Artificial disc replacement is one of the most significant advancements in modern spine surgery, offering patients the possibility of long-term pain relief while preserving natural motion in the spine. However, confusion around the procedure is common, often made worse by vague or inaccurate terminology used in clinical settings. Understanding what an artificial disc replacement truly involves—and how it differs from more traditional spinal procedures like fusion—is essential for any patient exploring surgical options.
WHAT IS AN ARTIFICIAL DISC?
Artificial disc replacement is designed to treat certain types of degenerative disc disease by removing the damaged disc and implanting a device, called an artificial disc, that mimics the natural disc’s function. This device allows the spine to continue moving, maintaining flexibility and reducing strain on surrounding segments. By preserving motion, artificial disc replacements can help prevent a common long-term complication of fusion surgery: adjacent segment degeneration. Dr. Domagoj Coric, a spine surgeon who has been at the forefront of spine innovation, explains why motion preservation matters. “When you fuse one level of the spine, the stresses don’t go away—they transfer to the levels above and below. That can cause new problems over time,” he says. “Disc replacement avoids that issue by keeping the joint functional.”
TERMS TO KNOW
According to Dr. Richard Guyer, a renowned spine surgeon and early pioneer in disc replacement surgery, patients often come into consultations believing they’re receiving a disc replacement when they are actually scheduled for a spinal fusion. This distinction is critical because the outcomes and long-term impact on spinal function can differ significantly. Therefore, it is important to know some of the interchangeable terms used when referring to these kinds of procedures. For example, artificial disc replacements (ADRs) are also called total disc replacements (TDRs). Additionally, artificial disc replacements fall under a procedure category called “arthroplasties” which is a catchall term for “motion preservation”.
AM I A CANDIDATE?
Disc replacement is not appropriate for everyone. The condition of the facet joints—the paired joints in the back of the spine—plays a significant role in surgical decision-making. If these joints are significantly arthritic or if the patient has spinal instability, such as spondylolisthesis (where one vertebra slips forward over another), then disc replacement is not recommended. In these cases, a fusion may be the better—and safer—option. In such cases, surgeons now also have emerging tools like artificial facet replacements, offering another motion-preserving option when the disc is healthy but the joints in the back are the root of the problem.
FDA APPROVAL AND INSURANCE COVERAGE
Artificial disc replacements are not experimental, although that label is often incorrectly used by insurance companies. As Dr. Guyer points out, every device must go through an extensive investigational process with the U.S. Food and Drug Administration (FDA), including laboratory testing, animal studies, human clinical trials, and long-term follow-ups. Once a device receives FDA approval, it is deemed safe and effective for human use. Despite having FDA approval of many artificial discs, patients can still face obstacles in access. Insurance coverage for artificial disc replacement varies widely. Many patients find themselves caught in appeals processes when insurers deny coverage—even when the procedure is FDA-approved and clinically appropriate. Surgeons often have to engage in peer-to-peer reviews with insurance company doctors to advocate for their patients’ care.
CONCLUSION
“The spine is meant to move,” Dr. Coric says. “Fusion can be effective when necessary, but it is inherently unnatural,”. Therefore, patients exploring surgical options should be empowered with accurate information, a clear understanding of their diagnosis, and access to a range of treatments. A well-trained spine surgeon will consider each individual’s anatomy, condition, and lifestyle in choosing between fusion, disc replacement, or other evolving options like artificial facet implants.
As technology continues to advance, and as advocacy organizations like the National Spine Health Foundation push for greater education and patient access, the future of spine care promises more personalized and motion-preserving solutions. For those who qualify, artificial disc replacement may offer not just relief—but a return to a more active, natural way of living.
