As spinal structures degenerate, they may cause back pain or neck pain, limiting function and decreasing quality of life. Total disc replacement (TDR, also called artificial disc) surgery is one of the latest advancements in spine surgery. Replacing the disc removes the cause of pain while preserving natural motion.
Total disc replacement is recommended only after extensive conservative therapies have failed to significantly provide pain relief. The surgeon makes an incision in the front of the neck. The contents of the neck are gently retracted, enabling the front part of the spine to be seen. Fluoroscopy is used to determine the correct level(s) before the disc material is removed and the artificial disc is inserted.
Cervical Total Disc Replacement (TDR) is performed for the treatment of herniated disc, painful disc degeneration, radicular syndrome and other cervical spine problems.
First, in the cervical spine, it is used to treat herniations that are pinching the nerves, giving the patient neck, shoulder and arm pain. This is probably the most common problem we see, particularly in younger individuals. As we get older; however, sometimes bones spurs can pinch the nerve passage and these too, depending on the size of the bone spur, are treatable by disc replacement. The patient may experience in addition the pain, numbness and tingling, as well as weakness in a certain nerve distribution.
Generally it is done through a small incision that parallels the skin crease in the neck. It is not much longer than a 1 inch incision, and sometimes even smaller. Normally, you will feel some soreness in swallowing for a day or two, but the incisional pain quickly gets better because no major structures are cut other than the skin and a very thin muscle underneath the skin. All the dissection is carried out by following normal tissue plains, in a fashion we call blunt dissection. It is actually a very pretty operation for a surgeon to carry out because it is basically bloodless and we do not violate or injury the normal tissues.
After surgery most patients usually experience relief of their arm symptoms and their neck pain as well. However, we know from all the FDA studies that the patients will quickly improve and will continue to do well for as long as we have been following them, and now up to ten years. Right after surgery the patient will be placed in a soft collar and then are normally discharged within 23.5 hours, in some cases it may be the same day, or may spend the day overnight. Generally the soft collar is worn to protect the wound.
After the first visit at two weeks, the patient will start some general physical therapy. Because the disc replacement depends on the bone attaching to the prosthesis, the only restrictions we give the patient are to avoid hyperextension or looking up the ceiling and no impact loading such as running for the first 6 to 12 weeks, and certainly, we like the patient to lift no more than 10 pounds for the first 2 weeks. After the disc is attached to the vertebral bodies, your doctor may release you to full activities, and in general, we wait for the 3 month mark before we allow people to go back to sporting activities. One can certainly carry on normal activities from the time they leave the hospital to the 3 month mark.