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Disc Replacement Side Effects: New Research Is Concerning

POSTED ON IN Back/lumbar Neck/Cervical Side Effects BY Chris Centeno

The whole idea behind disc replacement is that it should have fewer side effects than fusing the spine. The artificial disc allows motion, which is, in theory, similar to a normal biologic disc. However, what if an artificial disc ended up distorting normal motion so badly that it still caused the disc above and below to fail, just like a fusion? A new study suggests that abnormal motion in these devices may be responsible for a whole new class of disc replacement side effects.

The Concept Behind an Artificial Disc

The concept behind disc replacement is to try to eliminate pain and retain movement in the spine by removing an injured disc and replacing it with an artificial (metal or plastic) one, about the size of a small hockey puck. This is in contrast to a fusion where the disc would be removed and the vertebrae fused together to stop movement in that part of the spine. While on the surface it sounds like a better option than a fusion, this is also a very big surgery that can lead to many problems, such as wear-and-tear ions (from metal- or plastic-device breakdown) in the blood, revision surgeries, ongoing pain, and now as the new study shows even adjacent segment disease (typically associated with fusions) due to abnormal motion in the spine.

Before we look at our feature study, let’s review some prior studies we’ve covered concerning disc replacement side effects.

Other Studies Looking at Disc Replacement Side Effects

We’ve known about metal ions in joint-replacement devices, such as knees and hips, for a long time, but a recent study also found significant metal ion concentrations in the blood of patients who’d had cervical disc replacements.

Another study found tissue reactions to wear particles that were just as severe following disc replacement as they were following hip or knee replacements. The most concerning issue was that inflammatory cells were found alongside the wear particles, and unlike in the hip or knee, the spinal nerves are very close here, so inflammation in this area will cause other symptoms.

While this one isn’t a study, it shows a disturbing issue: even young people, as young as teens, are being offered these surgeries despite the serious fusion and disc replacement side effects The young patient featured in the linked post was on the path to disc replacement surgery when her insurance, thankfully, rejected not only the disc replacement but also the aggressive fusion surgery. She was able to find relief through precise injections of her own growth factors.

What Is Adjacent Segment Disease?

To understand adjacent segment disease (ASD), you need to understand the structure of the spine. There are 24 movable vertebrae or back bones. These stack one of top of the other, and stretch from the neck all the way down to the lower back. Between each vertebra is a disc that provides a cushion, and the vertebrae meet in the back at facet joints at each disc level. All of this functions to protect the spinal cord, that big bundle of nerves that runs through our spinal column.

In a fusion, the hardware is installed along two or more vertebrae to permanently “lock,” or immobilize the fused vertebrae. ASD occurs when the fused section overloads the vertebrae above and below it, causing a breakdown in those neighboring unfused levels as well. In ASD bone spurs and arthritis develop, causing a significant amount of pain.

While we’ve know fusion leads to ASD, we’re now finding out that ASD may also be a disc replacement side effect. Let’s look at the new research.

The New Research

The purpose of the new study was to look at the configuration of the vertebral joints and disc in patients who’d had a total disc arthroplasty (TDA), or disc replacement. Researchers concluded, “Under axial rotation of the cervical spine, additional lateral and/or ventral/dorsal displacements are produced by TDA. Consequently, adjacent level disease (ALD) may be mechanically stimulated.” So while adjacent segment disease can be caused by the lack of movement created by fusion surgery locking the spine in place, this study shows it can also be caused by the abnormal motion in the spine that is created by a disc replacement.

The upshot? There is no free lunch in spine surgery. Meaning that all of it is causing damage at some level in an attempt to restore something. In most cases we see, the risks often outweigh the benefits, and in some cases the risk of damage due to surgery is reasonable. In the case of disc replacement side effects, abnormal motion created by these devices may get rid of the main argument for using them—that they don’t cause adjacent segment disease. In fact, the opposite may be true!

 

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    comments

    chris says

    Do you have any opinion on the efficacy of rehab exercises done to specifically target disk health? I have been using a cervical posture pump and Therapeutic Wobble Chair for years now. I feel like they are helping, but honestly have no way of knowing. I wonder if it is even possible to "exercise" a disk to health.

    https://posturepump.com/
    https://pettibonsystem.com/WobbleChairVideo/

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    Chris Centeno says

    Chris,
    Both systems hydrate the disc and take pressure off the structure. Please see:https://www.regenexx.com/sitting-and-sciatica-pain/ A recent study looked at what type of exercise was helpful, and what type to avoid in DDD recently, and found one type of exercise had some regenerative potential:https://www.regenexx.com/ddd-and-exercise/ Exercise can be a good tool in working to manage pain in Degenerative Disc Disease by increasing stability. If significant improvement is not gained because the damage is too great, using your own platelets and stem cells have shown good results in addressing the physiopathology involved in DDD: bulging discs which irritate nerves, instability which leads to bone spurs, and painful facet joints.

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    Steave Parsons says

    Please don't stop these blogs , as l am being enlightened to understand why 80% of doctors diagnosis are wrong . Nothing finer than a honest man telling the truth ; you are compared to confusia of ancient china .

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    Chris Centeno says

    Thank you Steave!

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    Carah says

    I appreciate this blog. I had Arthroplasty December of 2015 and I've had pain in my shoulders, arms, hips and legs. It is frustrating because my lab work only shows Vitamin D & B deficiencies and no inflammatory or connective tissue issues. It makes me feel like a hypochondriac because nothing makes any sense as to why I'm having this pain. I have osteophytes and metal artifacts shown on MRI, as well as a T12 lesion (probably hemangioma) on MRI as well. Any advice? They put me on 1200mg Gabapentin daily.

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    Chris Centeno says

    Carah,
    Was this a disc replacement or another joint? We'd need to see you to figure out what's going on. You can submit the Candidate (to the right of the blog) form if you have a recent MRI to set up a candidacy evaluation by phone. Or you can set up an exam at any of these Regenexx locations with Spine to the right of the name: https://www.regenexx.com/find-a-physician/

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    Tim says

    I had a disc replacement, Jan 2015, at c5/c6. While the radiating pain in the right arm was mostly alleviated, I now have a whole new host of issues! I have pain in my shoulders, arms, collarbone and neck. I suffer chronic headache and I find most daily chores involving lifting, weight baring and raising the arms above shoulder height especially triggering. Glad to hear of others who’ve had further symptoms and it’s not just all in my head!

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    Chris Centeno says

    Tim,
    Sorry to hear that, but unfortunately, your experience is what we see in post fusion patients regularly. We can often help with the Adjacent Segment Disease and diagnosing what's currently going on so that it can be treated, like in this case: https://www.regenexx.com/neck-epidural-failed/ and https://www.regenexx.com/pain-after-back-fusion-adjacent-segment-disease/

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    Andrea says

    Do the stem cell and PRP procedures you offer help with pain from adjacent segment disease?

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    Chris Centeno says

    Andrea,
    Yes, Please see:https://www.regenexx.com/pain-after-back-fusion-adjacent-segment-disease/

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    Anita says

    I have Charite disc replacement in 2006. After surgery I had lots of pain relief, including epidurals. Eventually after pain relief via a procedure through my back I was actually free from pain in 2010. Over the last year the pain has returned and has gradually increased to me not being able to just do what I would call, normal things, i.e. getting out of bed in the morning, emptying the dishwasher, without increased pain. If I wake up on my back I'm in agony trying to turn round, the pain actually comes from the back through to my pelvic area, and today has been my worse. I've spent the last 5 hours with constant pain, plus shooting nerve pain on the right side, just above my right hip. I've been told I cannot go back to the consultant till I try physio. I was given 1 session, then discharged 5 minutes into my 2nd, they said physio was the correct way forward for me. So I'm now due to see a consultant in 2 months. Has anybody else had these pains at all - if, so what happened?

    Many thanks

    Anita

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    Chris Centeno says

    Anita,

    It sounds like you might be in the UK? We've known fusion causes adjacent segment disease for a long time, and although disc replacement was conceived to prevent that, it hasn't. With lumbar fusion, the hip is often affected. Please see: https://www.regenexx.com/yet-another-rason-low-back-fusion-mostly-dumb-idea/ and https://www.regenexx.com/disc-replacement-side-effects/ and https://www.regenexx.com/neck-epidural-failed/ If you are in the UK and would like to see if we can help, we have a Regenexx location in Brussels. Please see: http://oreme.eu/https://www.regenexx.com/find-a-physician/

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    Dave Mataftin says

    I had a Bryan disc replacement C5-6 about two years ago in Seattle. I ha d a great MD who did my surgery. BEFORE surgery he indicated my disk had completely failed and a second C6-7 was also becoming a problem. I've been very happy with the outcome of the surgery, but now some two years later I'm getting similar symptoms as I had before surgery. Right hand numbness during sleep, general Right sided neck pain and at times Right shoulder pain.

    Anyway, this comes as no surprise to me as I was told about the second weakened disc and viewed it on both x-ray and CT. I'm not at all concerned about a potential second surgery, but would like to get some input here. As I understand it the FDA allows for a second "stacked" disc. One final question, should I be concerned about chiropractic treatments? I've not had any since surgery but am considering it now to stave off surgery.

    Thanks-Dave

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    Chris Centeno says

    Dave,
    The symptoms mentioned are likely originating from that area. Please see: https://www.regenexx.com/a-colorado-regenexx-patient-review-pain-free/ As it discusses in the blog, while disc replacement was originally developed to avoid the Adjacent Segment Disease caused by fusion by allowing motion, unfortunately, ASD has been associated with Disc replacement as well. Please see: https://www.regenexx.com/pain-after-back-fusion-adjacent-segment-disease/ We treat ASD regularly, as well as the issues that disc replacement seeks to fix, nonsurgically, but we'd need more information through the Candidacy process to advise. If you'd like to do that, please submit the Candidate form. https://www.regenexx.com/the-regenexx-procedures/back-surgery-alternative/ An MRI would be needed.

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    Ken Katz says

    I would be interested to see your thoughts on the newer 3rd generation discs such as the spinal kinetics M6 and LP ESP available in europe. admittedly still artificial, these have been designed to mimic the motion and shock absorption of the disc (extensive lab testing and now >9 years use, 50K implants worldwide for M6). It appears heads and shoulders above the first and second generation discs to which these studies you reference refer. some patients may not respond to biologics so other options besides fusion and older disc technology are now available. Its moving in the right direction. Obviously surgery is still a risk but sometimes it is needed and can be a terrific option in the right surgical hands for the right indication. and if done well it can essentially replace the natural tissue which just doesn't have the capacity any more.
    www.spinalkinetics.com

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    Chris Centeno says

    Ken, medical care should always progress from less invasive to more. Right now, advanced spinal biologics fill that doughnut hole between traditional PT and block shop procedures and invasive surgery. We can prevent most patients from needing a disc replacement. I suspect that as spinal biologics mature and get better coverage, the number of disc replacement procedures will drop. However, better disc prostheses are always welcome for patients that can't be treated in any other way.

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    Ken Katz says

    That is fair and agree wholeheartedly. I myself have tried bioligics and am trying to remodel and help my spine naturally. It isn't easy but believe it can be done to get improvement.

    Surgery still should remain a last option but at least things are getting better from the days of old.

    Thank you

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    Rory McQuiston, PhD says

    I had C6-7 fused in August 2016 after viewing my MRI displaying significant spinal cord compression. I was talked into fusion by a couple of surgeons both of whom were second opinions. I wanted arthroplasty (total disc replacement or artificial disc replacement, ADR) but they both said that they believed the outcome was no better than with anterior cervical discectomy and fusion (ACDF). One of the two said that he didn't like doing artificial disc replacements and that if you really look at the data closely there are only insignificant differences, and after all an individual disc only provides 7% or movement in the cervical regions. Then he applied scare tactics regarding the trauma that a failed ADR would cause resulting in the need for increased number of levels of the cervical spine that would have to be fused to correct for the failure. The other couldn't do ADR and said that at our age (I was 51 at the time) we are better off with fusions. The latter also said that he had never seen a patient with an ACDF require revision surgery. WELL, in just over a year, my C5-6 has had a major rupture, even though it looked completely healthy prior to surgery. And when I mean major, to quote that latter surgeon, it is "incredible" in size. Biggest he has ever seen. Amazed that I don't have more significant symptoms. So, I have to say that anyone that is a candidate for ADR should choose ADR over ACDF. If you are active then you are going to require further surgery after an ACDF. Personally, because my extrusion is so large I am going to wait to see if I get significant resorption of the extruded disc (apparently the bigger the better in the resorption world). If I don't get enough resorption off of my nerve root and my twisted spinal cord doesn't normalize, then I am going to find a competent surgeon with significant experience doing artificial disc replacements. Surgeons doing anterior cervical discectomies and fusion are dinosaurs that need to retire. Do yourselves a favor, don't let dinosaurs talk you into fusions unless your spine has significant issues that would warrant that procedure. I am mad at myself for listening to these idiots and not believing the objective data that has been published in the literature.

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    Chris Centeno says

    Regrettably, since ADR has the same side effect profile as ACDF, there is no surgical solution to your problem that doesn't have the significant side effect of ASD.

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    Rory McQuiston, PhD. says

    Okay, lets try this again. I was denied my posting the last time because I did not provide references to my statement, even though my posting was in response to an inaccurate and non referenced response to my initial comment. Nevertheless, I will try again. Although I could not find the reviews that I had read previously, I will restrict my comments to the citations that I came across in the last half hour on the internet. Believe me it is not hard to find (most) studies indicating that total disc replacement (TDR) is superior to anterior cervical discetomy and fusion (ACDF) in every way from post op recovery to long term satisfaction. I know this from personal experience. I am very unsatisfied with ACDF - it was a complete failure. Anyway, I would submit that in the early days when surgeons were experimenting with cervical disc replacement things were pretty much equivalent to ACDF, largely due to the lack of expertise or competency in a new technique. That can be expected. However, as surgeons have become proficient in this skill, comparisons of the two techniques ACDF vs TDR have become more clear. This is most obvious in recent studies indicating that TOTAL DISC REPLACEMENT is SUPERIOR in terms of recovery, movement, and long term prognosis (far fewer future surgeries due to adjacent disc stress - i.e. basically the probability of you having to have another surgery is much lower - unlike me!):
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519406/
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379027/
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852596/
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312992/
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810897/
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728832/
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351268/
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810892/
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5706295/
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895371/
    And with improved devices and more experienced surgeons things are likely to improve significantly. So you can be the judge. Believe the M.D. who will choose the easiest path for themselves, or choose the better outcome for you. Stem cells won't help you. I had ACDF without stem cells and I fused fine (unfortunately). And I am in worse shape now, (less that 2 years later), than I was when I walked into the pre-op room. Although my current adjacent cervical disc extrusion is enormous (it twists my spinal cord), I will not have another fusion under any circumstances. If it comes to it, I will choose the most appropriate artificial disc, and the most experienced surgeon with that device, to perform the operation. Please, don't do what I did and panic.

    P.S. I am happy to upload my MRI's showing what an ACDF can do to a perfectly normal, healthy, adjacent disc. DON'T DO IT. ACDF is an unnecessary traumatic experience that will result in disappointment.

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    Chris Centeno says

    Rory, many of the studies you have posted were included in the meta-analysis or excluded due to having a mixed population of patients, see https://www.thespinejournalonline.com/article/S1529-9430(18)30194-3/fulltext?rss=yes . Your n=1 experience is noted.

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    Tanya Westphal says

    I had this procedure done in my lower back Ll4 and L5) 3 years a ago
    7 days after the procedure my abdomen was so distentend it was like I was 9 months pregnant.
    I have seen so many doctors since then.
    My symptoms are lower abdominal swelling that happens randomly but at least 20 times that I documented when it got really bad.
    I saw a gynecologist once when the swelling was extreme and she said my uterus was double the size of a normal one and thought I was pregnant. She along with everyone else can not figure out where this is coming from. I have had cat scan and mri and still no diagnosis for that.
    Chronic pain in my joints. Hands, neck, knees especially
    I have also vision loss and memory loss that is progressing
    Exhaustion and weight loss
    I am back on pain management and every day is a struggle.
    I just saw a documentary that many patients that have had metals put in their bodies for joint replacements (hip especially) are suffering from some form of metal toxicity and inflammation side effects.
    Is anyone else having these issues?

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    Victoria harrell says

    I was part of a study done in Atlanta GA and had TDR several years ago. Since that surgery I have had worsening pain and have had to undergo multiple surgeries for issues with the discs above and below the replacement disc. Over the past three years my overall health has gone drastically down hill and I have severe autoimmune problems, severe skin rashes/dermatitis and my recent MRI shows 3 bulged discs, a dislocated disc, multiple fissures, stenosis, narrowing of the spine and a number of other issues with my facets. I have been doing research on this and found many articles discussing metal allergies with implants and the symptoms are identical to mine. When I took my recent MRI report, lab reports and the piles of other medical reports I have to the DR who did the TDR he refused to acknowledge I had any problems, told me my disc looked fine and said he ultimately could no longer help me. I am at a loss on what to do as this is ruining my health and life. I desperately need help.

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    Chris Centeno says

    I'm so sorry to hear about your experience. The next best step is usually to get metal sensitivity testing via a dermatologist. See https://www.regenexx.com/more-problems-with-knee-and-hip-replacements-allergy-testing-now-advised/

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    Robert Gazy says

    OK, so I'm not sure what's happening. I saw a surgeon yesterday who said it was my choice to get fusion or replacement, but replacement seems to be generating better outcomes in the 10+ years it has been in widespread use. He also related a story about one of his (hundreds) of patients that developed a severe allergic reaction to the stainless steel that caused severe difficulty breathing, etc., but that they went back in very quickly and fused instead.

    I'm doing my research and trying to avoid the biased data that comes from people who are selling stuff (like the replacement disc makers). The NIH studies (for example https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752293/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895371/) seem to say that replacement is a newer procedure than fusion, so less data is available, but overall outcomes with replacement are better than fusion.

    Do you agree with the conclusion that replacement is showing overall better outcomes than fusion, and if not, why not?

    Thank you.

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    Chris Centeno says

    Robert,
    They cause a different set of problems.There is no free lunch in spine surgery. Meaning that all of it is causing damage at some level in an attempt to restore something. In most cases we see, the risks often outweigh the benefits, and in some cases the risk of damage due to surgery is reasonable. In the case of disc replacement side effects, abnormal motion created by these devices may get rid of the main argument for using them—that they don't cause adjacent segment disease. In fact, the opposite may be true, and if after all less invasive procedures were tried and failed first, the decision would need to be made on a case by case basis.

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    Katie says

    I had two artificial discs placed in my cervical spine in 2016. Prior, my pain was unbearable and was located in one area of my right my chest like a sharp drill from front to back. I suddenly lost ability to grip a toothbrush with my right hand or write my name. After surgery I felt ok. But gradually I started getting severe pain in my lower neck. My fingers started cramping and shooting straight out and I could not bend them. I had cortisone injections placed on both sides of the discs two times each. They helped luckily. It took over a year to get strength in my hand. The other discs pop and crack a lot. I am just waiting for them to go. I called the company to see if the discs could be removed by any doctor in the nation. I didn’t get a response. I would definitely have had a fusion if I had known. My fingers have started shooting out and locking up again.

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    Regenexx Team says

    Hi Katie,
    Unfortunately, Disc replacement has not avoided the problems of Fusion it was supposed to. While Cortisone injections provide temporary relief, they are a net negative. Please see: https://www.regenexx.com/blog/why-are-we-still-injecting-steroids-into-knees-and-spines/ We can often help with the problems created in the adjacent segments. Please see: https://www.regenexx.com/blog/pain-after-neck-fusion-2/ If you'd like to see if your particular situation would be a Candidate, please submit the candidate form here: www.regenexx.com.

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    Jason M. Cuéllar, M.D., Ph.D. says

    I think I would be careful about criticizing artificial disc replacement as a whole class of treatment. I have seen many patients with excellent outcomes for many years. You must take into consideration two things: 1) the spine surgeon that put them in - usually problems post op are more related to surgical technique than to something being wrong with the device, and 2). The device itself - not all devices are created equal; I don’t like the sloppy motion of the MobiC for example, but the 7 year two level randomized controlled trial on Medtronic Prestige LP for example shows far superior outcomes when compared to two level fusion. This implant has no nickel, which is the metal most common to cause an allergy in a small percentage of patients. And no, the metal ion level in the blood is far lower than that after metal on metal total hips. Make sure you check your facts before knocking something publicly.

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    Regenexx Team says

    Hi Jason,

    While some patients may require a cervical disc replacement, we are able to help avoid this invasive surgery in most patients deemed candidates. Hence, whether it's fusion or ADR, it's all too invasive if it can be avoided through injections.

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    Alan Jones says

    Hi. I am a Retired Trauma Surgeon, FRCS and FRCEM in the UK. I read all the comments with great interest especially an MD/PhD as well as a PhD poster. I was considering between an cervical fusion or artificial disc for my C4/5/6 and later my L3/4/5 all caused by trauma from out of hospital rescues resulting in ruptured L5 right and ruptured L4 left massive extrusions. I think I will keep my pain and continue with my celebrex. The previous posts have scared the shit out of me.

    replies

    Regenexx Team says

    Hi Alan,
    There is a good chance that our UK Regenexx providers may be able to help. Please see: https://www.algocells.com/?utm_source=regenexxreferral&utm_medium=webreferral&utm_campaign=regenexxlocations and https://www.regenexx.com/conditions-treated/spine/

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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