Can I Get Disc Replacement With Herniation and Spondylolisthesis?

Yes, disc replacement can treat both disc herniation and Grade I-II spondylolisthesis (25%-50% slip) if the spinal segment is stable. In this situation, the artificial implant can relieve pain and preserve motion while maintaining spinal alignment. However, if the spondylolisthesis is more advanced (Grade III or IV) and the spine is unstable, disc replacement is typically not recommended.

At Total Orthopedics and Sports Medicine, our surgeons perform X-rays, MRIs, CT scans, and dynamic motion studies to examine disc height, spinal slippage progression, and vertebral alignment. After that, we conduct flexion-extension imaging and neurological exams to assess whether disc replacement is appropriate for your condition. Call 855‑321‑6784 today to schedule a consultation with our spine surgeons for total disc replacement.

Is Disc Replacement Safe For Herniated Disc and Spondylolisthesis?

Yes, disc replacement can safely treat disc herniation and spondylolisthesis, but only if you have low-grade spondylolisthesis without dynamic spinal instability. In fact, according to a PubMed study, out of 310 patients who underwent lumbar disc replacement, 7 received a single-level Kineflex disc replacement at levels affected by degenerative spondylolisthesis or a Grade II slip. The clinical outcomes revealed the following results:

• VAS pain scores: 68% improvement
• Oswestry Disability Index (ODI): 56% improvement
• Lumbar lordosis: 29% increase
• Segmental listhesis: 85% reduction
• Pelvic tilt: 31% reduction

Similarly, disc replacement helps treat herniated discs by restoring disc height and relieving pressure on compressed spinal nerves. This spinal surgery also reduces leg pain, numbness, and other symptoms caused by nerve irritation. In addition, it preserves motion at the affected spinal level, maintaining normal biomechanics and reducing stress on the facet joints. By maintaining segmental motion, disc replacement also helps prevent adjacent segment degeneration and reduces long-term stress on nearby discs.

How Does the Type of Disc Herniation Affect ADR Eligibility?

Artificial disc replacement (ADR) can treat both soft and calcified disc herniations, but spine surgeons usually prefer it for soft disc herniations. In a soft disc herniation, hydrated disc material compresses the nerve root without any bony overgrowth. As a result, your spine surgeon can safely decompress the nerve and accurately position the prosthetic disc.

On the other hand, in calcified disc herniations, hardened disc material and bony growth directly compress the nerve. This bony overgrowth makes it difficult for the surgeon to safely remove the disc and increases the risk of the following complications:

• Damage to Vertebral Endplates: The hardened disc and bone can make precise removal difficult, increasing the risk of injury to the endplates.
• Incomplete Nerve Decompression: Calcified material can be more difficult to fully remove, potentially leaving residual pressure on the nerve root.
• Increased Stress on Adjacent Segments: Limited motion at the treated level can place additional strain on adjacent spinal segments, increasing the risk of adjacent segment disease.
• Reduced Spinal Mobility: Bony overgrowth can limit how much the artificial disc restores natural movement.
• Higher Risk of Spinal Infection: More complex surgical exposure and longer operative time may slightly increase the risk of infection.

Which Grades of Spondylolisthesis Are Eligible for Disc Replacement?

If you have Grade I (0–25% slip) or Grade II (26–50% slip) spondylolisthesis, you may be eligible for disc replacement. In these cases, the artificial disc can relieve pain, preserve motion, and maintain proper spinal alignment. However, if you have Grade III (51–75% slip) or Grade IV (76–100% slip), ADR is usually not recommended. These higher grades of spondylolisthesis involve significant spinal instability, which increases the risk of implant failure, poor alignment, and persistent symptoms. In such situations, surgeons typically recommend spinal fusion to restore stability and maintain proper spinal alignment.

Can Spinal Instability or Pars Defect Impact Disc Replacement Candidacy?

Yes, spinal instability or a pars defect (spondylolysis) can significantly affect disc replacement eligibility. Artificial disc replacement can preserve motion, but it does not stabilize the spinal segments. Therefore, many surgeons typically contraindicate (do not recommend) disc replacement when flexion–extension X-rays show spinal instability.

Moreover, according to PubMed, a pars defect is a stress fracture involving the pars interarticularis of the posterior vertebral arch. This defect weakens the posterior stabilizing structures of the spine and may progress to spondylolisthesis if the vertebra slips forward. When a pars defect leads to vertebral slippage or abnormal motion, doctors do not recommend disc replacement spine surgery. In such cases, spinal fusion may be considered to stabilize the affected segment before or instead of disc replacement.

Tip: If you have a pars defect or spinal instability, you should get a second opinion from our spine specialist to determine whether another treatment is safer than ADR.

Does Having Multiple Damaged Spinal Levels Affect Your ADR Eligibility?

Yes, multiple damaged spinal levels (multilevel degeneration) significantly affect artificial disc replacement (ADR) eligibility. Most spine surgeons typically recommend ADR for only one or two levels (in carefully selected cases). According to a Springer Nature study, patient satisfaction rates for two-level ADR procedures range from 75.5% to 93.3%.

However, if you have three or more damaged levels, the procedure can lead to post-surgical complications. For example, multi-level degeneration increases the risk of segmental instability, improper implant positioning, and added stress on adjacent spinal segments. In such cases, surgeons may recommend the following surgical procedures to restore spinal motion:

• Hybrid Surgery (ADR + Fusion): Combines disc replacement at one level and fusion at another to balance motion and stability.
• Staged ADR Procedures: Performing artificial disc replacements on different spinal levels in separate surgeries. This approach reduces overall surgical risk and allows surgeons to monitor spinal stability and patient recovery between each stage.
• Multilevel Decompression with Fusion: Relieves nerve pressure while maintaining spinal support across several levels.
• Artificial Disc with Supplemental Instrumentation: Using rods, screws, or plates alongside an artificial disc to provide extra stability in multi-level degeneration.
• Posterior or Lateral Approach ADR: Alternative surgical approaches that allow safer access and more precise implant placement in complex multi-level cases.

How Do Surgeons Measure Slip Progression Risk Before ADR?

To measure the risk of slips progression before ADR, our spine specialist, Dr. Georgiy Brusovanik, MD, orders MRI and CT scans. These scans help assess disc space, vertebral alignment, facet joints, and bone quality that impact spinal stability. He may also conduct flexion–extension X-rays to detect abnormal motion between vertebrae.

After these imaging studies, he may perform the following physical exams to assess vertebral slippage and instability:

• Step-off palpation test: Checks for a palpable vertebral offset that suggests slippage
• Passive Lumbar Extension (PLE) Test: According to Physiopedia, this test helps identify lumbar spine instability.
• Single-leg stance and load testing: Assesses how weight-bearing affects segmental stability
• Neurological stress testing: Identifies nerve symptoms that worsen with motion-related slippage
• Posterior Shear Test: Applies a gentle forward force on the vertebrae to assess potential anterior slippage.
• Gait and Posture Analysis: Observes walking patterns and posture changes that may result from unstable vertebrae.

If these tests and imaging confirm that your spine is stable with no slip progression, Dr. Georgiy Brusovanik will perform artificial disc replacement with precision. However, if the test results reveal slip progression, he may recommend safer surgical treatment alternatives to prevent further slippage. Call 855-321-6784 to schedule your appointment with Dr. Georgiy Brusovanik.

Can LDR Be Performed With Decompression?

Yes, ADR can sometimes be performed with decompression for a herniated disc and spondylolisthesis, depending on the severity of the slippage. In this procedure, the surgeon carefully removes the herniated disc material or bone fragments that are compressing the spinal nerves. After that, the surgeon removes the damaged disc tissue while preserving the vertebral endplates.

Then, the artificial disc implant is precisely positioned to restore disc height and preserve spinal mobility. This combined approach helps relieve nerve pressure while maintaining motion at the affected spinal level. After the procedure, patients typically undergo a structured rehabilitation program to restore strength, flexibility, and proper spinal mechanics.

How Does Segmental Motion Affect Disc Implant Performance?

After lumbar disc replacement (LDR), proper segmental motion helps the artificial disc replicate natural spinal movement, evenly distribute mechanical forces, and maintain disc height. It also reduces stress on the facet joints and adjacent spinal segments, supporting long-term spinal stability and preserving overall flexibility.

However, if the segmental motion is abnormal, the artificial disc may not function properly or mimic natural movement patterns. This can lead to uneven load distribution, increased implant wear, and added stress on facet joints. Over time, abnormal motion may also increase the risk of complications such as implant loosening, subsidence, or persistent pain.

Therefore, our surgeons carefully assess segmental motion before recommending ADR. They order imaging tests, such as X-rays, MRIs, and CT scans, to evaluate vertebral alignment, disc height, and segmental motion. If we detect any abnormal segmental motion, such as hypermobility or stiffness, our surgeons will adjust the surgical plan accordingly to improve implant performance. Call 855-321-6784 to book your appointment.

Do You Need Flexion-Extension X-Rays After ADR?

Yes, you typically need flexion–extension X-rays after ADR if you had spondylolisthesis, especially during early follow-up appointments. Flexion–extension radiographs help your surgeon analyze the dynamic stability at the treated spinal level. These X-rays also measure vertebral translation, assess angular motion, and confirm that the artificial disc maintains proper spinal cord alignment.

In some cases, flexion–extension X-rays can detect the following structural issues in the spine:

• Vertebral Slippage Progression: Identifies any forward or backward shift of the treated vertebra relative to adjacent vertebrae.
• Implant Migration or Loosening: Detects if the artificial disc has shifted, tilted, or settled improperly after surgery.
• Adjacent Segment Instability: Reveals abnormal motion or increased stress on spinal levels above and below the treated segment.
• Abnormal Angular Motion or Hypermobility: Measures excessive bending, rotation, or tilting of vertebrae beyond the normal spinal range.
• Microfractures: Shows early signs of bone stress or tiny fractures developing around the implant site.

Can Severe Nerve Compression Limit the Benefits of ADR?

Yes, severe nerve compression can reduce the effectiveness of artificial disc replacement (ADR). While ADR is designed to decompress nerve roots and relieve symptoms, patients with long-term and severe neurological deficits may not experience nerve recovery. Chronic nerve compression can also cause permanent nerve damage, which may lead to persistent weakness, numbness, or loss of sensation even after ADR. It can also result in ongoing pain, reduced reflexes, or limited motor function in the following body parts:

• Lower Legs: Weakness or numbness may affect walking, balance, and coordination.
• Feet and Toes: Patients may experience tingling, loss of sensation, or difficulty controlling foot movements.
• Thighs: Muscle strength may decrease, leading to instability or difficulty climbing stairs.
• Buttocks and Hips: Pain, reduced reflexes, or sensory changes can affect sitting and mobility.
• Lower Back: Persistent pain or stiffness may remain despite successful disc replacement.
• Pelvic Region: Nerve involvement may cause tingling, numbness, or altered sensation in the pelvis.

What Are Common Complications After Disc Replacement?

After ADR, you may experience heterotopic ossification, implant migration, subsidence, facet joint pain, nerve irritation, spinal infection, or mechanical failure of the implant. You may also notice persistent stiffness, reduced range of motion, or constant back and leg pain. Other than that, some patients may experience adjacent-segment degeneration, mild muscle soreness during recovery, or temporary difficulty with movement. In some cases, you may also experience the following complications after lumbar disc replacement (LDR):

• Dural Tears: Small tears in the protective covering of the spinal cord, potentially causing cerebrospinal fluid leaks.
• Blood Clots (Deep Vein Thrombosis): Formation of clots in the legs due to reduced mobility after surgery.
• Allergic Reaction: Reactions to metals or polymers used in the artificial disc.
• Failed Back Syndrome: Persistent or recurring pain despite technically successful disc replacement.
• Incisional Pain: Discomfort or delayed healing at the surgical incision site.
• Spinal Instability at Adjacent Levels: In rare cases, instability can develop in nearby vertebrae that were not initially affected.

Total Orthopedics & Sports Medicine Provides Expert Assessment for Disc Replacement Eligibility!

While artificial disc replacement can relieve pain from spondylolisthesis and herniated discs, you may still experience difficulty with bending, twisting, or lifting objects. In some cases, ADR can also cause adjacent-segment stress, leading to further degeneration, nerve damage, or discomfort over time.

At Total Orthopedics & Sports Medicine, our professional sports team consultant, Dr. Georgiy Brusovanik, MD, conducts a detailed pre-operative assessment to check your spinal stability, disc health, and nerve function. He also uses precise surgical techniques to reduce the risk of tissue trauma, nerve damage, or adjacent segment stress during the procedure. Call us today at 855-321-6784 or visit our clinic at 1111 Park Ave, #1, New York 10128 to explore your treatment options.

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