Overview: Spine is an extremely important structure in the body. It not only gives support to the body, but also allows mobility of the back in different directions. In addition to that, it houses the most important connection between brain and the rest of the body - spinal cord. When the discs wear out, spine at that particular level does not function normally and also the back becomes painful. The degeneration of disc leads to a condition called degenerative disc disease. Whereas large majority of such patients can be treated with painkillers, braces, physical therapy, small percentage of such patients do not respond to non-operative treatment and thus need a Disc Replacement.
What is Disc Replacement surgery?
Disc replacement surgery is the most innovative and modern treatment that is now available. In this surgery, the disc (which is a soft material between two vertebrae) is removed and the space is packed with bone graft. In due course of time, the bone creates a solid bony bridge across the two vertebrae. By doing away with movement, previously painful segment is made pain free.
Purpose of Disc Replacement surgery:
The reasons for choosing to replace a disc may vary for each condition. Generally, if the pain caused by the affected disc has not been reduced enough with non-surgical treatments, such as medication, injections, or physical therapy, a doctor may suggest disc replacement surgery. Several conditions that may prevent you from receiving a disc replacement: spondylolisthesis (the slipping of one vertebral body across a lower one), osteoporosis, vertebral body fracture, allergy to the materials in the device, spinal tumor, spinal infection, morbid obesity, significant changes of the facet joints (joints in the back portion of the spine), pregnancy, chronic steroid use or autoimmune problems.
Disc Replacement surgery types:
There are many artificial disc designs classified into two general types:
Total disc replacement: As the names imply, with a total disc replacement, all or most of the disc tissue is removed and a replacement device is implanted into the space between the vertebras.
Disc nucleus replacement: With a disc nucleus replacement, only the center of the disc (the nucleus) is removed and replaced with an implant. The outer part of the disc (the annulus) is not removed.
Artificial discs are usually made of metal or plastic-like (biopolymer) materials, or a combination of the two. These materials have been used in the body for many years. Total disc replacements have been used in Europe since the late 1980s. The most commonly used total disc replacement designs have two plates. One attaches to the vertebrae above the disc being replaced and the other to the vertebrae below. Some devices have a soft, compressible plastic-like piece between these plates. The devices allow motion by smooth, usually curved, surfaces sliding across each other. Most nucleus replacement devices are made of plastic-like (biopolymer) materials. One such material is called hydrogel. This material expands as it absorbs water. The device is placed into the nuclear cavity of the disc and hydrates to expand and fill the cavity. The device is compressible and by this means, allows motion, much like a normal disc nucleus. Another design consists of a piece of a plastic-like material that coils around to fill the nuclear cavity. There are also disc replacements designed for use in the cervical spine (the neck). These devices have only been used a relatively short time, and several are currently undergoing evaluation in FDA-approved trials in the United States.
Artificial Lumbar Discs:
Charite(3 piece) FDA approved
ProDisc (3 piece) FDA approved
Maverick (2 piece) in clinical trials. ( Very Promising)
Candidate for Disc Replacement surgery:
The best candidates for Disc replacement surgery would be patients who have failed prolonged nonsurgical treatment and who have moderate of severe degenerate disc disease. The ideal candidate for this procedure is someone who fits into the following criteria:
Is not over the age of 60
Does not have degeneration on multiple levels of the spine
Does not have osteoporosis
Is it good health?
Is not overweight
Has not had any previous surgery for this condition such as a spinal fusion
Has had at least 3 months of non-surgical treatments such as stretching, exercise and medications which has failed to reduce or eliminate pain in such as way that everyday functions can be returned to as close to normal as possible.
Artificial disc replacements have been shown to cause facet joint problems so it is best if you do not have any previous facet joint issues.
You do not have scoliosis or any other type of spinal deformity that would make disc replacement not possible.
The nerves in your spinal canal are not being compressed in any way.
You have never had any sort of spinal infection.
You don’t have spinal arthritis
Diagnosis for Disc Replacement surgery:
The indications for disc replacement may vary for each type of implant. Some general indications are pain arising from the disc that has not been adequately reduced with non-operative care such as medication, injections, chiropractic care and/or physical therapy. Typically, you will have had an MRI that shows disc degeneration. Often discography is performed to verify which disc(s), if any, is related to your pain. (Discography is a procedure in which dye is injected into the disc and X-rays and a CT scan are taken. See the NASS Patient Education brochure on Discography for more information.) The surgeon will correlate the results of these tests with findings from your history and physical examination to help determine the source of your pain.
Preparing for Disc Replacement surgery:
If you suffer from chronic low back pain caused by degenerative disc disease (DDD) that does not respond to other non-surgical therapies, you may be eligible for artificial disc replacement surgery. However, this procedure is not recommended for everyone. Based on your symptoms, your doctor will determine the best course of treatment for you. Disc replacement may be recommended for patients between the ages of 18 and 60 with DDD at one or two levels of the spine whose condition has not responded to at least six previous months of non-surgical therapy.
Patients who have other spinal abnormalities such as spinal stenosis, spondylolisthesis and scoliosis are usually not candidates for this surgery. Patients with osteoporosis may not have strong enough bone to support a disc replacement. Based on a series of tests, your doctor will determine if artificial disc replacement surgery is an option for surgery and the most effective treatment for your condition. Before artificial disc replacement, your doctor will discuss the procedure with you in detail, answering any questions you may have. Your doctor will also inform you of any special requirements that need to be completed before your surgery.
Disc Replacement surgery-Procedure: Artificial disc replacement surgery takes place under a general anesthesia, which means the patient is put to sleep. The procedure takes between one and two hours, followed by a three to four-day hospital stay. The artificial disc is designed as two metal end plates, between which may be found medical grade polyethylene or plastic or gel-like substances, much like a sandwich. After a general anesthesia as the first step, is to remove the diseased disc before installing the replacement. For a total disc replacement in the lower back, a type of disc prosthesis may be used which consists of two metal plates surrounding a mobile core made of plastic. Spikes protruding from the metal pieces fix them into the bone, which eventually grows and fuses with the plates. The plastic core allows gliding movements to occur. A different type of spine arthroplasty device, where two metal pieces articulate by way of a ball and trough, is sometimes used to replace a cervical disc in the neck. An alternative to a total disc replacement is what is known as a disc nucleus replacement, which may be carried out if the outer part of the disc is still quite healthy. In this procedure, only the center, or nucleus, of the original disc is removed. It is replaced by a type of plastic which absorbs water and swells to fill the nucleus cavity. As the material is soft and can be compressed, it allows the disc to continue to function in a relatively It may take up to eight weeks for people to return to normal everyday activities after an artificial disc replacement has been carried out, although it could be longer before more vigorous exercises, such as sports, can be pursued. Artificial disc prosthesis, usually made of a gelatinous or plastic substance, is inserted into the vertebral space to approximate the normal height of the original disc. The patient is often required to wear a back brace support for up to 12 weeks following such a surgical procedure to enable and encourage healing. Possible complications include the artificial disc replacement becoming damaged or dislodged. For this reason, following surgery, patients have regular checkups for life to make sure the prosthesis is functioning normally.
Life after Disc Replacement surgery:
Pain relief, the reduction of further degeneration and resumption of daily activities are typical goals of spine surgery. While both fusion surgery and artificial disk replacement can provide pain relief and stability, with spinal fusion the vertebrae surrounding the disk space are immobilized, and therefore limit flexibility in that area of the spine. Laboratory testing shows that patients who have undergone total disk replacement have more movement in the spine. Nobody can guarantee that after disk replacement surgery you will never feel pain again or that your spine will fully regain its flexibility. If you’re like the majority of spinal surgery patients, you’ll experience a decrease in pain and you’ll gradually be able to increase your level of activity. With your pain minimized or no longer an issue, your concentration level on task will be noticeably better.
Benefits of Disc Replacement surgery:
Most importantly, when fusion surgery is performed, although your pain symptoms may go away, the vertebrae surrounding the disc space are immobilized and therefore typically limit flexibility in that area of the spine. Laboratory testing shows that the Disc replacement design allows your spine to move. In the clinical study, patients were observed to have motion between 0 and 21 degrees while bending forward and backward. Another benefit to disc replacement surgery with the Artificial Disc is that no bone graft is required. Often times with spinal fusion surgery, the bone graft used to pack the disc space is bone that the surgeon has to remove from the patient's hip. This means that the patient ends up having two incisions that must heal, as well as pain in the back and hip during recovery from the surgery.
Risks associated with Disc Replacement surgery:
As with any surgery, there are risks associated with disc replacement. The complications when using artificial discs are similar to those associated with anterior spinal fusion. Possible complications include but are not limited to: infection, injury to blood vessels, nerve injury, dislodgement or breakage of the device, wear of the device materials, continued or increasing pain, development of new pain, sexual dysfunction, injury to urologic structures and death. Discuss these risks with your surgeon before deciding to have an artificial disc implanted.
Recovery after Disc Replacement surgery:
Most people spend one or two nights in the hospital. You may require an extra day or two if for some reason you're having extra pain or unexpected difficulty. Patients generally recover quickly after an artificial disc replacement. You should be able to get out of bed and walk within a few days. Some people wear a corset or brace for support. As you recover in the hospital, a physical therapist may see you to start you on a few gentle exercises. You'll also start a walking program that you are encouraged to continue when you get back home. When you leave the hospital, you should be safe to sit, and walk. Your surgeon will see you within a month to do an X-ray to make sure the disc is in place and holding steady. However, you should avoid lifting things for at least four weeks. You can often return to work after your surgeon has evaluated you, as long as your job does not include heavy lifting. It should be noted that a successful result of the disc replacement means that back symptoms are better but not necessarily perfect. Most studies show that 60 to 70 percent of patients have significantly less back pain and greatly improved function with the operation.
Cervical Disc Replacement Surgery:
An artificial cervical disc is a device inserted between two cervical vertebrae after an intervertebral disc has been surgically removed in the process of decompressing the spinal cord or a nerve root. The intent of the device is to preserve motion at the disc space. It is an alternative to the use of bone grafts, plates and screws in pursuit of a fusion following such a disc removal, which necessarily eliminates motion at the operated disc space in the neck.
Cervical disc replacement surgery would most typically be done for patients with cervical disc herniations that have not responded to non-surgical treatment options and are significantly affecting the individuals' quality of life and ability to function.
An artificial disc surgery may be done instead of an anterior cervical discectomy and fusion.
Benefits of Cervical Disc Replacement:
Artificial disc surgery has lesser chances of requiring a revision surgery, compared to spinal fusion surgery
Normal neck motion can be maintained
Unlike the spinal fusion surgery the adjacent spinal discs in case of cervical disc replacement don’t have to bear the extra stress.
Eliminates the need for a painful bone graft
Recovery time is quicker compared to the fusion surgery.
Lesser number of patients need a hard collar following the cervical Disc Replacement surgery
Disc Replacement Surgery vs. Fusion:
Disc replacement surgery is usually much less invasive than traditional spinal surgery. In most artificial lumbar disc replacements, the incision is made in the abdomen and the surgery performed through the front of the body. Recovery time is relatively quick, compared to spinal fusion.
Disc replacement maintains the flexibility of the spine and allows continued vertebral level movement, unlike fusion. This makes the disc replacement approach a far more enlightened technique which does not cause the long term degenerative effects associated with spinal fusion surgery.
The cost of Disc Replacement surgery in India: The global patients traveling to India for Disc replacement can enjoy savings of tens of thousands of dollars. They may save between 60 and 80% on costs found in the United States. Lower costs do not equate to lower quality, but lower operating costs, lower medical malpractice costs, and different healthcare systems in place in foreign destinations. The following table can give you a fair idea of the cost difference which is evident in India.
Medical Treatment
Procedure Cost
US($)
United States
India
Lumbar Disc Replacement surgery
55,000
12,000
Spinal Fusion
77,000
10,000
Cervical Disc Replacement
58,000
10,000
Orthopedic Surgery
( Joint Replacements)
28,000
7,000
Top Spine Surgeons in Our Panel: To be qualified as a good spine surgeon in India, a surgeon is required to have the following qualifications-
MS in Orthopedic or Neuro Surgery
MCH in Spine Surgery
FRCS/MRCS from International Colleges and Hospitals
International Fellowships and Training Programs
Publications and Paper Presentations in Reputed Scientific and Medical Journals
Wide Clinical Experience.
All of our associate doctors / surgeons have trained or worked in some of the best medical institutions in United States, United Kingdom, Europe and other countries across the globe.
Our Panel of Top Spine Surgery Hospitals in India:
Choosing the correct hospital can have a significant impact on the amount of recovery following a Spine Surgery. Our Spine Hospitals in India is to provide the first technologies, the best hope, and total care in spine procedures, treatments and procedures.
Spine Hospitals are equipped with world class Infrastructure & State of Art Medical Technology being at par with US, UK and other European countries.
Most of them work according to the international benchmark set by the global medical fraternity, wherein they maintain a high level of medical services confirming all the protocols of quality and ambience.
Zero Waiting Period -No waiting period for our patients
Our Panel of hospitals in India are backed by the most comprehensive neuro-diagnostic and imaging facilities, the Neurological services extend to the very latest in diagnostic equipment such as EEG, ENMG, and Video-monitoring, PET scanning, 3 Tesla MRI and 256 Slice CT Scan.
Access to top specialists on the very same day.
High quality medical and nursing care for a fraction of the cost in major health care institutions elsewhere in the world.
International patients are looked after by specially trained nurses, and other needs are taken care of by guest relations executives, like accommodation for the companion, shopping, interpreters, currency exchange, tourism packages etc. all through their stay.
Plan your Spine Surgery in India with tour2india4health consultants:
We will provide you with the choice of finest spine surgeons, leaving no stone unturned in a concise explanation of exactly what will take place before, during and after your spine surgery procedure. You will have plenty of opportunity to discuss your needs, concerns and expectations - all of which will be thoroughly explored between yourself and a highly qualified Indian spine surgeon of our panel.
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We provide facilities like quick visa letters on request by our patients, Language translators to our international patients, Foreign exchange facility.
