Let’s discuss the facts and myths associated with artificial disc replacement. First of all, we have been performing artificial disc replacements, on a regular basis, for well over a decade. These are no longer considered experimental devices and/or experimental procedures. Although there are some spine surgeons that claim this, the truth of the matter is that these operations have yielded both biomechanical, structural, and therapeutic results in patients.
The first thing we need to discuss, however, is that it is not the implant itself that ensures treatment. Rather it is the actual decompression aspect of the operation. Through an anterior approach (which is used in both the cervical and lumbar spine) we are able to remove the entire disc, and adequately decompress the spinal elements causing compression. Removal of bone, disc, and ligament material which develops chronically, is the most important part. Without adequate decompression, the patient’s symptoms will persist. As a result of the approach (removing the disc), something has to be replaced from structural integrity.
Traditionally this was by means of a cage (PEEK and now titanium) which would restore lordosis at that particular level and allow for a fusion (bone growing between the cage and creating a solid construct). In the cervical spine this was called an Anterior Cervical Discectomy and Fusion (ACDF) and in the lumbar spine, Anterior Lumbar Interbody Fusion (ALIF). The downside to a fusion is that the adjacent segments (above and below the level of the fusion) now bear the pressure and movement of the fused segment leading to an accelerated rate of deterioration of the disc. From a recovery standpoint, this means a longer time (approximately 3 months for the bone to fuse) and more lifestyle restrictions after.
With artificial discs, the only thing that changes is the implant itself. The decompression is still performed thoroughly, as usual. With an artificial disc, we are able to maintain movement at a particular junction. These are appropriately sized and allow patients to return to an unrestricted lifestyle in a matter of a couple of weeks. We have completed research, independently of company-sponsored research, strictly for the clinical outcomes of our patients. The results are as follows for the cervical and lumbar spine, respectively (per level):
In the cervical spine, we have performed 1, 2, 3, and 4 level disc replacements. In the lumbar spine, we have performed 1 and 2 level replacements. We perform several of these operations on a weekly basis and are able to reproduce these results for our patients consistently.
For some reason, there are surgeons around the country that still claim that this operation is experimental, all while they are being performed around the world on a routine basis. For this reason, we cannot determine why it is not readily embraced as a standard of care for degenerative disc disease and joint disease. Financially it is better for the patient to undergo an artificial disc replacement than a fusion.
I want to reiterate the fact that we have performed this operation on members of law enforcement, firefighters, MMA/Brazilian Jiu-Jitsu fighters, surfers, pilots, active duty military (including special operations), nurses/doctors, etc.
If you believe that you’re a candidate for artificial disc replacement visit www.drmesiwala.com and we will happily put you in touch with one of our former patients to discuss how we strive to ensure that you continue living life unrestricted.