Artificial Discs: A Revolutionary Spine Replacement Surgery

 

Artificial Discs

Degenerative disc disease is a condition that affects the soft, cushion-like discs located between the bones (vertebrae) of the spine. As we age, the discs start to break down and lose their flexibility and shock-absorbing capabilities. This leads to back pain and stiffness. Traditionally, fusion surgery has been used to treat severe and persistent back pain caused by degenerative disc disease. However, artificial disc replacement offers an alternative to fusion that aims to preserve motion in the spine.

What are Artificial Discs?

Artificial discs, also known as lumbar disc arthroplasty, involve surgically removing the damaged disc and replacing it with an artificial disc made of metal and plastic components. The artificial disc aims to mimic the cushioning and movement of a natural disc. There are several artificial disc designs available from different manufacturers that have different metal endplates and plastic or rubber centers. The goal is to restore height to the disc space and allow for continued movement at that spinal level.

Advantages over Fusion Surgery

Fusion surgery fixes the spine into place by combining two or more vertebrae with bone grafts and plates. While this stops pain from disk motion and reduces pressure on nerves, it eliminates flexibility and puts more stress on adjacent spinal levels over time. Artificial discs aim to avoid these long-term problems by:

- Maintaining mobility and flexibility at the treated spinal level instead of fusing it.

- Reducing further degeneration of nearby discs which have to compensate for the fused level.

- Relieving pressure on facet joints that bear extra load after fusion.

Surgical Technique

The artificial disc replacement surgery is performed under general anesthesia. Using scans as a guide, a small incision is made in the lower back. The damaged disc is removed using surgical tools. Endplates are then secured to the vertebrae above and below using screws or teeth. Finally, the artificial disc, consisting of metal plates and a plastic cushion, is inserted into the disc space. Surgery typically takes 1 to 2 hours for an artificial disc replacement versus 2 to 4 hours for a fusion.

Outcomes and Effectiveness

Long-term studies show artificial discs can significantly reduce back and leg pain in appropriately selected patients. Success rates for pain relief are equivalent to fusion surgery. Additionally, artificial discs allow for quicker recovery time and faster return to normal activities compared to fusion. While artificial discs don't entirely mimic natural disc motion and some loss of movement still occurs, preserving mobility reduces stress on nearby joints. Complications are low but include risks inherent to any spine surgery like infection, nerve injury, blood vessel damage and implant failure or migration over time.

Patient Selection and Contraindications

Not all patients are good candidates for Artificial Disc replacement. Surgeons carefully screen patients to evaluate if their anatomy, severity of disease and lifestyle are suitable. Ideal patients are younger (under 60), have disc degeneration affecting just one level, and are in good overall health. Factors that increase risks include multiple level disease, obesity, smoking, osteoporosis or instability. Contraindications include spinal deformities, tumors or fractures. Patients with certain occupations requiring heavy lifting may be advised to consider fusion instead.

Future Outlook and Research

As artificial disc technology improves and longer-term outcome data emerges, disc replacement may become a preferred option over fusion for most patients undergoing single level lumbar replacement. Newer disc designs with advanced materials aim to replicate natural disc mechanics even better. Tissue engineered and stem cell-based discs hold promise for the future. However, fusion will likely still be needed for multi-level cases or when other problems like instability are present. Ongoing research seeks to extend the benefits of motion preservation to more complex cases and older patients.

While not for everyone, artificial discs represent an exciting advance in spine surgery that aims to overcome long-term limitations of fusion. For appropriately selected patients, disc replacement surgery offers a way to dramatically reduce back and leg pain while preserving flexibility and avoiding additional stresses on the spine. As technology and surgical techniques continue to progress, artificial discs may become a standard treatment option for degenerative disc disease. With continued study, this innovative motion preservation approach aims to transform spine care.

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