What is ADR surgery?

ADR or disc replacement surgery is an operation performed on patients who suffer from disc degeneration in the cervical or lumbar spine, or from chronic nerve root pain, when conservative treatments have not provided relief. 

ADR is a type of prosthetic surgery that consists of replacing a degenerated lumbar or cervical disc with an artificial implant specifically designed to imitate a natural healthy disc. As we will explain in the following paragraphs, it is a less invasive surgery that the traditional fusion surgery.

At Instituto Clavel, we have more than 20 years experience with ADR, having performed over 1500 surgeries, which makes us the clinic with the most experience in all of Spain in this type of surgery, and one of the best in Europe. 

What is a key factor that sets us apart? Our skill in using the technique of anterior approach to the spine to place the implant, which avoids having to manipulate the back muscles. This way, the patient suffers less postoperative pain and can recover more quickly. All of this leads to a swifter return to normal quality of life.

What are the advantages of ADR over fusion surgery?

Fusion surgery is one of the options that can be used to address problems caused by degeneration of discs in the lumbar or cervical spine. In this operation, the vertebrae are fused together with screws and/or plates so that they are immobilized. 

Although fusion surgery is widely used, our specialists in spine surgery at Instituto Clavel have verified that ADR or disc replacement surgery is a valid alternative that offers the patient many advantages over fusion surgery. This is because by replacing the degenerated disc, we eliminate the element that causes the pain, which allows the patient to return to a normal life.

These are a few of the advantages that the doctors at Instituto Clavel would like you to know about: 

Better quality of life

Because the pain is totally or partially reduced, and the vertebrae regain their mobility, the patient can have a better quality of life, and even practice sports again. 

Greatly reduced risk

In disc replacement, the risk of degeneration in the adjacent discs is greatly reduced because the vertebrae are not immobilized. This degeneration does tend to occur following fusion surgery, because it leads to excess biomechanical stress on the discs immediately above and below the fused disc. This, in turn, can lead to needing another surgery in the future.

Minimally invasive surgery

ADR surgery is a minimally invasive surgery, because it is performed with an anterior approach to the spine, eliminating the need to manipulate the back muscles or nerves. All this significantly reduces the risk of postoperative pain or nerve damage.

Avoid blood loss

Osteotomies are not needed, which eliminate a possible risk of significant blood loss.

ADR surgical technique at Instituto Clavel

The surgical technique we use at Instituto Clavel is based on a combination of the latest advances, extensive experience, and the results achieved. The following explains our reasons for choosing the anterior and lateral approach techniques.

Anterior approach

The anterior approach to the spinal column consists of operating on the spine via the retroperitoneum, a natural path of entry we all have located in the abdomen.

Depending on the surgery, the patient, or the implant that needs to be used, the surgeon chooses the most appropriate approach in each case (anterior, oblique or lateral). No matter which of these approaches is used, the surgical path always lies through the retroperitoneum. Once this is done, we reach the spinal column aided by special spacers without causing any tissue damage.

The advantages of this type of approach are:

  • It allows a non-traumatic access to the spine, as it is reached through a natural path of the body.
  • It avoids manipulating the nerve structures, because the spinal canal where they are located is at the back of the spine.
  • The damaged disc is completely removed and replaced with a prosthetic disc or fusion cage.
  • Whether by anterior or lateral approach, the success rate is greater than 95% (much higher than using the classic posterior approach).
  • It is possible to correct deformities with fusion cages, without the complications inherent in a posterior approach.
  • Length of hospital stay is shorter, and therefore, the rehabilitation time is also reduced.

Which is used in each case?

Anterior lumbar approach

Is traditionally used to reach the lower sections of the spine, for example, when we want to place an artificial disc in the lumbar spine, or if we need to perform a fusion to make an important realignment of the spine.

We can also use these approaches to improve the outcome of the classic posterior arthrodesis, because we will be performing 2 minimally invasive surgeries, performing the fusion through anterior approach, followed by a posterior approach using small incisions to place the pedicle screws. In this way, despite involving two surgeries, the functional outcome is better and the patient’s recovery is faster.

Oblique approach to the spine

Is used to reach the intermediate lumbar levels between L2 and L5. Using this approach, we are able to reach the disc through a small opening that lies between the blood vessels that lie in front of the spinal column and the psoas muscle which covers the lateral side of the spine.

This technique is used for vertebral fusion, mostly with the placement of cages between the vertebrae, avoiding interference with blood vessels. This is the option chosen for elderly patients, to avoid complications, especially vascular ones.

Lateral approach to the spinal column

Is a minimally invasive technique for treating the intervertebral disc, using a small incision in one of the sides of the lumbar region. Here, access is made through the retroperitoneal path, which is completely avascular, along with gradual dilation of the psoas muscle located on the side of the disc.

This allows us to treat different pathologies of the intervertebral disc by placement of a fusion cage using a lateral approach:

  • Lumbar degenerative disc disease in segments L1 to L5.
  • Spondylolisthesis.
  • Unilateral foraminal stenosis.
  • Correction of deformities in the coronal plane in scoliosis surgeries.

 
This approach always requires supplementation with posterior pedicle screws. The advantage of placing lateral implants lies in that it does not require any manipulation of the delicate posterior nerve structures, thus simplifying subsequent surgeries.

Results of the surgical technique

Experience in ADR surgery is the key to getting the best results and ensuring the safety of the operation. This is demonstrated by the fact that 90% of patients report significantly reduced pain after having this surgery. Likewise, after disc replacement surgery, around 70% of patients have been able to make a complete return to playing sports, a percentage that has not been equaled by any other spine surgery technique. 
 
Additionally, the risk of complications is less than 3%. Often, with this type of approach, it is necessary to disturb the abdominal blood vessels, which can cause a small sore or laceration. This is a very rare occurrence, which we monitor and solve during the operation itself. The complications associated with artificial discs have practically disappeared thanks to constant innovation and improvements both in design and materials.

In addition to experience, selection and preparation of the patients are key factors that have contributed to improving the results and reducing the frequency of complications. This preparation includes a thorough analysis of various tests and a series of preoperatory consultations with our team of doctors, nurses, and physiotherapists who all form part of our Preparation, Empowerment, and Recovery (PER) program.

Benefits for the patient

  • Thanks to the elimination or reduction of pain, the patient returns to a completely normal life after the operation, recovering quality of life and even returning to sports activities that they practiced before. 
  • The probabilities of needing another surgery in the future are practically null, because as the joint retains mobility, it is not likely to cause degeneration of the adjacent discs.
  • The surgery is less costly that arthrodesis or fusion, especially when taking into account the swift return to working life.

What pathologies is it used for?

ADR surgery is indicated for degenerative pathologies of the cervical or lumbar disc, specifically cervical herniated disc, lumbar disc herniation, and neck pain or low back pain due to degenerative disc disease, when conservative treatments have failed. This intervention is much less invasive than fusion surgery, and replacing the degenerated disc with an artificial one allows movement to be recovered as if it were a healthy disc. 

Who is eligible for ADR surgery?

Generally speaking, the vast majority of patients with disc degeneration problems are candidates for ADR surgery. However, there are exceptional cases in which this surgery is not recommended.
 
You can find out more about ADR and the surgical process here.

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