Artificial disc replacement is an operation in which a damaged disc between two vertebrae is removed and replaced with a mobile artificial joint that preserves movement at that level, unlike fusion, which welds the two vertebrae together and stops motion between them. It is used more often in the neck than in the lower back, and at one or two levels in suitable cases. The option is usually raised when the symptoms are caused by a single disc pressing on a nerve root or on the spinal cord, producing radiating arm or leg pain, numbness or weakness, and only after a structured course of conservative care with physiotherapy and doctor-prescribed medication has failed. Patient selection is the decisive factor in the outcome: the best candidates have relatively healthy facet joints, a stable segment with no slippage and good bone density, and no infection, tumour, significant deformity or severe multi-level narrowing. The limits are explicit. An artificial disc does not restore a natural disc and does not halt degeneration elsewhere in the spine. It is not an alternative in every case, and many patients are suitable only for fusion, particularly where there is facet joint arthritis, instability or osteoporosis. It does not correct deformity and does not relieve widespread multi-level stenosis. It does not remove the possibility of further surgery later, and in a small number of cases the implant itself needs revision. Its main purpose is to relieve neurological symptoms while preserving motion, not to abolish chronic neck or back pain. The operation is usually performed from the front: in the neck through a small incision in the front of the throat between the natural structures, and in the lower back through an anterior abdominal approach. Radiographic imaging is used during the procedure to set the size and position of the implant precisely, because a poorly sized or poorly positioned device defeats the whole purpose of preserving motion. Whether you are a candidate is determined by clinical examination together with MRI, standing flexion and extension X-rays and assessment of bone density, not by reading a page, and the choice between an artificial disc and fusion is based on your own anatomy and the nature of your problem rather than on a general preference.
Procedure steps
- 1
Assessing candidacy and imaging
The doctor matches your symptoms to the suspected disc level on neurological examination, then uses MRI to assess the disc and nerves and standing flexion and extension X-rays to judge segmental stability and the state of the facet joints, with bone assessment when osteoporosis is suspected.
- 2
Anaesthesia and the anterior approach
Under general anaesthesia a small anterior corridor is opened: in the neck through an incision at the front of the throat, gently retracting structures without cutting the major muscles, and in the lower back through an anterior abdominal approach that may involve a vascular or general surgeon.
- 3
Discectomy and nerve decompression
The damaged disc is removed completely, any disc tissue or bony spur compressing the nerve root or spinal cord is cleared, and the surfaces of both vertebrae are carefully prepared so the implant seats correctly, preserving the bony endplate on which its stability depends.
- 4
Sizing and implanting the device
The implant size is selected according to the height and width of the disc space and is inserted in the exact position under live radiographic guidance, then checked for centring, stability and restoration of disc height and natural alignment, because positional accuracy is the condition for preserving motion.
- 5
Closure, early motion and follow-up
The wound is closed in layers with attention to the cosmetic result, gentle early movement is usually encouraged without a rigid collar in most cervical cases, and graded rehabilitation begins. Imaging is repeated at set intervals to follow implant position and motion at the level.
Before the procedure
Tell the doctor about any previous neck, thyroid or abdominal surgery, and about any problem with your voice, swallowing or reflux before an anterior approach, because these details change the access plan. List all medicines and supplements, especially blood thinners, aspirin and steroids, and stop nothing on your own. Bring your MRI discs, films and reports. Stop smoking before the operation, since it harms bone and recovery, bring blood sugar under control, complete blood tests and heart and lung assessment, and treat any active dental or urinary infection. Follow the fasting instructions before anaesthesia, arrange for someone to accompany you, and ask openly how this procedure compares with fusion in your particular case.
After the procedure
Begin gentle movement and walking early as your surgeon directs, because preserved motion is the aim of the procedure and stiffness defeats it. After an anterior neck approach, expect a sore throat and mild difficulty swallowing or a hoarse voice that improves over days to weeks, and start with soft food if needed. Avoid heavy lifting, contact sport and sudden movements for as long as your surgeon specifies, care for the wound, and stay completely off cigarettes. Follow the physiotherapy programme, since it is what makes the preserved motion useful. **Go to the emergency department immediately for increasing neck swelling, difficulty breathing or an inability to swallow after neck surgery, progressive weakness in the arms or legs, numbness between the thighs and around the anus, urinary retention, or loss of bladder or bowel control — these last three are cauda equina symptoms after lower back surgery and are a surgical emergency.** Contact your doctor quickly for fever or wound discharge, swallowing difficulty that worsens instead of improving, or pain and swelling in the leg.
Expected duration
The operation usually takes one to three hours for a single level, most often with a hospital stay of one to two nights.
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