Total disc replacement: what patients should know
Plain-language answers about artificial disc replacement for the neck and lower back: how it works, who it helps, and what recovery looks like.
Total disc replacement removes a damaged spinal disc and replaces it with an artificial one that moves. It treats the same problems as fusion, like a herniated or worn disc pressing on a nerve, but lets that part of the spine keep bending and turning.
How the surgery works
Simplified illustration: an artificial disc replaces one damaged disc, and the segments above and below keep moving.
The surgeon reaches the disc from the front of the spine: through a small incision at the front of the neck for cervical surgery, or through the abdomen for lumbar surgery. The damaged disc and anything pressing on the nerves are removed. The implant, usually two metal endplates with a smooth plastic core between them, is sized and placed in the space the disc left behind.
Disc replacement compared with fusion
| Disc replacement | Spinal fusion | |
|---|---|---|
| Goal | Relieve nerve pressure and keep the level moving | Relieve nerve pressure and stop motion at the level |
| Motion at the treated level | Preserved | Eliminated |
| Healing needed | No bone fusion to wait for | Bones must fuse over several months |
| Typical return to desk work | About 2–3 weeks | Often 4–6 weeks or longer |
| Load on nearby discs | Close to normal | Increased |
| Best for | One or two damaged discs with healthy joints | Instability, arthritis, deformity or many levels |
General comparison only. Your surgeon will explain what applies to your situation.
Neck or lower back
Read about cervical disc replacement for the neck and lumbar disc replacement for the lower back.
Who is a good candidate?
People with pain from one or two damaged discs, healthy joints behind them, good bone density, and symptoms that haven't improved after months of non-surgical care. Read the full candidate guide.
Recovery timeline
- ConsultationA full exam, a review of your MRI and X-rays, and an honest conversation about fusion versus disc replacement.
- Surgery dayUsually one to two hours per level. Cervical surgery is done through a small incision at the front of the neck; lumbar surgery through the abdomen.
- First daysWalking the same day. Most patients go home within 24 to 48 hours.
- Weeks 2–3Many patients return to desk work and light daily activity.
- Weeks 6–12A gradual return to exercise, lifting and more physical work, guided by your follow-up visits.
Common questions
What is artificial disc replacement?
Artificial disc replacement, also called total disc replacement (TDR), removes a damaged spinal disc and puts a motion-preserving implant in its place. It relieves pressure on nerves like a fusion does, but the level keeps moving afterward.
How is it different from spinal fusion?
Fusion joins two vertebrae into one solid bone, which stops motion at that level. Disc replacement keeps the level moving. That can mean a faster return to activity and less extra load on the discs next to it.
Does disc replacement work in the neck and the lower back?
Yes. Cervical disc replacement treats discs in the neck and lumbar disc replacement treats discs in the lower back. The implants, the approach and the criteria are different for each region.
Am I a candidate?
Good candidates usually have pain from one or two damaged discs, healthy facet joints behind them, good bone density, and symptoms that haven't improved with several months of non-surgical care. Only an exam and imaging can confirm it.
Who is not a good candidate?
Disc replacement is usually not advised with significant arthritis in the facet joints, osteoporosis, spinal instability, active infection, or certain prior fusions at the same level. In those cases, a fusion or another treatment may be the better choice.
How long is recovery?
Most patients walk the same day and go home within a day or two. Many return to desk work in two to three weeks. Heavier work and sport take longer, and Dr. Garber sets your timeline based on your surgery.
Will insurance cover it?
Many plans cover cervical and lumbar disc replacement when the medical criteria are met, though coverage rules vary. Our team checks your benefits and handles the prior authorization.
Can I get a second opinion if I've been told I need a fusion?
Yes. Many of our patients come to us after being offered a fusion elsewhere. Call us and we'll explain how to send your imaging for review.
I live outside Nevada. Can I still be treated here?
Yes. Patients travel to Las Vegas from across the country and abroad. Dr. Garber can review your imaging first, so you know whether the trip makes sense before you plan it.
Articles
February 11, 2024 · 3 min readWho is the ideal candidate for artificial disc replacement?
Disc replacement works best for a specific kind of spine problem. Here's how surgeons decide who is likely to benefit.
Find out if disc replacement is right for you
Talk with our team about a consultation or an imaging review with Dr. Garber. Patients are welcome from Las Vegas and anywhere else.