Spine - Total Disc Replacement (TDR)

What to Know About the Procedure

Total disc replacement (TDR) is an orthopedic procedure whereby the intervertebral disc between two vertebrae is removed and replaced with a prosthetic disc. This is a new surgical alternative to spinal fusion for treating patients suffering from a herniated disc. A herniated disc will often rub against sensitive nerves in the spinal column, resulting in back pain, or even tingling and weakness in the legs or genitals. This procedure, while FDA approved, is currently classed as being experimental in nature. As a result, many health insurance plans do not cover it.

The process begins with a routine discectomy. The patient is put under general anesthesia. They are then positioned face down on the operating table. A small incision is made on the back, over the region where the herniated disc is located. The surgeon will carefully cut through any soft tissue present until they have gained access to the spine. At this point it is common but not necessarily required that the surgeon remove a section of bone at the back of the spine called the lamina. This sub-procedure is called a laminectomy and it affords the surgeon a greater degree of visibility and access to the herniated disc in some cases. Once the laminectomy is complete, the surgeon locates and isolates the herniated disc and carefully removes it along with any loose fragments that may be present.

Once these procedures are complete, the prosthetic disc may be installed. First, metal plates are screwed into the intermediate surfaces between the two vertebrae the original disc was placed between. These plates are contoured to interact with the artificial disc in such a way that simulates six degrees of normal spinal motion. Next, the artificial disc (usually constructed from polyethylene) is placed between the two metal plates. No further securing of the artificial disc is required. The body weight of the patient, gravity and the natural growth of new bone over the metal plates is sufficient to secure the new disc. The soft tissue around the surgical area is then replaced and the incision is sutured shut. The procedure generally takes between two to three hours to complete.

What to Know Before the Procedure

Due to the delicate nature of the surgical region, the possible complications are more severe than some other surgeries. While the procedure is considered safe, it should be a last resort after exploring non-surgical methods to manage the pain and other symptoms being experienced. Weigh your options carefully with your doctor. Should you decide to proceed with surgery, your doctor will need to perform an imaging procedure, such as a CT scan or MRI to determine the exact location of the herniated disc.

What to Know After the Procedure

Patients are encouraged to return to walking right away after the surgery. This usually does not cause an increase in pain and helps prevent excessive amounts of scar tissue from building up. For several weeks after the surgery, sitting for more than 20 minutes at a time will be uncomfortable and is not recommended. Until you are fully healed, you may experience pain and discomfort at the surgical site. It is very common for doctors to prescribe pain medication after this procedure. Recovery time varies from patient to patient. The time table for returning to work and regular activity levels is typically between two to eight weeks.

As needed your doctor may prescribe several medications for you including antibiotics, anti-coagulants and pain relievers. As with any arthroplastic procedure, infection around the implant is a primary concern. You should do regular spot checks of the tissue around the surgical area for discoloration or discharge of any kind. Additionally, monitor your temperature, as even a slight elevation could indicate the beginnings of an infection.

If you Need to Travel Outside of your Local Hospital

Because a patient recovering from a total disc replacement will have trouble remaining seated for more than a few minutes at a time, travel can be challenging. Be sure to make arrangements that account for this limitation. If you choose to travel internationally, book first class for the return trip so you will have room to recline and spread out. The amount of money saved by having the procedure performed overseas will make this arrangement more affordable. If traveling domestically, train travel should be considered so you can stand and move around a bit as needed. Remaining seated for several hours straight will be painful and possibly damaging during the recovery period.

Any kind of surgery involving the spinal region is sensitive and should only be handled by the most experienced and highly qualified surgeons. The travel logistics are always worth working out to get the best doctor available that you can afford.