Diagnosis

Artificial Discs Only When Indicated

Life leaves its mark on everyone. Like everything else, the 23 intervertebral discs of the human spine are subject to the aging process. If, due to shrinkage and loss of elasticity, the disc no longer functions as a spacer between two vertebrae that now are in direct contact, painful processes can result.

The defective disc can put pressure on the spinal nerves and the spinal cord and cause severe pain. This is especially true for the highly mobile vertebrae of the cervical spine. A degeneration of the intervertebral discs in the cervical spine quickly leads to chronic pain, loss of nerve function, numbness, and paralysis even more rapidly than degenerated lumbar discs.

Disc degeneration does not necessarily mean that the use of an implant is indicated. The symptoms listed below are indicative of slight disc degeneration that does not necessarily require surgery:

Muscle tension
Headaches (occasionally)
Stiff neck
Shoulder pain (occasionally)

Indication - Recognizing Severe Disc Degeneration

Many patients with degenerative disc disease have already suffered multiple disc herniations. Disc degeneration is usually not detectable with x-rays. Only magnetic resonance imaging [MRI] can clearly reveal degenerative changes.

Sometimes only surgery can bring relief and prevent further damage. However, the implantation of a state-of-the-art lumbar or cervical artificial disc here in Cologne is only an option for patients whose chronic back pain is caused by disc degeneration and not by muscular or joint problems. In general, the pain caused by disc degeneration occurs only in a single segment of the spine.

The symptoms listed below are indicative of severe disc degeneration that usually can be corrected by artificial disc replacement surgery:

Numbness and loss of feeling
Weakness in arms and legs
Coordination and balance problems
Muscle weakness
Stabbing pain in the arms
Paralysis of the hands

Individual Pain and Suffering Are Determining Factors

Before deciding for state-of-the-art artificial disc replacement surgery, conventional non-surgical treatment options for back pain should have been exhausted. If these conservative treatments (such as physical therapy) did not succeed in relieving pain, and if your pain has persisted for six months or more, then the use of an artificial disc may be considered.

Imaging techniques are not stand-alone diagnostic tools. In addition to radiological images (x-rays and MRI), a recommendation for surgery must also be supported by appropriate clinical observations over a longer period of time, for example by your doctor who should have noted the (painful) symptoms of disc degeneration for a period of six months or more.

Finally, the decision for surgery must be driven by the level of pain and suffering you are experiencing. The justification for surgical treatment resides in the condition of the patient. The final determinant factors are your individual pain level, paralysis, and restriction of movement that we strive to alleviate with treatment.

Checklist

Please note that artificial disc replacement surgery is indicated only for patients whose back pain is caused by disc degeneration and fulfills the criteria described above.

Prior to artificial disc replacement surgery, a comprehensive diagnostic evaluation of the spine must be performed. In general, the use of an artificial disc is indicated only for healthy adults between about 18 to 60 years of age and for whom conservative therapy over a longer period of time did not result in improvement of their back issues.

In order to even consider artificial disc replacement surgery, no additional significant spinal diseases can be present. Another condition for artificial disc replacement surgery is that usually not more than three adjacent intervertebral discs are affected by degenerative changes. In order to clarify whether or not artificial disc replacement surgery is indicated for your particular condition, please complete our questionnaire.

Contraindications - Artificial Disc Replacement is Not for Everyone

Artificial disc replacement surgery is not appropriate for all types of back pain. In case of cervical spine issues, inflammation of the spine (spondylitis), rheumatoid arthritis, instability, and fractures or osteoporosis of the spine must be ruled out. Patients suffering from diabetes or obesity, or patients who are being treated with corticosteroids should not consider artificial disc replacement surgery.

Below are contraindications for lumbar artificial disc replacement surgery:
Acute herniation of the lumbar spine
Herniated disc with constriction of spinal cord or nerve roots
Osteoporosis (pathological decrease of bone density)
Scoliosis or kyphosis
Pseudarthrosis after spinal fusion (spondylodesis)
Significant arthritis of the facet joints
Segment instability
Spondylolisthesis (slipped disc)
Inflammation and infection
Ligament injuries to the spine
Narrowing of the spinal canal (spinal canal stenosis) in the spinal cord or at the nerve roots