I frequently discuss treatment options for debilitating neck and back pain caused by a variety of spinal conditions, including degenerative disc disease (DDD). Artificial disc replacement (ADR) is a promising potential alternative to traditional spinal fusion surgery for DDD, but it’s crucial to understand that ADR isn’t necessarily suitable for everyone. In this blog, I’ll delve into the characteristics of the ideal candidate for artificial disc replacement surgery while offering insights from my perspective as a spine surgeon.
Understanding the Goal: Restoring Function and Reducing Pain
The primary aim of ADR is to alleviate pain and other symptoms stemming from damaged spinal discs, all while preserving the patient’s spinal range of motion. Unlike spinal fusion, which eliminates movement between vertebrae, ADR aims to mimic the natural function of a healthy disc. The preservation of vertebral motion is a key advantage of ADR, potentially reducing the risk of accelerated degeneration in adjacent discs, a common long-term complication of fusion. This restoration of function and reduction of pain can bring a new sense of hope and optimism to patients. However, to reap these benefits, patients must be carefully selected.
Key Criteria for the Ideal ADR Candidate:
The ideal candidate for ADR typically exhibits a combination of specific characteristics:
- Symptomatic Disc Disease: This is the most fundamental requirement. Patients should have significant chronic pain, numbness, tingling, or weakness demonstrably linked to a damaged disc. These symptoms should be resistant to previously attempted conservative treatments, such as physical therapy, medication, injections, and lifestyle modifications, for a reasonable period (often several months). ADR isn’t recommended for patients with minimal or manageable symptoms or for those who have not already attempted some form of conservative treatment.
- Single-Level Disc Disease: ADR is most performed for single-level disc problems, meaning only one vertebral disc is affected. Most recently, the FDA has approved the use of ADR for multi-level disc disease in patients who meet specific criteria. We have gained valuable experience and achieved success in deploying ADR for patients with multi-level disc problems and are excited about the clinical outcomes we have achieved.
- Relatively Healthy Spine: The overall health of the spine is crucial. Patients with significant arthritis in the facet joints, spinal stenosis (narrowing of the spinal canal), or significant spinal deformities may not be ideal candidates. These conditions can compromise the stability and function of the artificial disc, potentially leading to less favorable outcomes.
- No Spinal Instability: The spine must be stable enough to support the artificial disc. Conditions like spondylolisthesis (where one vertebra slips over another) or significant ligament laxity can create instability, making ADR less suitable. Fusion is often preferred in cases of spinal instability.
- Healthy Bone Quality: Adequate bone density is essential for successful ADR. The artificial disc needs to be securely anchored to the vertebral bodies. Patients with osteoporosis or other conditions affecting bone health and quality may have an increased risk of complications, such as disc subsidence (where the disc sinks into the bone).
- Neurological Function: While ADR can address nerve compression caused by a damaged disc, the severity and duration of nerve compression play a role. Patients with long-standing, severe neurological deficits may not experience complete symptom resolution after ADR. A thorough neurological evaluation is crucial to assessing the potential for successful recovery.
- Psychological Readiness: Undergoing any surgical procedure is a significant decision. Patients should have realistic expectations about the procedure’s potential benefits and limitations. Patients should also be psychologically prepared for the recovery process, which can take time and require dedication to rehabilitation.
- Overall Health: Patients should be in relatively good overall health to minimize the risks associated with any type of surgery, including ADR. Pre-existing medical conditions, such as uncontrolled diabetes or heart disease, can increase the risk of surgical and post-surgical complications.
The Importance of a Thorough Evaluation:
Determining candidacy for ADR requires a comprehensive evaluation by a qualified spine surgeon. The evaluation typically involves reviewing medical history, physical examination, imaging studies (such as X-rays, MRI, and CT scans), and neurological assessment. The surgeon will carefully analyze these factors to determine if ADR is the most appropriate treatment option.
Shared Decision-Making:
The decision to undergo ADR should be shared by the patient and the surgeon. This collaborative approach empowers patients, giving them a clear understanding of the procedure, its potential benefits and risks, and the recovery process. Open communication with the surgeon is crucial to ensure that the patient’s goals and expectations are aligned with the potential outcomes of ADR. This shared decision-making process ensures that the patient is fully involved in their treatment, leading to a more positive experience.
Artificial disc replacement can be a life-changing procedure for the right patient. The ideal candidate is someone with symptomatic, single-level disc disease, a relatively healthy spine, adequate bone quality, and realistic expectations. A thorough evaluation by a qualified spine surgeon is essential to determine candidacy and ensure the best possible outcome. Remember, the goal is not just to replace the damaged disc but to restore function, reduce pain, and improve the patient’s overall quality of life.
Sources:
https://www.hss.edu/condition-list_disc-replacement.asp
https://www.yalemedicine.org/conditions/artificial-disk-replacement
https://my.clevelandclinic.org/health/treatments/16758-cervical-artificial-disk-replacement
