Learn about nonsurgical options to get you back to your everyday activities.
Artificial Disc
Perhaps the most anticipated advance in spine surgery over the past 20 years was the arrival of the artificial disc. The first artificial disc in the United States received formal approval by the Food and Drug Administration (FDA) for widespread use in the United States on October 26, 2004. While this technology is somewhat new to the U.S., artificial discs have been in use in Europe for more than 15 years.
It is important to remember that this technology is still evolving with new implants continually in development. Your spine surgeon is the best resource to discuss if it is appropriate for you, and what model of artificial disc is best suited for your case.
For example, there are about several models of artificial discs approved by the FDA for use in the United States and the number is expected to grow as new models emerge on the scene and surgeons become trained in their use. Each disc is designed for use either in the low back (lumbar area) or neck (cervical area).
In addition, other artificial disc models are available on a limited basis through “clinical trials” where a patient agrees to be part of clinical study designed to measure the success of a new disc model, which will be part of an FDA study. Patients who participate in a clinical trial can gain access to the most current technology, even though it has yet to gain FDA approval for use in the U.S.
An Alternative to Fusion Surgery
The artificial disc concept is intended to be an alternative for spinal fusion surgery. Each year in the U.S., more than 200,000 spinal fusion surgeries are performed to relieve excruciating pain caused by damaged discs in the low back and neck areas.
During a fusion procedure, the damaged disc is typically replaced with bone from a patient’s hip or from a bone bank. Fusion surgery causes two vertebrae to become locked in place, putting additional stress on discs above and below the fusion site, which restricts movement and can lead to further disc herniation with the discs above and below the degenerated disc. An artificial disc replacement is intended to duplicate the function level of a normal, healthy disc and retain motion in the spine.
When a natural disc herniates or becomes badly degenerated, it loses its shock-absorbing ability, which can narrow the space between vertebrae. In fusion surgery, the damaged disc isn’t repaired but rather is removed and replaced with bone that restores the space between the vertebrae. However, this bone locks the vertebrae into place, which can then damage other discs above and below.
A common aspect of all artificial discs is that they are designed to retain the natural movement in the spine by duplicating the rotational function of a normal healthy disc. Most artificial disc designs have plates that attach to the vertebrae and a rotational component that fits between these fixation plates. These components are typically designed to withstand stress and rotational forces over long periods of time. Still, like any manmade material, they can be affected by wear and tear.
Benefits
Some of the main benefits of the artificial disc parallel that of knee replacement and hip replacement. This can include the following benefits:
- An artificial disc in the neck or back, in principle, is designed to retain motion in that particular segment of the spine.
- It prevents degeneration of disc levels above and below the affected disc
- There is no bone graft required
- There can be a quicker recovery and return to work or activity
- It can be a less invasive and less painful surgery than a fusion
- There can be less blood loss during surgery
Lumbar vs. Cervical Artificial Discs
Because of the weight of the body and the rotational stress that the trunk places on discs in the low back (lumbar) area, more stress is placed on artificial discs in the lumbar area than in the neck (cervical) area, which only supports the weight of the head.
A second issue relates to the ease of the artificial disc surgery and any necessary revision surgery to replace a worn out artificial disc. Because the surgeon must access the front of the spine, an incision is made in the abdomen for lumbar discs and in the front of the neck for cervical discs. Generally speaking, many spine surgeons believe access to the cervical discs can be easier than the lumbar discs.
Other issues to consider
When treating knee and hip replacement patients, orthopedic surgeons try to postpone the implantation of an artificial joint until a patient is at least 50 years old so that they do not outlive their artificial joint, which typically lasts anywhere from 15 to 20 years. Revision surgery, which may be necessary to replace a worn-out artificial joint, can be complex. Unlike knee and hip replacement patients who are typically in their 50s or 60s, many patients can benefit from artificial disc technology at a much younger age — in their 20s or 30s. Therefore, the implantation of an artificial disc in younger patients can raise a surgeon’s concern about the potential life span of the artificial disc in the spine. If the artificial disc wears out, that will require a second revision surgery to replace the worn-out artificial disc. This revision surgery can be far more complex than the initial surgery.
The spine surgeons at Texas Spine and Scoliosis currently use the following artificial discs for the neck:
- Mobi-C
- Centinel Spine Pro-Disc C
- Medtronic Prestige LP
It is important to understand that not every disc herniation qualifies for an artificial disc. Each patient is evaluated by the spine surgeon to determine if their herniation is appropriate for an artificial disc, and then which artificial disc would be best for each person. For example, some discs come in different sizes to adjust for smaller frames, such as with women and smaller men.
How to Choose Between Prestige-LP, Mobi-C, and ProDisc-C
| Feature | Prestige-LP | Mobi-C | ProDisc-C |
|---|---|---|---|
| Material | Titanium-ceramic alloy | Cobalt-chromium + Polyethylene | Cobalt-chromium + Polyethylene |
| Core Type | Ball-in-trough (fixed) | Mobile core | Ball-in-socket (fixed core) |
| Motion Allowed | Good motion, some translation | Full natural motion + translation | Controlled motion, limited translation |
| Fixation | Keel-based | Teeth-based (no keel) | Keel-based |
| FDA Approval | 1-level only | 1-level and 2-level | 1-level only |
1. Number of Levels Affected
- 2-Level Replacement: Mobi-C is the only FDA-approved disc for 2-level replacement.
- 1-Level Replacement: All three discs are FDA-approved for this use.
2. Motion Requirements
- Mobi-C: Offers the most natural motion with a mobile core.
- Prestige-LP: Allows good motion but with a fixed, metal-on-metal design.
- ProDisc-C: More constrained motion — stable but less natural.
3. Surgeon Experience & Preference
- ProDisc-C: Preferred for stability in patients with good bone density.
- Mobi-C: Popular for its flexibility and 2-level approval.
- Prestige-LP: Valued for long-term durability and metal-on-metal wear resistance.
4. Bone Quality & Surgical Considerations
- Keel-based designs (Prestige-LP, ProDisc-C) require good bone quality and more invasive implantation.
- Mobi-C uses a teeth-based design — less bone removal, often preferred for older patients or lower bone density.
5. Metal Sensitivity
- Prestige-LP: Made from titanium-ceramic alloy — better for those with metal sensitivity.
- Mobi-C and ProDisc-C: Contain cobalt-chromium, which may cause reactions in sensitive individuals.
6. Insurance & FDA Labeling
- Mobi-C: FDA-approved for both 1-level and 2-level use — but check insurance for 2-level coverage.
- Prestige-LP & ProDisc-C: FDA-approved for 1-level only.
Quick Comparison Table
| Factor | Best Choice |
|---|---|
| 2-Level Replacement | Mobi-C |
| Most Natural Motion | Mobi-C |
| Maximum Stability | ProDisc-C |
| Durability (Metal-on-Metal) | Prestige-LP |
| Less Bone Removal Needed | Mobi-C |
| Metal Sensitivity Concerns | Prestige-LP |
About lumbar artificial disc replacement
Most spine surgeons are cautious about artificial disc replacement in the lumbar spine as the technology of lumbar artificial discs is constantly evolving. Unlike the neck which has less weight placed on the artificial disc, the artificial discs in the low back have much more weight on the components which can affect the lifespan of the artificial disc.
Secondly, the front of the neck area is much easier to access than the front of the lumbar spine, as the surgeon must work around internal organs to install the artificial disc. So artificial disc replacement surgery in the low back is more complex.
Thirdly, while the neck has only six disc levels to preserve motion, the back has many more levels to provide rotation, so the option of fusing one level is less problematic to preserving natural rotation.
Lastly, if an artificial disc wears out after 15 to 20 years, revision surgery to remove the old disc and replace it is more complex in the low back than in the neck.
The spine surgeons at Texas Spine and Scoliosis who specialize in artificial disc replacement include: Dr. John Stokes, Dr. Eeric Truumees and Dr. Alex Cruz.
Spine |
||
|
|
|
|
|
|
Comparing Artificial Disc Replacement to Spinal Fusion
For decades spinal fusion has been the standard treatment for herniated discs in the back and neck. In a fusion surgery, the disc is removed and either bone from a cadaver, or bone is harvested from the patient’s hip, is placed in the disc space to restore disc height. A metal plate and screws are then placed on the front of the vertebrae to hold the bone spacer in place. During the healing process the bone implant fuses to the vertebrae above and below. The result is a segment that no longer moves, or is “fused”.
In the neck the common treatment for repairing herniated discs in the neck is an Anterior Cervical Discectomy and Fusion (ACDF) procedure. When two vertebrae are locked together as in the ACDF surgery, not only does the person notice that they have less rotation in the neck after surgery, but other issues also come into play. Because two vertebrae are locked, the other vertebrae above and below have more stress on them, which can in turn cause additional disc herniations in the remaining segments. This is referred to as “adjacent segment disease.”
In the low back, because of the number of vertebrae, this loss of movement is less of a problem as the remaining vertebrae can provide enough rotational movement. In the neck, however, there are only seven vertebral bones and six discs to provide all rotation.
Studies by the North American Spine Society (NASS) — the largest international group of spine specialists — concluded that for herniations in the neck, artificial disc replacement should replace the traditional neck fusions. Their research found that fusing two of the seven vertebrae in the neck caused other discs above and below to herniate. Because the artificial disc preserves the natural motion in the neck, the artificial disc reduces the risk of future herniations.
Researchers — as well as health insurance companies — have found over the years that spinal fusion can have variable outcomes. One 2011 study cited that 76% of patients had continuing use of opiod pain relievers after spinal fusion. Another study looked at 40,000 admissions and found that the average hospitalization costs exceeded $40,000 per spinal fusion surgery.
What is the long term outcomes on Artificial Disc? What percent of artificial disc implants fail?
Research on artificial disc replacement in the neck is encouraging in that the patients are preserving their natural range of motion which lessens the risk of future herniations at other disc levels, all without increasing the risk of a future revision surgery.
A 2024 study evaluated 1,626 patients who had artificial disc replacement in the neck for treatment of herniated discs. The surgeries dated back 20 years to 2003 up to 2021. The study found that the artificial discs were removed in 23 cases, or a failure rate of 1.48% in the 1,626 patients. On the 23 cases, an ACDF (neck fusion) was done in 18 of the patients, and the remaining 5 had a new artificial disc implanted.
Another study in 2024 featured 53 patients that had revision surgery after having a cervical artificial disc implant. The study noted that some of the discs that were removed were from a specific artificial disc design (M6 artificial disc) that has since been removed from the market. Of the 53 revision cases, 16 patients had another disc implant installed, while 36 needed an ACDF (neck fusion) largely because of bone loss and structural damage related to removing the failed implant.
The researchers concluded that the low rate of removals or revisions over a long period of time demonstrated the safety of artificial disc replacement in the neck.
What is the lifespan of an artificial disc?
Artificial discs are still relatively new, with the first artificial disc being approved for use in the United States in 2004, about 20 years ago. However, artificial discs have been used successfully in Europe since the 1990’s. This means some of the oldest artificial discs have been in place for nearly 30 years.
The materials, engineering, and implantation techniques used in the new discs are far superior to when the discs first arrived in the early 2000’s. The repetitive forces from activities like running, exercising or playing sports directly affect the lifespan of an artificial disc or joint.
Unlike hip replacement and knee replacement which as been done since the 1960s, artificial discs for the spine are relatively new technology. A big reason is that the knee and hip joints are more easily accessible than having to navigate around internal organs to reach the front of the spine to install an artificial disc.
Also, if there is a problem with the disc, or if it wears out and needs to be replaced, revision surgery for an artificial disc is far more complex than revising a hip or knee joint — especially when the patient is over age 70 when the disc wears out.
This explains why joint replacement surgeons try to delay knee replacement and hip replacement surgery until the patient is in their 50s and the pain is unbearable. The joint surgeon hopes the artificial knee or hip joint will last 20 years — perhaps long enough to outlive the patient. Similarly, an orthopedic surgeon may require that a joint replacement patient lose weight before surgery as the extra weight on an artificial knee or hip will cause the artificial joint to wear out faster.
Conversely, people in their 20s and 30s can herniate a disc in their spine requiring disc replacement with an artificial implant. Manufacturers of artificial discs note that they put disc designs through rigorous testing in a lab to simulate the wear and tear placed on a disc when implanted in the spine. According to Zimmer Biomet, it notes that its Mobi-C artificial disc has been implanted more than 70,000 times across Europe and the United States.
How to find an artificial disc surgeon near me?
Board-certification is a standard baseline for any surgeon. For spine surgery, one should also be looking for “fellowship training” which is the highest level of medical education in the Unites States. For a surgeon to be “fellowship-trained,” they will have spent an extra year of surgery in a regional center operating alongside an experienced spine surgeon who is proficient in their area of specialization.
For artificial disc surgery, the spine surgeon will have had additional training in several artificial discs. The benefit of proficiency in several artificial discs is that one disc may be better than another design for a specific patient. For example, some discs come in different sizes recognizing that a petite woman is different than a large man.
For minimally invasive spine surgery, the spine surgeon is working through instruments the size of a ballpoint pen and a 1-inch incision. That proficiency takes extensive training to use the surgical instruments. Many older surgeons in their 50s may not want to invest the time to learn this new skill and will simply use a large 3-inch incision that they were trained to do in medical school in the 1990s. The larger incision, while easier for the surgeon, results in more blood loss and the need for outside blood and the risks involved with that for the patient. After surgery, the large incision causes more disruption to muscles and ligaments resulting in a longer and more painful recovery.
Each year, new artificial discs are approved by FDA. These new discs can have features that improve on previous discs. The best spine surgeons will stay abreast of new technology and the research related to that.
Typically spine surgeons with this expertise will tend to be in larger cities and within a regional spine center. So when trying to decide if you should travel to a larger city to access a regional spine center with spine surgeons with proficiency in the latest technology, consider the long-term benefits the patient receives.
A good spine surgeon will be cautious but will have an open mind about new technology, including artificial disc technology. If the surgeon you are meeting with discourages questions, or outright dismisses or criticizes new technology that has been FDA approved, those are warning signs to explore a second opinion from someone with experience with the latest options in spine surgery.
With that said, not every patient qualifies for an artificial disc.
More information specific to artificial disc replacement with articles authored by spine surgeons who are proficient in artificial disc can be found at: CentersforArtificialDisc.com.
We Value Your Privacy