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Artificial Disc Replacement Surgery: From Start to Finish

Published December 1, 2017    

What happens when a chronic back pain patient's disc degenerates so much that it needs to be replaced? Artificial Disc Replacement (ADR) surgery is a potential option.

General Overview: Before & DuringAn FDA-approved artificial disc implant.

The purpose of artificial disc replacement (ADR) surgery is to help relieve a patient's chronic back or neck pain and increase mobility in those with chronic lower back pain. Artificial disc replacement (ADR), also known as total disc replacement (TDR) surgery, decompresses the patient's spinal cord and protects the natural movement of the patient's neck, spine, and back.

The Food and Drug Administration (FDA) has approved artificial disc replacement for use in the United States because they have judged this surgery to be safe and effective to relieve a patient’s lower back or neck pain.

The end goal of artificial disc replacement (ADR) surgery is decreased back pain without increased risk of problems occurring at an adjoining level of the patient's spine that can happen as a result of spinal fusion surgery. To date, the results are promising for ADR.


Like other surgeries, you want to ensure that you have the best available spine surgeon operating on your back or neck.

Spine specialists recommend that patients who smoke quit prior to having surgery. If it's not possible to immediately quit, doctors recommend that the patient cut back on cigarette intake, using the nicotine patch for additional support.

The chronic back pain patient should try to exercise on a regular basis in an effort to improve their recovery rate. Doctors suggest stopping any non-essential medications, including herbal remedies, which may react with anesthetics.

There are usually no extraordinary demands for artificial disc replacement (ADR) surgery other than not drinking or eating after midnight the evening prior to surgery. Some physicians also ask patients to undergo bowel preparation.

The Food and Drug Administration (FDA) has approved artificial disc replacement for use in the United States because they have judged this surgery to be safe and effective to relieve a patient’s lower back or neck pain.

Bowel preparation is commonly known as "bowel prep", which is the process of removing all feces from the patient's colon in preparation for surgery or a medical procedure. In many operations, this is necessary to cleanse the colon of stool, food particles and any other nonbodily matters that may be present for several reasons. Speak with your surgeon about specific requirements for your specific surgery.


The concept of an artificial disc isn't new; however, the technology behind it has only been used within the last decade. Although it's innovative in material and configuration, the method of placing an artificial disc (whether in the neck or lower back) is considered routine and safe as told by surgeons at Cedars-Sinai Spine Center in California.

In both traditional and artificial disc replacement (ADR) surgeries, the surgeries starts by eliminating the old gelatinous disc between the vertebrae.

The surgeon makes a small incision on the patient's stomach — normally directly below the belly button. Then, the surgeon shifts the intestinal organs gently to the side. This is done so the surgeon can firmly see the spine to protect the anatomic structures inside the patient's stomach. At this point, the spine surgeon is ready to remove the patient's damaged, degenerated disc and perform ADR.

An artificial disc is then inserted into the patient's spine, replacing the damaged disc with an artificial one using.

Once that disc is dislodged, two metal plates are then pressed into the bony endplates over and beneath the space now relinquished by the old disc. Metal spikes keep those plates fitted against the bone.

Eventually, bone will grow over and around the metal plates,” experts at Cedars-Sinai adds. "A plastic spacer made of a polyethylene (the most common plastic) core is put between the plates. The patient's own body weight compresses the spacer after the surgery is complete. The device allows for a near-natural preservation of motion.”

Post Op: Recovery & Results

RecoveryAn ADR surgeon discussing recovery procedure.

Recovery from artificial disc replacement (ADR) surgery and post-op care are similar to that of other approaches to lumbar spinal surgery. In various circumstances, recovery is faster than for a traditional spinal fusion surgery. There can be less pain from artificial disc replacement (ADR) surgery and fewer complications. 

Many patients in their hospital recovery rooms have felt immediate pain relief or lower pain levels, which is the best-case scenario for this treatment. These are normally the results of cervical disc replacement surgery.

Other patients wake from surgery saying their back pain has been relieved but, complain about new nerve and leg pain, which is a common due to the nature of the procedure. Surgeons call this “distraction pain.” It normally resolves itself within six to eight weeks.


Most patients are out of bed and walking around the evening following artificial disc replacement (ADR) surgery. Patients may need to stay in the hospital for one to two days post-op for monitoring.

There are some restrictions on what activities the patient can do for the first month, but after that, the patient can often resume normal activities with the approval of their physician. Patients should request a complete list of activity restrictions from his or her surgeon. In most cases, the patient can return to regular activities within six to eight weeks of artificial disc replacement (ADR) surgery.

In most cases, a self-directed walking and stretching program is what the patient needs during the first four weeks after artificial disc replacement (ADR) surgery. Later, an abdominal strengthening program may aid those who were deconditioned prior to artificial disc replacement (ADR) surgery.

Regarding doctor follow-ups, patients are typically seen at four to six weeks, three months, six months, one year and once a year after the initial year. X-rays are also done too to make sure the artificial disc hasn’t moved and that your bones have fused with the disc endplates. Additionally, during the X-ray testing, the patient will be asked to bend and move in different positions to ensure the disc is functional.

Many patients in their hospital recovery rooms have felt immediate pain relief or lower pain levels, which is the best-case scenario for this treatment.

Bending X-rays following a patient's ADR allows the surgeon to determine if the motion of the new artificial disc will closely resemble normal motion of a healthy disc.

Last change: January 24, 2019