May 8, 2018
Degenerative disc disease usually causes strong or unbearable neck or back pain. Non-surgical spinal decompression, physical therapy and physiotherapy are the most commonly used treatments. However, surgery is required when these are not effective. The most commonly performed surgical procedures are lumbar or cervical fusion and fixation, but according to Doctor Clavel, Artificial Disc Replacement (ADR) surgery is a much better alternative, since it is less invasive.
What is degenerative disc disease and what are its symptoms?
Degenerative disc disease is the degeneration of one or several intervertebral discs due to aging or a severe injury. Fluid deterioration in the central part of intervertebral discs is caused by the rupture of continuous ligaments, and it can affect the cervical and lumbar regions of the spine. When untreated, this disease can evolve, causing more serious injuries such as bone spurs, tumors and herniated discs.
The first symptoms of this disease are usually numbness and a tingling sensation in legs or neck, which often lead to discogenic pain and disc bulging. Discogenic pain is the mechanical or structural pain caused by a damaged intervertebral disc. It occurs when disc degeneration causes the inner material of the disc to leak out, irritating the nerves adjacent to the disc or the spine and affecting its normal function. On the other hand, disc bulging occurs when the fibrous tissue surrounding the intervertebral disc weakens over time due to degeneration. If any pressure is exerted on the central core of the disc, it will extend beyond this outer edge.
Is artificial disc replacement the best treatment for degenerative disc disease?
Artificial Disc Replacement or ADR is a procedure used to replace degenerated lumbar or cervical discs with an artificial implant designed to mimic a healthy natural disc. Since joint movement is preserved, and therefore there are no immobilized vertebrae, ADR has some advantages over other procedures such as vertebral fusion. By maintaining segment mobility, the lower and upper discs do not undergo degeneration, so adjacent disc degeneration is prevented.
During ADR, prostheses are placed using an anterior approach. As a result, there is no need to open up the back muscles, so there is less immediate, and even medium and long term, postoperative pain. Most surgical procedures to treat degenerative discs, such as arthrodesis, fixation and fusion, require long back incisions, large muscle dissection and manipulation of nerve structures. All of which can lead to significant blood loss, nerve injuries, muscle atrophy and subsequent chronic pain.
With ADR, however, there is no need to manipulate or mobilize muscles or nerves, so there is less risk of injury. Furthermore, this kind of surgery does not require osteotomies to introduce the implants, which eliminates the risk of vertebral destabilization and large blood losses.
Risks and side effects of artificial disc replacement
Doctor Clavel is one of the best non-invasive spine surgeons in the world and a reference in ADR surgery. In his prestigious Center, he has been performing this procedure for more than 15 years, and states that ADR is a low-risk surgery, although sometimes there might be a few minor complications such as minor injuries to the abdominal vessels. However, this is a very rare complication, and it is easily resolved during surgery.
As for side effects, some patients may have residual low back pain after surgery due to mechanical stress on the interapophyseal joints (facets joints), which respond favorably to treatment with infiltrations or radiofrequency.
Prosthesis extrusion is extremely rare, and if necessary, can be easily solved by the placement of a new prosthesis.
Benefits of Artificial Disc Replacement
As opposed to open spine surgery, minimally invasive surgery approaches are faster and safer. Thanks to the minor damage of muscles and ligaments the main benefits of ADR are:
- smaller incisions and better healing
- less blood loss during surgery
- less cervical or lumbar muscle injury
- faster recovery
- almost no need for rehabilitation
- lower risk of infection during the intervention
- less postoperative pain
- less need for analgesics
Recovery is fast and easy, and patients are able to lead a completely normal life after surgery, including an early return to work. They can continue to practice sports or any other physical activities that they used to carry out before the procedure, and it is highly probable that they will not require further surgery. Moreover, the economic cost is lower than other spine surgical procedures such as arthrodesis or vertebral fusion.