Joint replacement surgeries are among the most common orthopedic procedures performed, leading to the general public’s familiarity with hip and knee replacement surgery. Yet many will ask, what is disc replacement surgery? Just as the knee and hip joints allow for movement, so do the discs in the spine. These similarly may wear out and need replacing with implants that maintain or even restore motion, called artificial discs.
Artificial disc replacement, also known as total disc arthroplasty, has witnessed several generations of implants, each offering unique features and functionalities. Selecting the appropriate implant for a patient is crucial to ensure optimal outcomes, but how do surgeons know which option to choose? In our Spine Talks on Deciding on a Cervical Implant, Dr. Khachatryan and Dr. Schuler explore the factors involved in choosing an artificial disc replacement and shed light on the significance of implant selection in achieving successful results.
How do ADR Implants Differ?
Artificial disc implants vary in design and function, addressing specific anatomical requirements and patient needs. “Artificial discs that will allow and help resist shear protect the joints and the nerves a bit better” said Dr. Khachatryan. While discussing the selection process, it is important to consider the anatomy, particularly in the lower cervical spine. High-angle slope on standing x-rays necessitates a disc that resists shearing or sliding. For this purpose, a fixed core artificial disc is recommended, as it aids in protecting the joints and nerves by resisting shear forces.
As the location moves higher in the spine, different considerations come into play. Typically, a slightly more mobile core is preferred to provide functional mobility in those areas. Additionally, in higher regions, a compressible core may be utilized. The choice of implant for each level depends heavily on the individual’s anatomy, ensuring the proper device is selected to optimize outcomes and correct placement.
Does Surgical Expertise Matter?
Correctly placing artificial discs is a critical aspect of the procedure requiring expertise in artificial disc surgery. Identifying the center of rotation, which allows the vertebrae to roll normally, is crucial for placement. This expertise ensures that the chosen implant functions optimally and meets the patient’s specific needs. The experienced panelists have shared their insights on the various artificial disc implants they use in their practices. While none of the implants are perfect, there are several excellent options available. Each implant has specific indications, taking into account different pathologies and alignment parameters. Surgeons, having observed colleagues worldwide, develop proficiency in selecting the most suitable implant for each patient.
It is not uncommon for patients to come with preconceived notions or preferences based on marketing or personal research. Surgeons, in such cases, thoroughly evaluate the requested implant’s compatibility with the patient’s needs. However, if an alternative implant is believed to offer better outcomes, surgeons educate patients about the reasons behind their recommendation. The goal is to perform the surgery with the implant that will yield the best results for the individual patient.
Choosing the right artificial disc replacement implant involves a comprehensive evaluation of the patient’s anatomy, pathology, and needs. While each implant offers unique benefits, there is no single “perfect” disc replacement. Surgeons must draw from their experience, expertise, and observations to select the most suitable implant for each patient. Proper placement and mastery of the chosen implant’s technique are paramount for achieving successful outcomes. By optimizing the implant selection process, surgeons can ensure improved patient satisfaction and long-term benefits.