Individuals with degenerated discs in the lower (lumbar) spine may suffer from chronic low back pain. Most patients with symptomatic degenerative conditions in the spine are treated non-surgically with anti-inflammatory medications, physio therapy and corticosteroid injections. Many of these patients have a positive response to non-surgical methods of treatment, but there are a number of patients who continue to experience “chronic” and disabling pain that may interfere with the patient’s ability to work.

Artificial Disc Replacement Surgery

The spine is a column that is made of up bones and discs. The blocks of bone (or vertebrae) provide the anterior support and structure of the spine. Posteriorly, the two facet joints at each level provide stability and movement of the motion segment. The spinal discs are in between the bones and act like a cushion or “shock absorber” between the vertebrae and also contribute to the flexibility and motion of the spinal column.

Cervical Pain

In the case of a degenerative disc, the inner jelly material can bulge out and press up against the annulus fibrosus. This can stimulate the pain receptors causing back pain to occur. The cracks or tears that develop within the annulus fibrosus can also become a source of pain. Back pain that is caused by the spinal disc is often referred to as discogenic low back pain.

The purpose and advantage of artificial disc replacement is to replace the worn out disc, while preserving the motion at the operated spinal level. This could potentially not only treat the underlying back pain, but also protect patients from developing problems at an adjacent level of the spine.

An artificial disc is a three-piece device consisting of a sliding core sandwiched between two metal endplates. The sliding core is made from a medical grade plastic and the end plates are made from medical grade cobalt chromium alloy. These materials usually do not harm the human body and are used in other medical implants. The implant is designed to move like a normal disc, thereby maintaining the desired flexibility of the spine.

The unhealthy disc is completely removed in order to implant the new artificial disc.

A relatively small incision in the abdomen is made usually below the belly button. The abdominal organs are then gently moved to the side so that the surgeon can visualize the spine while protecting important anatomic structures. This part of the surgery is usually done by a general surgeon or vascular surgeon with the appropriate skills.

• The spine surgeon then removes the patient’s collapsed, degenerated disc.
• The Artificial Disc is then implanted - first the two endplates, then the core in the middle, using specialized instruments. The two endplates (made of a cobalt chromium alloy) are pressed into the vertebrae above and below the disc space and teeth along the border of the endplate grip the vertebral bone. A polyethylene core is then placed between the endplates
• The artificial disc is designed to be held in place by the spinal ligaments and the remaining part of the annulus of the disc as well as the compressive force of the spine. Bending X-rays of patients after the surgery show that the motion of the artificial disc (flexion, extension, side bending and rotation) can closely approximate the normal motion of a healthy disc.

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