Goodbye Herniated Disc, Hello ProDisc

In this month’s first blog we discussed a relatively new area of spinal surgery known as “motion preservation surgery.” A variety of procedures that fall under this umbrella have the goal of preserving full motion by allowing the patient to avoid fusion surgery. At this point, the only FDA-approved surgery is known as total disc replacement.

We talked about some general aspects of this surgery, when it could be better than fusion, who it’s right for, and other issues. In December’s second blog, let’s get into how Dr. Tinley performs total disc replacement using the ProDisc-C or ProDisc-L devices.

How is a motion preservation surgery performed?

When patients have degenerative disc disease, odds are they have at least one spinal disc that has herniated. This is the process where the tough outer covering of the disc cracks/herniates, allowing the soft inner gel to push out through the outer shell. As the gel pushes outward, it will often begin to push on nerve roots exiting the spinal canal or on the spinal cord itself. This creates pain in the back or neck, and in the area served by the compressed nerve.

At a certain point, a patient will need to relieve the pressure on the nerve. Discectomies do that, but sometimes more aggressive treatment is needed. That’s when fusion or disc replacement are needed. For total disc replacement, Dr. Tinley uses the ProDisc-C in the cervical spine and the ProDisc-L in the lumbar spine. Both of these procedures are similar in how they are done.

First the patient is put under general anesthesia. For both the cervical discs and the lumbar discs, access is made from the front of the body. Most cervical disc problems originate in the C4-C7 levels of the seven-vertebrae cervical spine. In the lumbar spine, all five vertebrae and their four spinal discs can be problematic. In the cervical spine, a one-to-two-inch incision is made in the front of the neck. The thin platysma muscle that lies just underneath the skin is cut and moved aside, and the pre-vertebral fascia, a thin layer of tissue that surrounds the spine, is removed to expose the spinal discs. An incision is made in the outer ring of the disc, the annulus fibrosus, and the entire soft inner core of the disc, the nucleus pulposus, is removed. Most of the remainder of the outer disc is also removed, but some may be left in place.

Next, the vertebrae are spread to their normal height and the ProDisc-C is placed into the space. The ProDisc-C has what is called a keel that protrudes on the top and bottom pieces. These keels are placed into the upper and lower vertebrae and ensure instant stability and fixation. In between these pieces is the polyethylene center than simulates the natural spinal disc. Once the artificial disc is placed, the incisions are closed, and the surgery is complete.

With lumbar disc replacement, the process is very similar. An incision is made in the abdomen. Muscles are moved as necessary to gain access to the vertebrae. Then the degraded disc is removed and replaced by the ProDisc-L in basically the same way as the cervical disc was replaced.

Compared with fusion, total disc replacement usually involves a much easier recovery period. Amazingly, patients can return to everyday activities such as light work and driving within just a week of their surgery. Full recovery takes just 6-12 weeks. The compressed nerve can take a full year to fully heal.

Are you saddled with chronic back or neck pain? Call Dr. Tinley at 817-916-4685 and let’s see how we can help.

Posted in: Back Surgery, Degenerative Disc Disease

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