Proceeding with artificial disc replacement surgery is a big step. It’s typically undertaken only after a thorough evaluation and in-depth conversations between the patient and their surgeon.
It’s important for patients to feel secure in their decision, to know what to expect with the surgery, and to understand how to best prepare for surgery, according to Dr. Jessica Shellock, a spine surgeon on the medical staff at Texas Health Center for Diagnostics and Surgery (THCDS) in Plano, Texas and co-director of the Center for Disc Replacement.
“It’s important to feel confident that you’re on the right path,” said Dr. Shellock. “The first question to ask: ‘Is disc replacement surgery right for me?’ Many factors go into the decision: the nature of your back condition or injury; your lifestyle, your age and overall physical health.”1
Often, Dr. Shellock sees patients who are considering two options: spinal fusion versus disc replacement.
Spinal fusion connects two or more vertebrae in the spine, fusing them together to immobilize the two bones, stabilizing the spine and alleviating pain. By contrast, surgical disc replacement involves removing the painful or damaged disc and replacing it with an artificial disc, a prosthesis that mimics the motion of a normal disc.
Patients often ask whether disc replacement is the superior procedure compared to spinal fusion.
“This is a question that deserves a little bit of explanation,” she said. “It's not a simple yes or no answer, because not everybody is a candidate for disc replacement. But if you are a candidate for both procedures, I would absolutely recommend artificial disc replacement.”2
Dr. Shellock notes that long-term data shows good outcomes with artificial disc replacement because the surgery allows the spine to move more naturally after surgery.
Spinal fusion surgery usually reduces or eliminates back pain but can lead to adjacent segment degeneration.
“Because the two fused vertebrae are immobilized, the adjacent vertebrae have to work harder,” she said. “Because they’re working harder, they wear out faster. And that increases the likelihood that over the next seven to 10 years, you may have an issue at one of those surrounding discs that could lead to another surgery.”
By contrast, with artificial disc replacement, the vertebrae adjacent to the implanted artificial disc don't have to work harder and shouldn’t wear out faster. That’s why, for patients who are candidates for either procedure, Dr. Shellock recommends artificial disc replacement.
“Artificial disc replacement decreases the long-term potential of needing additional surgery, and most patients enjoy a faster recovery after artificial disc replacement, compared to spinal fusion,” she said.3
For those patients who aren’t candidates for artificial disc replacement surgery, spinal fusion may be the right choice. Spinal fusion does help patients to get back to normal, pain-free living.
“Clinical data suggests that your improvement of the symptoms you came in with should be equivalent with spinal fusion and artificial disc replacement,” she said. “So, you will still do well with spinal fusion. You will still be able to improve the back or leg pain or neck or arm pain that you came in with. It’s just that spinal fusion does involve a longer recovery period, and patients may have the need for additional surgery down the road.”
Preparing for Surgery
For those patients who choose artificial disc replacement, it’s important to understand what the surgery involves and what to expect during recovery. Preparing properly helps ensure the best possible outcome.
“It’s very important to have a plan for how things are going to be after you come home,” said Dr. Shellock.
In most cases, patients at THCDS schedule a preoperative visit with their surgeon a few days before the surgery.
“You should use this opportunity to ask any last-minute questions that you have,” Dr. Shellock advises. “The goal is to make you feel less anxious about the surgery. No question is silly or stupid! Ask anything. Everybody's situation is a little different. And there may be factors that are specific to you or your home situation that you're worried about. Hopefully, we can answer those questions and help minimize any anxiety you may be feeling.”
Typically, patients will stop taking some or all their medications, particularly blood-thinning medications, for up to a week before surgery.
For artificial disc replacement in the cervical (neck) area, patients may be asked to shave the night before surgery.
“I want to make sure that the skin is prepped, clean and ready for surgery,” Dr. Shellock. “If you have a beard, you need to shave it. I've had many patients look at me very unhappily when I've told them that, but we want to avoid using the clippers on the day of surgery.”
It’s not always easy to predict exactly how every patient will feel after surgery or how long they’ll need to recover, Dr. Shellock adds. For patients, your best defense is to have a plan and get the support you might need to handle the first few days after surgery.
“During that first week, you should have somebody who can check in on you and help out if needed,” she said. “That’s especially important if you have a lot of home responsibilities – if you have younger children at home, or if there are tasks that you have to do around the home that might involve lifting or bending or twisting. Likely those are the things we're going to tell you not to do after surgery.”
Some patients may experience side effects, such as constipation, from the pain relievers prescribed after surgery.
“Know that constipation is something that may happen when you take narcotics,” said Dr. Shellock. “We encourage patients to have some stool softeners on hand at home. You should be able to get through it if you have the appropriate medications at home.”
Understanding what’s ahead, and what to expect, helps patients feel more confident and more comfortable, and less likely to encounter unpleasant surprises.
“That’s really important: feeling confident that you've made the right decision and that you feel confident in your surgeon,” Dr. Shellock said. “You may be a little nervous about the surgery. That’s normal. But look at this as the beginning of getting back to the life that you're really hoping for.”4
[1] Shellock video: How to prepare for disc replacement surgery?
https://www.youtube.com/watch?v=fS9WimXSOG8
[2] Shellock video: Is disc replacement surgery better than fusion surgery?
https://www.youtube.com/watch?v=fL23LtD3nJI
[3]Shellock video: Is disc replacement surgery better than fusion surgery?
https://www.youtube.com/watch?v=fL23LtD3nJI
[4] Shellock video: How to prepare for disc replacement surgery?
https://www.youtube.com/watch?v=fS9WimXSOG8
This is general information for educational purposes only. You should discuss your symptoms with your provider.