Questions and answers about ADR

Our medical team answers the most commonly asked questions about disc replacement surgery (ADR). Find your answers here!

ADR - Before the operation

Degeneration is a natural process directly related to aging. We all grow old and, in the same way, all our joints degenerate. This degeneration can cause pain in some people, and not others. The most frequent causes are as follows:

Aging process.
Genetic predisposition.
Other causes: injury, problems of metabolism, rheumatologic pathology.

  • When there is chronic cervical or lumbar pain that does not improve with less invasive treatments. 
  • When the patient’s quality of life is limited by the pain. 
  • In cases of sudden onset pain that severely limits the patient’s activity and which does not improve with conservative treatments and when there is no expectation that it will improve spontaneously in a reasonable period of time.

No. We do not use artificial disc implants in the following cases:


  • Spondylolisthesis with or without spondylolysis.
  • Previous spinal surgeries that have compromised the posterior articular facets by more than 50%.
  • Serious atrophy of the muscle or posterior multifidus.
  • High pelvic incidence or very steep sacral slopes.
  • Previous abdominal surgery, especially if it affected the retroperitoneal space.
  • Bone weakness, osteopenia and osteoporosis.
  • Other factors: psychological, substance abuse, various prior surgeries, etc.

In addition, patients allergic to any metals must undergo metal allergy tests, including aluminum.

To determine if the patient requires surgery, functional x-rays of the spine (flexion and extension) are needed to observe the mechanics of the spine and the segment to be operated on. A full-body telemetric radiography (EOS) is also necessary to rule out imbalances or degrees of curvature of the spine that would be a contraindication for the ADR technique. A lumbar magnetic resonance (MRI) is also required to verify the state of the disc, the nerves and the retroperitoneal elements.

In addition, in some cases a lumbar CT scan is also needed to supplement, or instead of, the MRI, and, finally, in some cases a bone density test (densitometry) is also required.

For women over 40 and men over 50, a bone densitometry should be performed before the operation. This is so that we can rule out the existence of significant osteopenia or osteoporosis, which could pose a high risk of subsidence and failure of the implant.

ADR operation

It consists of replacing a degenerated disc that does not work properly and that causes pain, with an artificial disc that reproduces the cushioning and movement capacity of a natural healthy disc.

The surgery lasts between 1 to 2 hours, depending on the number of levels operated on.

The most frequently used surgical alternative is the traditional lumbar or cervical arthrodesis or fusion. In this surgery, as its name suggests, the vertebrae are fused or immobilized to remove the degenerated disc and with it the pain it produces. However, at Instituto Clavel we choose ADR whenever it is a medically prudent option, since it offers many benefits for the patient.

There are many! We offer you a detailed explanation here.

No, the cost is very similar to the cost of a fusion operation. What’s more, as recovery from ADR tends to be much faster than from fusion surgery, it means that after ADR the patient can go back to a full normal life sooner, including work, which is an economic benefit.

Because the anterior approach technique is complex and complicated. At Instituto Clavel, thanks to our training and experience, we are fully capable of performing ADR surgery.

Yes, it is. For both cervical and lumbar spine procedures. It is true that not even reconstruction of the ligament guarantees it will function like before, but in this type of surgery, it is impossible to avoid cutting this ligament in order to perform the discectomy and to implant the prosthesis.

For the cervical spine, yes. We use a small quantity of bone wax on the back edge of the top and bottom endplates. We have not seen any infection occur in the cervical spine cases we have treated and we believe that the use of bone wax can prevent heterotopic ossification (bone growth in abnormal locations).

For cervical ADR surgery, the average hospital stay is 24 hours, although it can be extended to two days if the patient needs it. In the case of lumbar ADR surgery, the hospital stay is usually 3 days, although it can last up to five days, especially if the patient comes from another country.

ADR postoperative period and recovery

Although practically any spinal surgery involves a certain degree of postoperative pain, since ADR is a minimally invasive technique, the degree of pain reported by patients is significantly less than with the traditional fusion procedure.

This means, that for most patients, the speed of recovery is faster. Patients are able to stand up the day after surgery.

Yes, as in all surgery. In this type of operation, due to the approach, there is a risk of affecting the abdominal blood vessels because of the approach, but it is a very infrequent situation, controlled and resolved during the operation. As in any operation, the main complications would be the risk of postoperative bleeding and infection, although these complications in total, occur in less than 3% of cases.

In addition, the new generations of discs with better designs and materials, have practically made the complications associated with the implants themselves disappear, with cases of sinking or extrusion of the prosthesis being rare.

In 10% of cases, there may be facet joint pain during the first 6 months. This is caused by the increased mobility of the facet joints that had mild or moderate degenerative pathology before surgery, but not enough to make ADR surgery unadvisable. These discomforts are usually resolved by functional recovery or, if necessary, by infiltrations or radiofrequency.

In males operated on at the L5-S1 level, there is a 0,5% risk of retrograde ejaculation, which does not entail erectile dysfunction, and in the great majority of cases, is temporary.

Generally, 1 to 3 days of hospital stay, and 2 to 5 weeks to until return to work in the case of the cervical ADR, or 4 to 10 weeks for lumbar ADR, depending on the nature of the patient’s work and the physical effort it requires. However, every patient has specific circumstances, so the recovery time will be estimated in a personalized way.

On the average, the patient can make this kind of flight at about 10 days after the operation. 

Yes! The goal of this surgery is to give the patient back their normal quality of life, so that they can return to all the activities they used to carry out before the pain made it impossible. However, if your previous activity poses a high risk of new spinal injuries, your doctor will guide you and advise you specifically on when it is appropriate to make a change in habits.

No, the disc implant is a definitive solution for the level that is operated on. This does not preclude that a hernia could appear in a different disc.

Yes, we do recommend that our patients take this kind of medication for the 3 months following surgery. These drugs are known to inhibit bone growth, which reduces the probability of heterotopic ossification (bone growth in abnormal places), in addition to being helpful with reducing postoperatory pain. 

We provide our patients with a very complete rehabilitation treatment while they are in Barcelona or Madrid. Our specialized physical therapists work with patients starting from the very first day after the operation, twice a day, during the time they are hospitalized.

When the patients return home, the Instituto Clavel medical team is in charge of follow-up and each patient receives specific recommendations and instructions from our specialized spine rehabilitation team so they can continue their rehabilitation on an outpatient basis.

About the implant

Absolutely. Most disc replacement implants are designed specifically with that goal in mind. The ones we use at Instituto Clavel are the best design for imitating the function of a natural, healthy disc.

Other surgeons don’t use these models because the anterior approach ADR is very technically complex.

There are different sizes, so we choose the most appropriate size for each patient.

The types of implants different from each other in the material they are made of, their mechanical design, and the way they are anchored to the vertebra bone.

For example, some manufacturers use metal, others use polyethylene in combination with a metal, which is usually titanium or chrome-cobalt. Finally, there are more advanced and sophisticated designs that combine metal with the shock absorption capacity (like the natural core) of polyurethane.

The basic mechanisms are usually what is known as a ball and socket or that of an inverted ball joint.

Mainly we use the C-ESP and or M6C for cervical surgeries, and the L-ESP or M6L, for lumbar spine surgeries. Sometimes we have used other models such as Baguera. We always consider what is best for the case of each patient individually.

Would you like more information?
Tell us about your case!

Contact us so that we can give you a personalized assessment.

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