Neck and back pain can make following your routine challenging. While the discomfort can improve over time, it might require disc replacement surgery if the condition persists. Disc replacement is a new surgical procedure involving removing the damaged disk and replacing it with an artificial one. While the procedure is safe, it has potential risks like excessive bleeding, allergic reactions to the medical device, and infections. In this article, LAMIS Institute, a seasoned practice in Los Angeles, explores the different disc replacement alternatives to assist you in weighing your treatment options.
What is Disc Replacement?
You can consider disc replacement if you suffer from chronic pain due to degenerative disc disease (a disease of intervertebral discs and the spine) that does not respond to non-surgical therapy and medication.
However, only some qualify for disc replacement. An ideal candidate should be:
- Between ages 18 and 60 and
- Suffering from degenerative disc disease at one or two levels of the spine that has not responded to more than six months of conventional treatment
Scoliosis, spondylolisthesis, and spinal stenosis patients are not eligible for the surgical procedure. Also, people with osteoporosis may not have robust adequate bone to support the disc replacement.
Generally, candidates for the surgery have the characteristics below:
- Suffering from back pain due to at least one arthritic intervertebral disk
- Body size that is not obese
- No facet joint condition or bony compression on spinal nerves
- No previous major lumbar spine surgery
Before the disc replacement, your competent surgeon should perform many tests to determine whether this is the best treatment option for your health condition.
What Happens During the Surgery
Before the procedure, tell your physician about all your medications, supplements, herbs, and vitamins. Some drugs may affect your healing or cause blood clothing, so you should stop taking them beforehand.
Your doctor might instruct you not to drink or eat anything before the surgical procedure. You will also remain admitted to the hospital for a couple of days. Finally, you will require assistance at home with activities like shopping, grooming, cleaning, and bathing, so make arrangements for this ahead of time.
Here is what to expect with disc replacement:
- Your surgeon will put an intravenous (IV) line into a vein in the arm or hand through which they administer general anesthesia. The anesthesia will put you to sleep and prevent you from feeling pain during your procedure. You will be lying on the back.
- Next, the physician will make a small incision in the abdomen and move your blood vessels and organs to the side to access the spine.
- The doctor will remove your damaged disc and replace it with an artificial disc. Then they will put your blood vessels and organs back in place before closing the incision.
- The nurses will take you to a recovery section for monitoring and observation until you wake from the general anesthesia. You will have the IV line and probably a catheter in the bladder. Once you are awake, they will take you to a hospital room.
Some disc replacement devices have the nucleus of the intervertebral disc and annulus (outer ring). However, this technological advancement is in the investigative stage.
On the other hand, total artificial disc replacement substitutes for the nucleus and annulus with a mechanical device that stimulates spinal fusion.
While there are different types of disk designs, they all reproduce the function and size of the standard intervertebral disk.
Your doctor should guide you on the best disk design.
Typically, you will be in the hospital for one to three days after the procedure. The length of the stay depends on how well you manage the pain and your return to normal function.
You can walk after the initial day following the surgery. Since bone fusion is not needed during the treatment, patients are encouraged to move through their midsection. Early motions in your trunk area can result in quick recovery and rehabilitation.
You should avoid jarring motions or activities until you have fully recovered. Moreover, discuss with your doctor about:
- Instructions to follow following the surgery
- Signs of issues to watch out for
- What to do and avoid
- When to consult the physician
Risks and Complications
Like any surgical procedure, disc replacement has potential risks like:
- Infection of your artificial disk or the area surrounding it
- Dislodging or dislocation of your artificial disk
- Implant fracture or failure
- Implant wear or loosening
- Blood clots in the legs due to decreased activity
- Rigidity or stiffness of your spine
- Challenges due to a poorly positioned implant
- Narrowing of your spine due to spine bones breakdown
Stem Cell Therapy
Stem cell therapy is a regenerative medicine approach that targets the root cause of your pain without surgery, prolonged recovery duration, or medication. The outpatient procedure uses your body’s healing ability to regenerate damaged tissues, heal injuries, and reduce chronic pain by acting as an anti-inflammatory agent on damaged tissues.
Your doctor can harvest stem cells from any part of your body. Although the hip bone is the most typical area for harvesting stem cells, many back pain procedures will cultivate them from the bone marrow.
A centrifugal machine will process the stem cells to create bone marrow aspirate concentrate. The compound contained the required stem cells to enhance growth factors and growth factor-rich platelets to rebuild damaged tissues. The cells work together to cause an immunomodulatory and anti-inflammatory effect, relieving pain. After the stem cells are ready, the medical expert will inject them into your affected area.
Your physician can also harvest stem cells from fat cells using liposuction.
Typically, the cells are administered via intra-articular or intramuscular injections, though your doctor can administer them intravenously. Stem cell therapy neither requires anesthesia nor an inpatient hospital admission.
Some of the back-related disorders relieved by stem cell therapy include:
- Orthopedic conditions
- Degenerative disc disorder
- Disc herniations
- Sacroiliac joint dysfunction
- Pinched nerves or radiculopathy (Irritation or damage of the nerve roots that exit your spine)
Stem cell therapy is a perfect disc replacement alternative because:
It offers quick recovery time, and you can quickly return to your life without requiring significant downtime.
Since stem cells help your body regenerate and target the source of your pain, they can effectively offer lasting relief for the underlying condition instead of only alleviating your symptoms.
Stems cells are administered through intravenous routes or injection and do not require anesthesia, making the procedure ideal for patients looking for non-surgical treatment options.
A spinal fusion is a surgical procedure that reconnects more than one vertebrae. The fusing of the vertebrae keeps them from moving out of place, which is the cause of discomfort and back pain.
Before the surgery, your orthopedic surgeon will take you through the details of the procedure and address your concerns and questions. They will also conduct tests to determine whether you qualify. Even if you are suffering from a condition treatable by spinal fusion, the following factors can lower the success rate of this treatment option:
- Being a smoker
- Suffering from arthritis in your back
- Being obese
During the surgery, the doctor will make an incision in your back and move muscles to the spine, exposing your spine. The joints between your vertebrae are removed to loosen them up. Then the vertebrae are roughened up, allowing your body to respond by producing another bone. Eventually, the new bone bridges the gaps between your vertebrae, making them fuse. Surgeons use metal implants like rods and screws to hold the spine in place as the vertebrae fuse.
The fusion is augmented with bone graft. It can be acquired from your body (autogenous) or a bone bank (allogenous). The benefits of bone harvested from your body are quick integration with the vertebrae and safety.
The surgical process takes approximately four to six hours, depending on the patient’s needs and condition.
Some of the potential complications of the surgery include:
- Nerve injury
After the surgery, the doctor will take you to a hospital room to observe your response to medication. A physical therapist can help you walk after surgery.
Before discharging you, the surgeon will perform an x-ray to ensure you are okay.
It would help if you did not disturb the dressing on your wound until your follow-up appointment unless there are concerns about your injury. Limit your activities to those of daily living and avoid strenuous physical activities.
Spinal Fusion vs. Disc Replacement
Spinal fusion aims to correct spinal deformities by fusing at least two vertebrae to enhance stability and reduce motion that could lead to pain. The process involves removing the damaged disc and replacing it with a bone graft, stimulating bone growth during the procedure.
On the contrary, disc replacement is identical to joint replacement. The procedure involves removing and replacing the damaged disc with an artificial one. It preserves your spine’s mobility. While these two surgical procedures have similar goals, they are different. Disc replacement is a newer approach but with many benefits than spinal fusion.
The adjacent bones joined together in the spinal fusion eliminate all spine movement. In other words, it can alter how the spine moves, adding more pressure on your adjacent joints. Other challenges with this procedure include the following:
- Loss of range of motion
- Back stiffness
By fusing your spine, segments below and above the fusion are at risk of increased stress and can result in adjacent disc challenges in the future.
Intradiscal Electrothermal Therapy (IDET)
Intradiscal electrothermal therapy is another disc replacement surgery alternative recommended if:
- Your doctor believes your chronic lower back pain originates from your disc, and
- Other treatment methods have failed.
Your intervertebral disc has tiny pain-sensitive nerves. When it is diseased, the nerves increase in number. Also, the synapses, small gaps between nerves where nerve impulses are transmitted, increase the pain.
Ideal candidates for IDET are patients diagnosed with discogenic lower back pain. However, not every spine pain is discogenic. The procedure is inappropriate for patients with back pain due to severe arthritic disease or spondylolisthesis.
How the Procedure Works
Your physician will insert a tiny needle through your skin, to your spine’s side, at the level of your diseased disc. They will advance the needle until its tip reaches the disc’s nucleus pulposus (center).
Then they will pass a catheter using the needle to the disc between your annulus fibrosus and nucleus pulposus. The doctor will use opaque markers to enable them to place the catheter in the preferred location.
The wires in the catheter heat the disc until the disc tissue adjacent to the catheter tip melts (denatures). As a result, it:
- Deactivates the nerve tissues within your disc
- Seals the rents and tears in your outer annulus fibrosus
Risks of IDET
All spinal procedures are surgical regardless of whether minimally invasive or performed open. That means the IDET procedure also risks nerve injury and infection in your intervertebral disc.
Luckily, there are ways to prevent these risks. The operating team should pay attention to sterile techniques to avoid disc infection. Medical experts should also use C-arm fluoroscopes (special imaging tools) to help guide the catheter.
Why IDET is a Better Disc Replacement Alternative
IDET is a minimally invasive procedure, so its recuperation period is short. Also, your disc is repaired mechanically, like a parched tire, lowering the possibility of re-herniation.
Laminectomy is a disc replacement alternative that creates space by removing tissues and bone spurs linked to spine arthritis. It also involves removing ligaments and bone spurs pressing on nerves.
Before the procedure, your surgeon will guide you on how to prepare during your initial consultation. Here is what to do:
- Avoid drinking or eating anything before the procedure
- Put on loose and comfortable clothes
- Carry your insurance details
- If your surgeon believes you might return home the same day, carry a person to drive you home
On the day of the procedure, the medical staff will take you into a private room and ask you to change into loose-fitting clothing. The anesthesiologist and surgeon will examine you before taking you to the operating room.
The procedure is performed with mechanical ventilation and general anesthesia, and here is what to expect:
- The anesthesiologist will first place a mask with anesthetic gas and oxygen over your face. They will also administer medications via the veins to assist you in relaxing. After a couple of breaths, you will be unconscious.
- Then the professional will insert a tube via the vocal cords and mouth into your trachea (windpipe). It is known as intubation. During the procedure, a ventilator will pump air in and out of the lungs.
- Next, the doctor will roll you with your face facing down, providing access to the back.
- Your surgeon will make a small incision in your skin over your affected area. They will pull soft tissues and muscles around your spine aside, exposing your spine.
- Then the physician will cut away ligaments, bone, and bone spurs compressing your nerves. It is called decompression. Your physician can choose to remove a considerable portion or part of many spinal bones, depending mainly on why you are undergoing surgery.
- Finally, the surgeon will stitch your wound, turn you over, turn off the anesthesia, and remove your breathing tube.
The doctor will take you to a post-operative room for close observation and monitoring of your vital signs. It is possible to be awake but sleepy for hours after the surgery. You can remain admitted to the hospital for a day or two.
It is normal to experience substantial pain that requires medication. You should not drive while taking the medication. While you can operate your car for a week, your physician should tell you when it is safe to get back on the road.
You should limit activities that involve lifting, stooping, or bending. Also, avoid long car rides or plane flights. They can result in blood clots in the legs.
Your recovery duration depends on your surgery degree and personal situation.
Spinal surgery once involved huge incisions, painful rehabilitation, and a long recovery. Fortunately, a disc replacement surgery alternative like microdiscectomy has enhanced the treatment.
Microdiscectomy is also known as microdiscectomy or micro-decompression. It is a minimally invasive procedure ideal for patients suffering from a herniated lumbar disc. Sciatica is a painful disease due to spinal nerve compression, often resulting in a herniated lumbar disc. When the hernia develops and damages tissue in your spinal column, it pushes on your nerves, causing your nerves to send pain signals to your brain. The brain interprets the pain as stemming from your legs.
How Microdiscectomy Surgery is Performed
The treatment involves removing parts of the herniated disc to relieve pressure on your spinal nerve column.
The surgical procedure is performed under general anesthesia while lying face down. It involves the following steps:
- The surgeon will make a one-inch incision over your affected disc. They will use a lighted microscope to help them see your affected region.
- The physician can remove the bone part protecting your root nerve. Then they will use a scissor-like tool to remove your damaged herniated tissues, relieving the pressure on your nerves.
- Finally, they will close the incision with sutures.
While microdiscectomy is a safe treatment option, like most surgical procedures, it has the following risks:
- Nerve root damage
- Dural tear
- Bladder or bowel incontinence
- Recurring disc herniation
How Much Does Microdiscectomy Cost?
The procedure is specialized and requires highly-trained and experienced medical experts. Consequently, it can be more high-end than many disc replacement alternatives. Its cost range between $15,000 and $50,000. Please note this price is exclusive of follow-up care and doctor’s visits.
Your health insurance coverage can cater to a significant part of the expense after paying your coinsurance and deductible.
Anterior Cervical Diskectomy and Fusion (ACDF)
ACDF is an ideal disc replacement alternative with a 73% to 83% success rate on patients experiencing neck pain. It involves removing damaged bone spurs and disks in the neck.
Generally, the procedure takes one (1) to four (4) hours, depending on how many disks are removed and your condition.
The surgery is commonly used for:
- Removing a disk in the spine that is injured or worn down
- Removing bone spurs on the vertebrae that pinch the nerves. Pitched nerves can result in weakness or numbness in your legs. Therefore, treating the compressed nerves in the spine can alleviate weakness or numbness.
- Treating your slipped disk (herniated disk)
To perform the surgery, the professional will:
- Make a tiny incision on your neck’s front
- Move your trachea, esophagus (food pipe), and blood vessels aside to access the vertebrae.
- Identify your affected nerves, disks, or vertebrae and take an x-ray of the region.
- Use tools to take out the damaged disks or spurs or push pain-causing nerves
- Take a bone harvested from your body from a donor, or use a synthetic compound to fill the space left behind by your removed bone material.
- Attach screws and a plate to the two (2) vertebrae where the surgeon removed your disk
- Return your trachea, food pipe, and blood vessels to their normal position before closing the incision with stitches.
ACDF vs. Disc Replacement
Some advantages of ACDF over disc replacement include the following:
- Treats a broader range of patients — Most patients qualify for anterior cervical discectomy and fusion compared to artificial disc replacement. They include patients with cancer, prior neck surgery, poor bone quality, and facet joint degeneration.
- Although insurance providers are increasingly covering disc replacement when considered medically essential, ACDF is more insured.
- Disc replacement is more complicated and has fewer physicians qualified for it than anterior cervical discectomy and fusion. If the artificial disc is wrongly implanted or the incorrect size, it can lead to complications like pain and the need for a revision surgical procedure.
- Doctors have used ACDF for many years, and a lot of data is available about its long-term efficacy and safety. As a newer medical technology, one risk about risk replacement is not knowing how durable the artificial disc is.
Find a Knowledgeable and Qualified Spine Surgeon Near Me
Disc replacement is a new procedure with promising results that relieves patients frustrated by constant back discomfort, improving mental and physical health. However, the approach comes with risks like infection of your artificial disk or the area surrounding it, dislodging or dislocation of your artificial disk, implant failure, implant wear or loosening, spine rigidity, and blood clots in the legs. The development of disc replacement alternatives allows you to achieve the same goals with fewer complications.
Here at LAMIS Institute, we understand that back and neck pain can be debilitating and treat all patients with the utmost care and compassion. Call us at 310-734-6088 to schedule your consultation, and our skilled Los Angeles surgeons can bring our knowledge and experience to help you choose the best treatment option for your condition.