The traditional surgical treatment for a damaged disc whether in the neck or lumbar spine is usually a lumbar fusion. In the right circumstances, this fusion whether with anterior cervical discectomy and fusion (ACDF) or a posterior lumbar interbody fusion (PLIF) is an excellent choice especially if done with a minimally invasive spine surgery (MISS) technique in an outpatient setting. These surgeries can relieve significant pain and allow patients to resume pain-free activities.
Recently, spine surgeons now have a new non-fusion treatment for patients suffering from both neck and back pain due to a damaged, painful disc. This new treatment is a disc replacement in which a damaged disc is removed and replaced with a mechanical device which replicates the natural movement of the lumbar or cervical disc. The benefits of a cervical total disc replacement (CTDR) or a lumbar total disc replacement (LTDR) is that by preserving motion has the potential of not placing additional stress on the adjacent undamaged discs.
Both CTDR and LTDR are placed from an anterior approach; that is, from the front of the spine, and in each case the damaged disc is removed and replaced with the disc replacement that fits in between the adjacent vertebral bodies. After surgery, early movement by the patient is encouraged. For patients who have both back/neck and leg/arm pain, they can expect to relieve of their symptoms since not only does the artificial disc support the adjacent vertebral bodies but also remove pressure from the pinched nerves.
The main concern about disc replacements is that like any mechanical device such as a knee or hip replacement it can wear out over time requiring the removal and another replacement. Additionally, not every patient with a damaged disc is a candidate for a TDR. In patients where the disc is too damaged and there is too much arthritis, a TDR is not a good option since the disc replacement will continue the movement of a painful joint. In these patients, a MISS cervical or lumbar fusion is a better option.