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Dr. Cuéllar and his partner Dr. Lanman are experts at artificial disk replacement for the relief of neck or back pain while maintaining spinal motion.
Total replacement of a spinal intervertebral disk is known by several terms, such as total disk replacement (TDR), artificial disk replacement (ADR) or total disk arthroplasty (TDA). All of these terms refer to the same thing – removing a diseased intervertebral disk and replacing it with a device made mostly of various mixes of medical grade metal. Sometimes the device also contains a part which is made of specialized wear-resistant plastic referred to as high-molecular weight polyethylene – the same material used in total hip and total knee replacements.
Why do I think total disk replacement is better than fusion when appropriate?
Our spines are meant to move. Each intervertebral segment is made up of two complex shaped bones called vertebrae that form several joints with each other (see diagram below). In the back (posterior) aspect of the spine there are two joints called facet joints. In the front (anterior) aspect of the spine there exists an intervertebral disk that sits between the two vertebrae that compose the spinal segment. This disk acts as a shock absorber for your body weight, and allows motion such as forward bending (flexion), backward bending (extension), side bending and rotation.
What happens when one or more levels of the spine are fused together?
Sometimes it is necessary to fuse one or more levels of the spine together, such as when there is instability between these levels. One potential downfall to this procedure, however, is accelerating the rate of degeneration of the next (adjacent) level. Although we all have some level of spinal degeneration over time, some studies have demonstrated that fusion at one level may accelerate the rate of degeneration at the adjacent level, likely due to increased stress at that level:
Compare this to an artificial disk replacement:
More spinal motion is maintained after a disk replacement compared to after a fusion. This continued motion attempts to replicate your natural spinal anatomy and physiology. Disk replacement at one level does not result in as much increased stress at the adjacent level and therefore is less likely to accelerate the degenerative process at that adjacent level. Long-term studies are starting to demonstrate that years after surgery, disk replacement patients have lower rates of accelerated adjacent disk degeneration compared to patients that underwent fusion surgery.(Serhan et al 2011, J Neurosurgery)
Above shows a lateral XRAY of a patient with lumbar 4-5 artificial disk replacement
Above shows a lateral and AP XRAY of a patient after a two-level cervical artificial disk replacement
Scientific evidence for the superiority of artificial disk replacement compared to fusion is mounting heavily:
Cost-effectiveness of artificial disk replacement: Not only is evidence mounting that in the long-term, artificial disk replacement is superior to fusion, several excellent studies have demonstrated that it is more cost-effective!
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