   

4.        How do I know if I am a candidate?

As in most spinal disorders, surgery is usually a last resort. If you have some of the symptoms      described and have tried other methods of treatment such as physical therapy, chiropractic, traction   or epidural injections, surgery may be an option.  These would be situations in which a person can be a candidate for disc replacement.

5.       In what discs can disc replacements be performed?

Disc replacements can be performed in the neck or cervical spine, or in the lower back or lumbar spine. Both are FDA approved devices like hip and knee replacements.  There were large research studies performed to determine the safety and effectiveness of disc replacements.  In the studies involving the lumbar spine, the disc replacements proved to be as effective as a fusion in reducing pain and nerve damage, but not superior to fusion.  Therefore the lumbar disc replacement surgery was not been as readily accepted by insurance companies and is used less that the cervical disc replacements.

The studies involving the cervical sic replacements showed the results to be superior to fusion in reducing pain and nerve damage.  Therefore cervical disc replacements have been more widely used and accepted.

6.            How does the surgery work?    

Surgery usually takes about two hours and can be done as an outpatient or overnight stay in the hospital.  Initial recovery varies, but is generally about four to six weeks.  No brace is used, and motion can begin immediately after surgery.  Most people can expect to return to fairly normal activity including sports by three months.  We have had patients return to professional athletics, police work and one patient was inducted into the South Carolina Hall of Fame for bowling after his replacement.