Artificial Disc Replacement (Arthroplasty)

Artificial disc replacement, also known as *arthroplasty*, is the replacement of a damaged spinal disc with an artificial (manufactured) disc.

An artificial disc is designed to support the vertebrae while still allowing backward and forward bending, side-to-side bending, and turning. Many artificial discs have been approved for use by the Food and Drug Administration (FDA). In general, they are composed of two endplates that move and slide on a central core, made of metals like titanium or cobalt and sometimes a plastic such as polyethylene or polyurethane.

The vertebral column (backbone) is made up of 33 vertebrae. Between each set of vertebrae is a "cushion" called a disc. Age, genetics, and everyday wear and tear can contribute to disc damage and degeneration or herniation, which may cause pain, weakness, and numbness that radiate into the shoulders and arms.

Many patients with degenerated or herniated discs respond well to non-operative treatment, such as physical therapy, injections, and neck braces. These measures often relieve symptoms and avoid the risks of surgery. If patients have severe neck and/or arm pain, or non-operative measures don't bring relief, arthroplasty may be considered.

The best candidates are younger patients who have a single disc herniation and normal spinal motion at the level of the disc. In some patients, more than one disc can be replaced. Older patients with significant arthritis, bone spurs and limited mobility at the disc level are generally not good candidates.

The procedure is performed under general anaesthesia.

The surgeon makes an incision in the front of the neck and carefully exposes the front of the spine. X-ray imaging confirms the correct level.

Using an operating microscope, the surgeon removes the herniated or damaged disc (a discectomy). An artificial disc of the appropriate size is then inserted into the disc space, another X-ray confirms the position of the plates, and the incision is closed with sutures.