Discs can now be totally removed and replaced with an artificial disc, also called a prosthesis. Orthopods call total knee replacement TKR and total hip replacement THR, so I will call this TDR.

When we say we are “taking out” a herniated disc, we really mean we are just removing the torn chips of disc cartilage that are pressing on the nerve. We leave in most of the disc, removing enough to get the disc back flush with the bone and any other loose fragments that may be prone to come out later. The recurrence rate in the low back is pretty low, around 10% over 5-10 years and in the neck it is almost negligible. I think I have had only 3-4 recurrent disc herniations in the neck in several hundred patients over many years. In the lower back, we now have a device to close the hole in the disc after removing the herniating part of it, so the recurrence rate should be down to only 5%.

I have not done any TDR in the lower back. It requires going in through the stomach and there’s risk of damaging major blood vessels, the ureters, and making men impotent. I just don’t see the need for it in the great majority of patients.

However, in the neck, it’s the same exposure as an anterior fusion (see Anterior Cervical Fusion on the Home Page) and it makes sense to try and avoid a fusion. Unfortunately, the FDA has only approved neck TDR for single level use in patients with no other problems in the neck except one herniated disc, so many patients don’t qualify.

For more information on cervical disc replacement, see:
http://www.necksurgery.com.