Spinal disc replacement surgery replaces your damaged disc (in your neck or lower back) for an artificial one that still bends and glides. Patients increasingly ask me about this newer procedure after more than twenty years of putting implants into human joints, I want to explain the engineering honestly, and carefully highlight both the benefits and risks.
What is spinal disc replacement surgery?
Spinal disc replacement surgery removes a worn or damaged intervertebral disc (the cushion between two spine bones) and replaces it with a manufactured implant designed to preserve motion at that level. Surgeons also call it artificial disc replacement, total disc replacement, or disc arthroplasty. Those names all describe the same operation. If your problem is in the neck specifically, the details of cervical disc replacement surgery are covered separately.
The disc itself is not just padding. It has a tough outer ring and a softer center that absorbs load and lets the vertebrae tilt and rotate. When that structure breaks down, the spacing narrows and nearby nerves can get pinched.
Here is what I tell my patients: an artificial disc is trying to do the same job my hip implants do. Restore the space, restore the bearing surface, keep the motion.
What does the artificial disc actually do?
Modern disc implants pair metal endplates (usually titanium or surgical steel) with a bearing core made of medical-grade plastic or a compressible elastic material. The endplates lock into the bone above and below. The core in the middle takes the load and allows the segment to bend, twist, and compress.
That middle piece is the whole ballgame. In hip and knee replacement we learned decades ago that if the bearing surface cannot move the way the original joint moved, the implant takes abnormal stress and wears out faster. Spine implants follow the same rule.
How long does spinal disc replacement surgery take?
Roughly one to two hours per level treated, under general anesthesia. A single-level neck case is often quicker; a two-level lumbar case takes longer.
Access differs by region. Cervical (neck) discs are reached through a small incision at the front of the throat. The windpipe and blood vessels are gently moved aside.
Lumbar (lower back) discs are reached through the front of the abdomen. A vascular or general surgeon often assists, because large blood vessels sit directly over the spine.
How does disc replacement compare to spinal fusion?
Fusion locks two vertebrae together permanently. Disc replacement keeps them moving. Keeping the motion means the levels above and below absorb less extra work, which may lower the risk of trouble at those levels years later.
The evidence there is detailed and still maturing. If you want the studies rather than the summary, read the research comparing disc arthroplasty and fusion.
Does Dr. Calendine perform spinal disc replacement surgery?
No. My surgical practice is hip and knee replacement only, roughly 700 joint replacements a year, and I do not operate on the spine.
If your neck or back is the problem, you want a surgeon who does spine work every day. At the Bone and Joint Institute of Tennessee, that is Casey Davidson, MD, Zachary Kalb, DO, John Klekamp, MD, and Michael McNamara, MD. They treat degenerative disc disease, herniated discs, stenosis, and pinched nerves, using both disc replacement and fusion. You can reach the BJIT spine team at the same Franklin phone number you would use to reach me.
I say this plainly because scope matters. A surgeon who claims he does everything is telling you something about his practice.
Could your leg pain be coming from your hip instead of a disc?
Yes, and this mix-up is common enough that I see it most weeks. Hip arthritis and lumbar nerve compression can produce pain in overlapping places, and patients frequently arrive at my office after months of back treatment that never helped.
Some patterns worth knowing:
- Groin pain that shows up when you stand, pivot, or get out of a car usually points to the hip joint.
- Buttock and posterior thigh pain that runs past the knee into the calf or foot, especially with numbness or tingling, points toward a nerve in the lower back.
- Pain putting on socks or shoes is a hip stiffness sign, not a disc sign.
- Pain that eases when you lean forward on a grocery cart is a classic spinal stenosis pattern.
Plenty of people over sixty have both problems. The MRI shows disc wear, which is nearly universal with age. The X-ray shows an arthritic hip. Treat the wrong one and you end up two surgeries deep and still limping.
In my practice, an injection of numbing medicine into the hip joint often settles the argument. If the leg pain quiets down for a few hours, the hip was the driver, and total hip replacement is the conversation. If nothing changes, the spine team takes it from there.
Who is a good candidate for spinal disc replacement?
The strongest candidates have pain from one or two discs, good motion left at that level, and little arthritis in the small facet joints behind the disc. They have also tried months of nonsurgical care without relief. Artificial discs carry FDA approval for one-level and two-level use in both the neck and the lower back. Most candidates carry a diagnosis of degenerative disc disease.
Spine surgeons typically look for:
- Symptoms lasting six months or more for the lower back, or about three months for the neck, without improvement from therapy, medication, or injections
- Imaging that matches the symptoms, not just imaging that looks abnormal
- Preserved disc height and segment motion
- Healthy bone density
- No prior surgery at that same level
Who is usually not a candidate?
Disc replacement is usually ruled out by osteoporosis (thin, weakened bone), significant facet joint arthritis, spinal instability or slippage, scoliosis, active infection, or severe stenosis.
That last one matters. If the nerve needs more room than an implant can create, a fusion or a decompression is the better operation, and a good spine surgeon will say so.
What is recovery like after disc replacement?
Most patients spend at least one night in the hospital, walk the same day as surgery, and are back to ordinary daily activity within a few weeks. Return to full, unrestricted activity generally lands around three months.
A rough sequence looks like this:
- Day of surgery: up and walking with staff assistance
- Week one: short frequent walks, no lifting beyond ten to fifteen pounds
- Weeks two to four: desk work for many patients, driving once off narcotic medication and cleared by the surgeon
- Weeks four to six: physical therapy for core and postural strength
- Three months: most patients reach their new baseline
Bracing rules vary by surgeon and implant. Some patients wear nothing at all. Others wear a soft collar or corset for a few weeks.
What are the risks of spinal disc replacement surgery?
Every operation carries risk of infection, bleeding, blood clots, and injury to nearby structures. Disc replacement adds implant risks on top of that: the device can loosen or shift, it can wear over time, and some patients need revision surgery later.
One risk is worth naming. Heterotopic ossification means unwanted bone forms around the implant, which can quietly stiffen the segment the surgery was meant to keep moving.
Results also depend on the symptom. Disc replacement works most reliably for radiculopathy, the shooting nerve pain that runs down an arm or leg. Relief of neck or back pain by itself is less predictable, and any surgeon who promises otherwise is overselling.
I say the same thing about hips and knees. These are low-risk operations, not no-risk operations, and your surgeon should say that out loud before you sign anything.
Where to get evaluated in Franklin and Middle Tennessee
The Bone and Joint Institute of Tennessee is at 3000 Edward Curd Lane, Franklin, TN 37067, on the Williamson Medical Center campus just off I-65. Patients drive in from Nashville, Brentwood, Spring Hill, Columbia, Nolensville, and Murfreesboro. Imaging, physical therapy, spine specialists, and joint replacement all sit under one roof.
If your main problem is neck or back pain, call (615) 791-2630 and ask for the spine team.
If your problem is hip or knee pain, or you are not sure which joint is at fault, that is my area. You can request a consultation with Dr. Calendine or call the same number. No referral required.
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Medical disclaimer: This article is for educational purposes only and does not replace medical advice from a qualified physician. Individual results vary. Talk with a licensed surgeon about your own imaging, symptoms, and treatment options. In a medical emergency, call 911.
References
- Othman YA, Verma R, Qureshi SA. Artificial disc replacement in spine surgery. Ann Transl Med. 2019;7(Suppl 5):S170. Full text
- Steinberger J, Qureshi S. Cervical disc replacement. Neurosurg Clin N Am. 2020;31(1):73-79. PubMed
- Phillips FM, Coric D, Sasso R, et al. Prospective, multicenter clinical trial comparing the M6-C compressible six degrees of freedom cervical disc with anterior cervical discectomy and fusion for single-level degenerative cervical radiculopathy: 2-year results of an FDA investigational device exemption study. Spine J. 2021;21(2):239-252. PubMed
- Paek S, Zelenty WD, Dodo Y, et al. Up to 10-year surveillance comparison of survivability in single-level cervical disc replacement versus anterior cervical discectomy and fusion in New York. J Neurosurg Spine. 2023. PubMed
- Witiw CD, Smieliauskas F, Ham SA, Traynelis VC. Cervical disc replacement: examining real-world utilization of an emerging technology. J Neurosurg Spine. 2020;32(5):689-695. PubMed
- Maldonado DR, Mu BH, Ornelas J, et al. Hip-spine syndrome: the diagnostic utility of guided intra-articular hip injections. Orthopedics. 2020;43(2):e65-e71. PubMed
