Artificial disc replacement is a modern option for treating spinal pain and is gaining popularity due to its promising results in improving mobility and relieving pain, making it the focus of attention for doctors and patients alike. With the advancement of technology and the variety of options available, many consider it to be an effective alternative to traditional surgeries.
Statistics indicate that between 5% and 10% of spine surgeries in Europe are performed using the disc replacement technique, while in some developed Asian countries such as South Korea and India, the percentage reaches about 12%, and these percentages are expected to increase in the coming years due to its positive results and short recovery period, as this growth reflects the increasing confidence in the surgery by patients and medical staff around the world.
What is artificial disc replacement, and why is it performed?
Artificial disc replacement is an operation aimed at treating vertebral issues that result from wear or damage to the cartilaginous discs located between the bones of the spine, these discs act as flexible cushions that help absorb shocks and give the spine its ability to move and bend, but with age or as a result of chronic stress or injuries, these discs may lose their elasticity and begin to wear out and this leads to severe pain in the back or neck and may extend to the arms or legs later.
Artificial disc replacement comes as an advanced medical solution in these cases, where the damaged disc is precisely removed and replaced with an artificial disc made of strong and compatible materials, where this disc is designed to perform the function of the natural disc in terms of support and movement, which relieves pain and allows the patient to regain his daily activity gradually. This type of surgery is usually performed after other treatments, such as medications and physical therapy, have failed, and doctors carefully choose this solution after careful evaluation of the patient’s condition.
Materials used in industrial tablets
Artificial disc replacement uses artificial disks composed of a combination of metals and medical plastics, designed to mimic the function of a natural disk. Titanium or cobalt chromium alloys provide rigidity and support, while the moving surfaces are covered with high-density polyethylene, a flexible plastic that absorbs shock and facilitates movement. This configuration in artificial disc replacement helps maintain spinal flexibility, reduces friction and wear, and ensures a perfect fit of the disc in place.
Artificial disc replacement surgery steps
Artificial disc replacement surgery is a delicate procedure used to treat cases where conservative treatment fails, such as chronic painful herniated discs, and of course the source of pain must be ascertained before operating, as many confuse herniated discs with sciatic neuritisand ankylosing spondylitis, especially in the early stages, this operation aims to remove the damaged disc and replace it with an artificial disc that maintains the flexibility of the spine and relieves pressure on the nerves, these are the most important steps the surgeon follows while performing this type of operation:
Pre-operative preparations
Before entering the operating room, the patient undergoes final examinations, including radiographs (such as an MRI or CT scan) to determine the exact location of the damaged disc. The patient is asked to fast for certain hours before surgery, and the medications they are taking are reviewed to avoid complications from anesthesia or bleeding.
General anesthesia
At the start of the procedure, the patient is given general intravenous anesthesia so that they are completely asleep and do not feel any pain during the procedure, and their vital signs are monitored throughout by the anesthesia team.
Making the incision and accessing the spine
In cases of the neck (cervical vertebrae): A small incision is made in the front of the neck (usually on the right side) and the skin, muscles, and blood vessels are gently mobilized to access the spine.
In lower back (lumbar) cases: The incision is made in the abdomen, and the anterior organs are gently moved under the guidance of a general surgeon to aid safe access to the spine. This “anterior” approach allows the surgeon to stay away from the spinal cord.
Removing the damaged disk and compressive tissue
Once the affected disc is found, it is completely removed using precision instruments, and any bone spurs or decaying tissue that may be pressing on the nerves are removed to free the nerve roots and prevent continued pain.
Prepare the paragraphs and adjust the distance between them
After the disc is removed, the bony surfaces of the neighboring vertebrae are cleaned to prepare them to receive the implant, where special tools are used to determine the ideal distance between the vertebrae, which ensures the return of the natural curvature of the spine.
Artificial Disc Implant
The surgeon gently inserts the artificial disc into the prepared space using precise guidance tools. The disc is usually made up of metal and plastic layers designed to mimic the natural movement function of the spine. Radiography is used in the operating room to ensure proper and accurate placement of the implant.
Closing the incision
After making sure the artificial disk is stabilized, the incision is closed with several layers of muscle and then skin using medical sutures or surgical adhesive, a bandage is applied, and the patient is transferred to the recovery room for monitoring during the first few hours after surgery.
What are the possible complications of artificial disc replacement surgery?
- Infection and Bleeding: As with most surgeries, there is a possibility of infection or bleeding during or after surgery.
- Reactions to anesthesia: Some patients may experience adverse reactions as a result of the general anesthesia used during the procedure.
- Failure or movement of the implant: In some cases, the implant may not stabilize properly, causing it to move or fail to function.
- Abnormal bone growth (abnormal ossification): Bone tissue may form in unwanted places, reducing the flexibility of the spine.
- Nerve injury: There is a rare possibility of injury to surrounding nerves during surgery, which can lead to weakness or numbness in the limbs.
- Difficulty swallowing or speaking: Especially in neck surgeries, the patient may experience temporary difficulty swallowing or a change in voice.
There are factors that increase the risk of complications:
- Smoking: Increases the likelihood of complications such as infection or implant failure.
- Presence of chronic diseases: Osteoporosis or arthritis may affect the success of the surgery.
- Previous surgeries in the same area: May increase the complexity of the procedure and the likelihood of complications.
Who is not suitable for artificial disc replacement?
- Degenerative joint diseases: Such as rheumatoid arthritis or severe facet arthritis.
- Curvature of the spine: Such as kyphosis and scoliosis.
- Bone diseases: Such as severe osteoporosis.
- Infection: There is an active infection in the spine or in surrounding tissues.
- Allergies: Sensitization to metals or materials used in the tablets.
- Obesity: It can affect the outcome of surgery and recovery.
- Chronic diseases: Such as severe heart or lung disease.
- Previous surgeries: Having previous spinal surgeries may affect the success of the procedure.
What are the benefits of artificial disc replacement compared to spinal fusion?
Maintaining normal spinal mobility
Artificial disc replacement: This surgery enables the movement of the affected vertebra to be preserved, as the artificial disc functions like a natural disc in terms of absorption, shock absorption, and movement. Artificial disc replacement prevents spinal stiffness and maintains flexibility, especially in the neck and lower back.
Fusion of vertebrae: Permanent stabilization of two or more vertebrae leads to a loss of normal movement in that part of the spine and may result in stiffness or limited movement.
Rapid recovery and rejuvenation
Artificial disc replacement: Most patients show faster improvement after surgery and are able to return to daily activities within 4 to 6 weeks, as no bone healing is required, unlike in spinal fusion.
Fusion of vertebrae: It takes several months for the fused bones to heal, sometimes more than 6 months, and the patient should avoid movements and activities that may affect the fusion of the vertebrae.
Reduce the risk of injury to neighboring vertebrae
Artificial disc replacement does not cause changes in motion or loading on neighboring vertebrae, minimizing the development of issues over time. Maintaining the spine’s natural motion mechanics protects the remaining vertebrae.
Fusion of vertebrae: This increases the mechanical stress on the upper and lower vertebrae of the fused vertebrae, increasing the likelihood of future damage to the vertebrae, known as paravertebral degeneration.
Patient satisfaction and long-term results
artificial disc replacement: Numerous studies and medical reviews have shown that patients experience a significant improvement in quality of life after surgery with a reduction in pain, restoration of normal activity, and a higher satisfaction rate compared to spinal fusion.
Vertebral fusion: Although pain may improve, mobility restrictions and a long recovery period may reduce satisfaction for some patients, especially those who are young or have an active lifestyle.
The need for future surgeries
artificial disc replacement: Considered a long-term option, especially for younger patients, because the procedure preserves normal motion, there is less chance of future issues with other vertebrae and less likelihood of needing additional surgeries.
Fusion of the vertebrae: The likelihood of needing subsequent surgeries as a result of erosion of neighboring vertebrae or failure to properly heal the bone fusion increases, which can happen quite a bit, especially in people who are athletically active.
Comparison of available types of synthetic tablets
Prodisc C Nova disk
Based on a fixed ball joint design featuring a titanium alloy end plate with a cobalt-chromium alloy insert and a polyethylene inner layer, this disc is designed to maintain the spine’s natural range of motion.
M6-C disk
It has a flexible polymer core and titanium end plates with a polyethylene outer layer, similar to the movement of a normal Zephyr shock absorber, and an outer shell to prevent the entry of debris. All sources confirm that this is the best type of disk.
Simplify disk
Consisting of PEEK plates and a zirconia-reinforced ceramic core, it has a three-part semi-constrained design that provides a 12-degree range of motion and is safe for MRI.
Mobi-C disk
It uses a hydroxyapatite-coated metal plate with a polyethylene plastic core, features a movable bearing system that allows the core to slide and rotate, and is approved for one or two-level cervical spine replacements.
Prestige LP
Made from a titanium-ceramic composite, it has a ball joint that allows for a variable center of rotation that reduces wear over time and noise in MRI images.
Prodisc-L disk
Designed for lumbar vertebrae and consisting of cobalt-chromium alloy plates and a polyethylene inner layer, it is a fixed ball joint design, used to replace one or two levels.
ActivL disk
It consists of cobalt-chromium plates with a titanium coating and a polyethylene core, featuring a movable joint that allows movement in all directions, used for one level at L4-L5 or L5-S1.
Recovery period after artificial disc replacement
After artificial disc replacement, the patient stays in the hospital for one to two days and is encouraged to walk for the first 24 hours after the operation, during the first weeks the patient is advised to avoid bending, lifting weights or sharp turns and can gradually resume simple daily activities in two to six weeks.
After artificial disc replacement, the doctor may recommend the use of a support belt for the back or neck, depending on the location of the surgery and the patient’s condition. Painkillers and anti-inflammatories are also prescribed as needed, and he undergoes physical therapy sessions usually between the second and fourth weeks to improve mobility and strengthen the muscles supporting the spine.
The cost of surgery in Turkey and the reasons for its popularity
Turkey is one of the most prominent destinations for disc replacement surgery, with costs ranging from $5,000 to $8,000 and up to $13,700 in some centers. Due to the low costs compared to Western countries, the availability of internationally accredited hospitals and specialized doctors, the centers offer comprehensive packages that include accommodation, transportation, and care, making it a convenient and effective option for patients from Europe and Asia, especially with high success rates and patient satisfaction.
Artificial disc replacement surgery is an excellent and safe option for cases that have not responded to non-surgical treatment, as it helps relieve pain and maintain spinal movement. Although artificial disc replacement is not suitable for all patients, its success depends on accurate diagnosis and choosing the appropriate type of artificial discs. With the development of medical care and its availability in countries such as Turkey at reasonable costs, artificial disc replacement has become more accessible to those who need it.
Sources:
- Qureshi, S. A., McAnany, S. J., & Baird, E. O. (2019). Artificial disc replacement in spine surgery. Annals of Translational Medicine, 7(Suppl 5), S170.
- NHS. (2024, April 24). Slipped disc.
