June 19, 2018

Photo: Bethel Amiel

Amiel Bethel, M.D.

By: Dr. Amiel Bethel

Knee and hip replacements have been common for decades, offering patients who suffered from degeneration a full range of pain-free movement. But spines and backs have been more problematic. Spinal fusions, the gold standard, have meant a limited range of motion for patients and even future procedures on adjoining discs. But a newer procedure that involves inserting an artificial disc, called total disc replacement (TDR), means patients can get that range of motion and pain relief without the drawbacks of fusion. Once other therapies have been exhausted a neurosurgeon performs the procedure through a small incision, minimizing tissue disruption.

Spine degeneration is an aging process that affects everyone. In the normal aging process, we reach a point in our lives where the amount of tissue being destroyed is more than the amount being produced. The ligaments become weakened. The discs lose water and degenerate. The bones degenerate and form spurs. The joints become less lubricated, the muscles weaken. This all contributes to the degeneration of the spine. Before surgery there are some nonsurgical treatments are generally explored. Some people try medication to alleviate the pain associated with spine degeneration and a course of physical therapy. Other patients will undergo steroid injections for the degeneration and nerve pain. However if these do not work, then surgery is normally required.

A popular procedure to help patients with this condition is total disk replacement surgery. Total disc replacement is similar to more standard discectomy procedures in its approach. The recovery is usually six to eight weeks, although the patient has full movement throughout the recovery period. It is different from spinal fusion surgery in that the affected disc, unlike fusion, is no longer a burden to the adjacent discs for movement. Total disc replacement was developed because of the effects that a spinal fusion may have on the vertebrae. Because two adjacent bones are fused together, the biomechanics of the spine may be altered after a fusion, which, in turn, may place pressure on the adjacent joints. Some believe the added pressure results in degeneration in those areas.

People of all ages are a candidate for total disc replacement however young patients often benefit from the surgery because of the added benefit of motion preservation at the affected disc, retaining the neck's full range of motion. So if you are suffering from spine and back problems, contact your health care provider to discuss your options. Total disc replacement just may be one of them.

-Dr. Amiel Bethel is Chair of Neurosurgery, at UM Baltimore Washington Medical Center and a Clinical Assistant Professor of Neurosurgery at the University of Maryland School of Medicine. He can be reached at 410-553-8160.