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Artificial Disc Replacement for Degenerative Disc Disease

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Physical anatomical models of the human spine and vertebrae being used by a medical professional to explain spinal disc arthroplasty and degenerative disc disease. Cervical disc arthroplasty

Cervical Disc Arthroplasty (CDA) in the US

What is Spinal Disc Arthroplasty (SDA) for Degenerative Disc Disease (DDD)? Spinal disc arthroplasty, or artificial disc replacement, is a motion-preserving surgical alternative to traditional spinal fusion for patients suffering from degenerative disc disease. While traditional methods like Anterior Cervical Discectomy and Fusion (ACDF) have long been considered the gold standard, SDA offers the distinct advantage of preserving segmental motion and significantly decreasing the risk of adjacent disc disease. Currently FDA-approved for one- and two-level disc pathologies in the cervical and lumbar spine, this advanced procedure helps restore mobility and alleviate nerve root compression. At the Bone and Joint Institute of Tennessee, Dr. Cory Calendine and his team provide personalized, minimally invasive surgical care to help patients return to an active lifestyle with improved spinal function.

Anterior cervical discectomy and fusion (ACDF) is historically the gold standard for treating degenerative disc disease (DDD) in the cervical spine. More recently, cervical disc arthroplasty (CDA) has become more prominent as an alternative to ACDF for treating cervical DDD due to its ability to preserve segmental motion and decrease the risk of adjacent disc disease along with nerve root compression. Long-term clinical studies on single-level treatments have demonstrated superior clinical outcomes for CDA versus ACDF.

 

FDA Approved Spinal Disc Arthroplasty Procedures

  • CDA is currently approved by the FDA for one- and two-level disc pathologies (there are no approved trials for three-level or more cervical pathologies)
  • Thoracic SDA has not been approved by the FDA
  • Multilevel SDA has been approved in the cervical and lumbar spine, but hasn’t been approved in >2 adjacent vertebral levels
  • Hybrid arthroplasty (arthroplasty and fusion techniques are combined in alternating fashion at adjacent levels) compared with SDA is currently being studied in clinical trials
  • SDA has been approved for usage in one- and two-level lumbar disc pathology with encouraging results (SDA was first approved in the lumbar spine by the FDA on October 26, 2004)
  • SDA has not yet been approved for more than two adjacent vertebral levels.
Table showing FDA approval dates for cervical and lumbar artificial disc replacement devices from 2004 to 2020.
FDA approval timeline for cervical and lumbar disc arthroplasty devices (2004–2020), beginning with the Charité lumbar disc in October 2004 and progressing through cervical systems including Prestige, Prodisc, Bryan, Mobi-C, M6-C, and Simplify.

Current Spinal Disc Replacement Summary

SDA (first approved by FDA in 2004) continues to be an alternative to standard decompression and fusion methods for the treatment of DDD. Clinical studies have shown that CDA preserves segmental motion and decreases the risk of adjacent disc disease and nerve root compression when compared to ACDF. Lumbar arthroplasties have also been shown to be safe and effective. The FDA has approved treatment of one- and two-level cervical and lumbar disc pathologies. There are no approved trials for thoracic disc replacement. More recent studies have shown excellent outcomes with three-level or more disc arthroplasties at adjacent levels. New surgical methods investigating the combination of decompression and fusion with arthroplasty have shown comparable results to disc replacement alone. (more data are needed for FDA approval).  Continued surgical studies, utilizing long-term randomized controlled trials or observational studies with larger patient sample sizes, are needed to better evaluate the efficacy of SDA vs. more traditional fusion methods.

Full Article: “Investigational Research: Timeline, Trials, and Future Directions of Spinal Disc Arthroplasty” [Published online 2021 Jul 29. doi: 10.7759/cureus.16739]

For The Latest Spinal Disc Replacement Information

The Bone and Joint Institute of Tennessee’s spine specialists offer personalized surgical and non-surgical treatment for neck and back problems. Whether you’re suffering from trauma, injury, arthritis or other orthopaedic condition, our experts will help relieve pain and restore mobility. We offer the most up-to-date surgical care for spinal conditions, including total disc replacement and minimally invasive spinal surgery. It’s important to note that not all spinal problems require surgery, and we recognize that every patient is different. That’s why our specialists seek out the least invasive and most effective treatment option for each patient. Physical therapy and rehabilitation are also essential elements of spinal care, and we have an experienced team of medical professionals armed with the latest recommendations and tools to help promote healing. For more information or to schedule an appointment, call 615-791-2630.

Bone and Joint Institute of Tennessee Spine Specialists

Bone and Joint Institute of Tennessee spine specialists: Dr. Casey Davidson, Dr. Zachary Kalb, Dr. John Klekamp, and Dr. Michael McNamara.
Meet the Bone and Joint Institute of Tennessee spine team: Casey Davidson, M.D., Zachary Kalb, D.O., John Klekamp, M.D., and Michael McNamara, M.D. — fellowship-trained spine specialists offering personalized surgical and non-surgical care for cervical and lumbar conditions, including cervical disc arthroplasty.
Additional Educational Videos:

*Please note that these are only educational videos and not precisely how the procedure may be performed at the Bone and Joint Institute. Videos are meant to be used as a general explanation of the procedures.

Keywords: disc arthroplasty, artificial disc, degenerative spine disease, lumbar disc degeneration, cervical disc degeneration, interbody device, range of motion, pseudoarthrosis, adjacent segment disease, hybrid

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FREQUENTLY ASKED QUESTIONS

Common Questions From Readers

What is the main benefit of an artificial disc over a spinal fusion?
The primary advantage of spinal disc arthroplasty (SDA) is that it preserves the natural motion of the spine. Traditional fusion (ACDF) locks the vertebrae together, which can increase the stress and wear on the discs directly above and below the surgical site. SDA reduces this “adjacent segment disease” and maintains greater flexibility for the patient.
Yes, the FDA has approved spinal disc replacement for specific uses. Lumbar disc replacement was first approved in 2004, and today, artificial disc procedures are approved for one- and two-level pathologies in both the cervical (neck) and lumbar (lower back) regions. It is not currently approved for more than two adjacent levels or for the thoracic spine.
Long-term clinical studies focusing on single-level treatments have demonstrated superior clinical outcomes for cervical disc arthroplasty (CDA) compared to traditional fusion (ACDF). Patients typically experience preserved motion and a lower incidence of nerve root compression or further disc degeneration in surrounding areas.
No, there are currently no FDA-approved trials or procedures for thoracic spinal disc arthroplasty. Treatment for degenerative disc disease via artificial disc is currently limited to the cervical and lumbar sections of the spine.
Hybrid arthroplasty is a surgical technique currently being studied where a surgeon combines both artificial disc replacement and fusion techniques in an alternating fashion across adjacent levels of the spine. While recent studies show results comparable to using only disc replacements, more data is required for full FDA approval of this specific hybrid approach.
Dr. Cory Calendine, MD, board-certified orthopedic surgeon specializing in hip and knee replacement at the Bone and Joint Institute of Tennessee in Franklin, TN, shown in a gray suit with glasses and a blue tie during a professional portrait session.

BOARD-CERTIFIED · FELLOWSHIP-TRAINED

About Cory Calendine, MD

Dr. Cory Calendine is a board-certified, fellowship-trained orthopedic surgeon specializing in hip and knee replacement at the Bone and Joint Institute of Tennessee in Franklin, TN. He performs more than 700 hip and knee replacement procedures annually and serves as a consultant to Stryker for the Mako® robotic platform.

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