When a damaged disc causes unbearable neck or back pain, it's time to learn about the benefits of disc replacement surgery. Board-certified neurosurgeon Ali H. Mesiwala, MD, FAANS, has been performing outpatient disc replacement surgery since 2008. Over the years, he has developed minimally invasive techniques that use small incisions, minimize tissue damage, and eliminate the need for hospitalization. To learn more about disc replacement, call one of the four offices in Newport Beach, Marina del Rey, and Rancho Cucamonga, California, or book an appointment online today.
An artificial disc replacement (ADR), also called total disc arthroplasty (TDA), is a minimally invasive procedure to remove a damaged intervertebral disc and replace it with an artificial disc.
Removing a damaged disc causes spinal instability, a problem that can be solved by a spinal fusion or disc replacement. Both treatments alleviate your pain and restore stability, and in other spine conditions such as fractures or deformities, a fusion may be the best choice.
However, fusing two vertebrae together stops movement, while inserting an artificial disc preserves normal spine mobility. The new disc moves like your original disc, duplicating its function so you have the full range of motion, as well as stability. Additional benefits to disc replacement surgery include faster recovery, decreased rate of degeneration of adjacent discs, and decreased pain post-operatively.
You may need to have a cervical (neck) or lumbar (lower back) disc replacement when you have a herniated disc or degenerative disc disease. Both conditions make the disc collapse, so it stops supporting its share of the load on your spine.
Damaged discs increase wear and tear on the facet joints, leading to arthritis. The loss of a healthy disc also reduces the size of the natural vertebral openings, which in turn compresses the spinal nerves and nerve roots.
Then the nerves become damaged and inflamed, and you develop pain and limited spinal movement.
Dr. Mesiwala specializes in using an anterior approach, making the incision in the front of your neck or abdomen for a cervical or lumbar disc, respectively. As an expert in minimally invasive disc replacement, he makes a 1- to 1½-inch incision for a cervical disc or a 1-2 inch abdominal incision.
Using the anterior approach allows Dr. Mesiwala to carefully guide narrow instruments through the muscle fibers without cutting the tissues or damaging the spinal joints.
He also gently moves structures like blood vessels, the esophagus, and the sac containing your abdominal organs, pushing them out of the way without causing damage.
By comparison, other surgical procedures that approach your spine from the back or side, such as laminectomies and foraminotomies, require Dr. Mesiwala to peel the muscle off the spine and cut away the bone protecting your spinal cord.
After making the incision and gaining access to your spine, Dr. Mesiwala uses specialized tools to remove the disc, as well as any bone spurs or disc fragments, that are pinching the nerves. Then he inserts the artificial disc and closes the incision with sutures and glue.
It takes 10-20 minutes to give you general anesthesia and position you for surgery, and another 10-20 minutes for you to wake up after surgery.
Your actual disc replacement procedure takes less than an hour. However, it takes longer if you have multiple discs replaced. Most people go home the same day, but some may need to stay overnight in the hospital.
If you have a cervical disc replacement, you wear a soft collar for two weeks after surgery. Once the collar is off, Dr. Mesiwala doesn't place any restrictions on your activities, and you can start physical therapy.
Patients who have a lumbar disc replacement don't wear a brace or abdominal binder. It takes 2-4 weeks for the abdominal incision to heal. While you heal, Dr. Mesiwala allows all activities except those that place a strain on your abdomen. After four weeks, you can return to all activities, including physical therapy if needed.
Minimally invasive procedures cause significantly less trauma, while disc replacement has distinct advantages over the option of bone fusion.
In addition to preserving normal spine movement, your advantages include:
Replacing the disc also prevents accelerated degeneration in the spinal segments above and below the disc.
If you have a damaged disc and would like to learn more about disc replacement surgery, call Ali H. Mesiwala, MD, FAANS, or book an appointment online today.
A rigid fusion with screws and rods will limit a patient’s range of motion of their spine. Whereas a disc replacement will preserve motion. If we can allow the patient to keep their full mobility, this is preferred!
Also, frequently a patient’s neck or low back disc is collapsed and their motion is impaired at this level. A disc replacement can then improve their range of motion at this level. 30% of the time, a patient who has a previous fusion will require additional surgery at the levels above or below the fusion construct.
Whereas, a disc replacement will not lead to adjacent level degeneration and therefore reduces the risk for additional surgery in the future. Many of our cervical and lumbar disc replacements can be done in an outpatient surgery center, allowing the patient to go home the same day. Therefore, a disc replacement allows for fewer hospital stays and reduces healthcare costs as well.
A TDA only requires a soft cervical collar for 2 weeks or no bracing at all for the lumbar spine. A disc arthroplasty also has less risk for hardware malfunction, again decreasing the risk of further surgery.