Arthroplasty, often referred to as joint replacement surgery, is an orthopedic procedure that replaces a deteriorated joint with a prosthesis made from synthetic materials like metal or plastic. It is not to be confused with arthroscopy, which is a procedure that uses a special tool to examine and diagnose joint problems. When surgery is recommended for persistent back or neck pain, the most common procedure remains fusion, the fusing together of 2 or more vertebrae. Disc arthroplasty is another type of surgery that can maintain greater long-term movement in the spine.
Discs are the soft cushioning that act as shock absorbers between the bones of the spine, or vertebrae. Disc arthroplasty is the surgical replacement of the damaged part of a disc with an implant made of manmade materials. This prosthesis is intended to imitate the function of the natural disc. Arthroplasty can be performed on both the lower part of the back, called the lumbar spine, as well as on the neck, or cervical spine. Most people with back or neck pain will not need surgery, but disc arthroplasty may be recommended when other non-surgical methods have not helped with pain or stiffness.
Reasons for disc arthroplasty
A risk factor is something that increases your chance of developing a certain disease or condition. Risk factors that may increase the need for disc replacement surgery include:
- Joint pain and stiffness that prior treatment has not helped
- Rheumatoid arthritis
- Increased age
- Family history of back problems
- Back or neck injury
- Heavy physical work
What to expect
Before disc arthroplasty
Your doctor may perform imaging tests, including:
- Magnetic resonance imaging (MRI) scans
- Computed tomography (CT) scans
Not everyone is an ideal candidate for disc arthroplasty. You may be advised to have a different procedure if you:
- Have back pain that is caused by more than 1 or 2 intervertebral discs
- Have a joint disease or certain compression of the spinal nerves
- Are obese
- Have had prior spine surgery
- Have a deformity of the spine, such as scoliosis
Before surgery you should:
- Make arrangements for someone to take you home and to help you after surgery.
- Tell your doctor about any medicines, vitamins, and supplements that you take. Some may need to be stopped up to 1 week before surgery.
- The night before surgery, do not eat or drink after midnight, unless your doctor instructs you otherwise.
- Remove items at home that could cause a fall, such as throw rugs or power cords and place frequently used items where they are easy to reach. You also may want to install safety devices to help protect you from falls. These include:
- Handrails near steps
- Shower seats and safety bars
- Raised toilet seats
During the procedure
Before the operation, you will be placed on your back on the operating table and a catheter will be inserted to help with urination during and after surgery. General anesthesia will then be given through an IV in your arm to keep you free from pain and asleep during the procedure. You also may be given antibiotics to help prevent infection.
Disc arthroplasty surgery takes between 2 and 3 hours and usually is done through the joint effort of orthopedic and vascular surgeons. Lumbar arthroplasties are performed through the abdomen so that the nerves of the spine remain undisturbed. Your organs and blood vessels are moved aside to provide access to the spine, allowing the damaged disc(s) to be removed and replaced with artificial ones.
Following disc arthroplasty
After disc arthroplasty, most patients stay in the hospital for 1 to 3 days. You may need to stay longer if there are any complications. Typically, your healthcare team will help you to stand and walk within a day of surgery. Since the bone does not need to heal after arthroplasty, recovery is faster than with other types of spinal surgery. Moving your torso is encouraged to help speed recovery. You will begin physical therapy and perform some basic exercises, like walking and stretching, but will need to be careful not to overextend your back.
Within a few weeks to a few months after disc arthroplasty, back pain usually begins to diminish, though it may not go away entirely. Your doctor will help set expectations for what pain level to expect, and you will be given pain medication as needed. Before you go home, your IV and catheter will be removed and you will be given instructions on how to care for your wound site.
When you are deciding whether or not to have disc arthroplasty surgery, your doctor will tell you of potential complications, such as:
- Issues with blood clotting
- Localized Bleeding
- Severe nausea
- Trauma to nerves or blood vessels near surgical site
- Issues with anesthesia, including the potential to develop pneumonia or other similar conditions
The chance for complications increases if you:
- Have other medical conditions, especially those related to the heart and/or lungs
- Are obese—If you are severely overweight, try to lose weight before surgery to reduce strain on your new discs.
- Have an infection in other parts of the body that may allow bacteria to enter the affected disc(s)
- Have blood clotting issues
- Are a smoker—ask your doctor about ways to quit before your surgery
Your doctor will help you weigh the pros and cons of having disc arthroplasty surgery.
When to call your doctor
Before you go home, your doctor will help set expectations for your recovery. If, at any time, you believe you are having complications, contact your physician immediately. If you are having an emergency, call 911. Complications from disc arthroplasty surgery may include:
- Pain that is getting worse
- Bleeding and/or leakage near your incision site that is beyond what is considered normal
- Swelling, tingling, or loss of sensation in your legs or feet
- Shortness of breath
- Fever or other signs of infection
- Back or neck pain that is not helped by pain medication
- Severe nausea