If you’ve been told you have a herniated disc in the neck and that you need a spinal fusion, you should get a second opinion from a physician who is proficient in artificial disc surgery.
Fact: Neck surgery has changed dramatically over the past three years, with new artificial discs getting FDA approval — a rigorous and expensive approval process to pass. While 5 years ago the standard treatment for a herniated disc was indeed spinal fusion, that is changing rapidly — thanks to the new spinal implants now approved for use by the FDA.
Even health insurance companies — typically the last ones to grudgingly adapt to or accept the newest technology — are now recognizing that artificial disc in the neck can provide better clinical outcomes than a neck fusion.
What perhaps interests health insurance companies more than the clinical outcome of the disc level treated or the natural rotation provided back to the person wanting to hit a golf ball or swing a tennis racket, is that the artificial disc can actually SAVE THEM MONEY. Research provided at the North American Spine Society (NASS) showed that cervical artificial disc replacement reduces “adjacent segment disease.” Because fusion locks two vertebrae together, it can then put more pressure and rotational demand on the few remaining discs in the neck. This is much like having 6 links in a chain, and welding two of the links together. The friction demand placed on the remaining links increases.
Said another way, the artificial disc in the neck has been shown to prevent a herniation at another level that requires a SECOND neck surgery, or even a THIRD. So from the health insurance company perspective, it’s becoming more clear that any device that can increase the chance that it’s ONE and DONE, vs. several subsequent neck surgeries, that makes economic sense.
Do you qualify for an artificial disc
Not everyone with a herniated disc qualifies for an artificial disc.
The spine surgeon needs to perform a thorough assessment of your specific case to determine if you even qualify for artificial disc replacement. There are many considerations related to your disc herniation, the location, severity, presence of bone spurs, even your age. Also, if you’re a golfer or tennis player, that places more rotational demand on your neck which can influence what is the best way to deal with your herniated disc.
Typically, if the pain symptom appears to be coming from the disc, and it has not responded to non-surgical treatment, including drugs, therapy, manipulation/manual therapy or spinal injections, that may indicate you are a candidate for artificial disc replacement.
Some spine surgeons may order diagnostic tests like a discogram to verify the exact disc level that is causing the pain symptom. The worst case scenario would be to operate on the wrong disc level. Consequently, such diagnostic tests are to confirm the disc level to increase the success of the surgery at eliminating pain symptoms.
Similarly, the indications for disc selection may vary for each type of artificial disc.
There are several FDA approved artificial discs for the neck, the most popular being the Prestige, M6, Prodisc, Bryan and Mobi-C.
The spine surgeon will often use different discs to address a patient’s anatomic issues such as the slope angle of the vertebrae, etc. The patient’s age, and the type of activity they hope to return to (e.g. golf, tennis, skiing) may all affect the type of artificial disc the surgeon recommends.
Consequently, a spine surgeon may use one disc at one level and a different disc for another level for the optimal bio-mechanical result.
Dr. Michael Rohan, Jr.
Fellowship-trained Spine Surgeon
Dr. Michael Rohan, Jr. is fellowship-trained in spine surgery, the highest level of medical education in the U.S. His fellowship was done at the prestigious Texas Back Institute, which in 1986 was the first and largest spine specialty center in the United States. During his fellowship, Dr. Rohan, Jr. specialized in minimally invasive spine surgery techniques that require the surgeon to operate through a one-inch incision using tubular retractors with tiny cameras and cutting devices in the tip.