Tests Needed Before Lumbar ADR & Cervical ADR

If you are exploring cervical or lumbar artificial disc replacement (ADR), one of the first surprises is how detailed the evaluation can be. Many patients walk in thinking, “I already have an MRI. Why do I need anything else?”

Before anyone is approved for disc replacement, a careful workup is essential. These tests are not hoops to jump through. They are tools that help your surgeon confirm the diagnosis, rule out red flags, and make sure ADR is both safe and likely to work for your specific spine.

This guide breaks down the most common tests used before cervical and lumbar ADR, what each one shows, and why multiple scans sometimes matter even when you already have imaging.

Dr. Jason M. Cuéllar is a board-certified orthopaedic spine surgeon who focuses on motion preservation and disc replacement in South Florida. His preoperative recommendations are grounded in evidence-based practice and refined by real-world outcomes from caring for patients with complex neck and back problems.

Why Testing Matters Before Artificial Disc Replacement

Artificial disc replacement is not a one size fits all procedure. It is a precise, motion-preserving surgery, and success depends heavily on choosing the right patient, treating the right level, and selecting the right implant.

Your testing helps answer three big questions:

First, is the disc truly the main source of pain and nerve symptoms? A disc can look abnormal on imaging but not be the primary pain generator. The goal is to avoid replacing a disc that is not actually responsible for the symptoms.

Second, is the spine stable and aligned enough at that level for ADR? Disc replacement relies on good alignment and controlled motion. If the spine is unstable, the risks and failure rates go up.

Third, is the patient healthy enough to heal well and benefit from the procedure? Bone quality, inflammation, anemia, and underlying medical conditions can all influence recovery and long-term durability.

A thorough workup is designed to improve safety, reduce surprises in surgery, and increase the odds of a strong long-term result.

Core Imaging Tests Used Before ADR

Most ADR candidates will need a combination of imaging studies. Each one answers a different question, and together they give a clearer picture than any single scan can provide.

MRI Scan

MRI is often the starting point because it shows soft tissues in detail. It can reveal disc degeneration, disc herniations, nerve compression, spinal stenosis, and changes that may be irritating the spinal cord or nerve roots.

For both cervical and lumbar spine problems, MRI helps your surgeon understand what is happening around nerves and how severely they are affected. It can also show inflammation, swelling, and other soft tissue findings that do not show up on standard X-rays.

X-rays (Standing and Dynamic)

X-rays are not “old school” compared to MRI. They provide information MRI cannot, especially when taken standing. This matters because your spine behaves differently under real-life load than when you are lying down in a scanner.

Standing X-rays show alignment, disc height, the overall curve of the neck or lower back, and signs of structural changes.

Flexion and extension X-rays are dynamic views. They show how much a segment moves and whether there is instability. This is particularly important for disc replacement, where appropriate motion and stability are key.

CT Scan (When Needed)

CT provides higher-resolution detail of bone. It is not always necessary, but it becomes very helpful in certain situations, such as:

• Prior surgery at or near the level being evaluated
• Complex anatomy that needs clearer bony definition
• Concern for bone spurs, facet joint changes, or calcified discs

In plain terms, MRI is best for nerves and soft tissues, while X-rays and CT clarify alignment, motion, and bone structure. Disc replacement decisions usually require all of those pieces.

Tests Specific To Cervical ADR Candidates

Cervical disc replacement is typically considered when symptoms are well localized and tied to one or two levels. Testing helps confirm that the problem is coming from the disc, not from a different structure that would respond better to another treatment.

A cervical MRI can show disc disease, herniation, foraminal stenosis that pinches a nerve, and spinal cord compression. It helps your surgeon determine whether symptoms like arm pain, numbness, or weakness correlate with what is happening at a specific level.

Cervical X-rays add critical information, especially about posture and alignment. They help evaluate:

Overall neck alignment. A healthy cervical spine usually has a gentle forward curve. If the neck has lost that curve or has reversed into kyphosis, it can change whether ADR is appropriate and what approach is safest.

Motion at the involved level and adjacent levels. A disc replacement is designed to preserve motion, so your surgeon needs to confirm the overall motion pattern makes sense for a motion-preserving device.

In some cases, additional imaging may be used to evaluate bone spurs, facet joints, or prior hardware. The goal is to confirm the problem is clearly defined and that the neck is aligned and stable enough to benefit from ADR.

Tests Specific To Lumbar ADR Candidates

Lumbar disc replacement requires a careful selection process because the lower back is load-bearing and the surrounding joints and alignment play a bigger role in long-term comfort.

Lumbar MRI helps assess disc herniation, disc collapse, Modic changes that suggest inflammation at the disc level, and nerve root compression that can drive sciatica, numbness, or weakness.

Lumbar X-rays are especially important because they show the spine in weight-bearing position. They help evaluate lumbar lordosis and pelvic parameters, which affect balance and how forces travel through the spine.

X-rays can also show spondylolisthesis and subtle instability that might not be obvious on MRI. Even small shifts can matter when considering a motion-preserving implant.

CT scans are often most helpful in lumbar ADR when surgeons need to assess the severity of facet joint arthritis or plan around prior surgery or atypical anatomy. If the facets are significantly arthritic, disc replacement may not relieve pain the way a patient hopes, because the disc is not the only pain generator.

In general, lumbar ADR is most successful when there is a clearly defined disc problem at one or two levels, with preserved alignment and manageable joint changes.

Evaluating Bone Quality And Overall Health

Disc replacement is not only about the disc. It also relies on your bones and your overall health.

Bone Density Testing (DEXA Scan) When Indicated

Good bone quality helps the artificial disc anchor securely and stay stable long term. If a patient has significant osteoporosis, the risk of implant-related problems rises, and surgeons may recommend fusion or another approach instead.

Not every patient needs a DEXA scan, but it is often considered when there are risk factors such as older age, history of fractures, or other reasons to suspect low bone density.

Basic Lab Work and Medical Clearance

Most patients will have basic blood work before surgery. Common tests include a complete blood count and a metabolic panel, along with clotting studies when appropriate. These help identify concerns like anemia, infection risk, kidney or liver issues, or other factors that could affect healing and safety.

Medical clearance may also include heart and lung assessment when needed. The goal is not to create obstacles. It is to reduce preventable risk and optimize anything that could impact recovery.

When Additional Diagnostic Tests Are Needed

Not everyone needs every test. But when symptoms and imaging do not line up cleanly, or when more than one structure could be contributing to pain, additional studies can bring clarity.

Nerve Tests (EMG and Nerve Conduction Studies)

These tests can help when the pattern of symptoms does not perfectly match the MRI findings. They can also be useful when your surgeon is trying to determine how much of the problem is coming from the spine versus a peripheral nerve issue.

Diagnostic Injections and Nerve Blocks

When multiple structures are involved, targeted injections can help identify the main pain generator. For example, a facet injection or selective nerve root block can provide insight into whether a particular joint or nerve is driving symptoms.

Discography (Rare, Highly Selected Cases)

Discography is sometimes used to identify a painful disc, but it is more limited and more controversial in modern practice. It is not routine for ADR. In some highly selected situations, it may be considered if it is likely to change the treatment plan and improve confidence in the diagnosis.

Dr. Cuéllar uses specialized testing selectively, focusing on studies that meaningfully improve decision-making rather than ordering everything by default.

What To Expect From The Preoperative Workup With Dr. Cuéllar

Patients often feel better once they understand the process and what each step is meant to solve.

A typical preoperative evaluation may include:

• An initial consultation with a detailed review of symptoms, activity level, work demands, prior treatments, and goals. This is where your story matters, not just your scan.
• A review of any existing imaging you bring. In many cases, your current studies provide a strong starting point.
• Ordering updated MRI, X-rays, or CT if your imaging is outdated, incomplete, or does not include the specific views needed to evaluate stability and alignment.
• Laboratory tests and medical clearance based on your age, health history, and surgical plan.

Dr. Cuéllar explains what each test is for and how it influences the decision between ADR, fusion, and continued non-operative care. He prioritizes motion-preserving options when the studies support it and when the plan matches the patient’s goals and lifestyle.

Common Questions About Testing Before ADR

Why do I need more tests if I already have an MRI?

An MRI is extremely valuable, but it does not show everything needed for disc replacement planning. Standing X-rays reveal alignment and balance. Dynamic X-rays show stability and motion. CT can clarify bony anatomy, bone spurs, and facet joint changes. Each test fills a different gap so the decision is based on the full picture.

How recent do my scans need to be before surgery?

In general, surgeons prefer imaging that reflects your current symptoms. Spine findings can change over time, and treatment decisions depend on what is happening now, not what was true a year or two ago. If symptoms have changed or progressed, updated scans are often necessary to plan safely.

Are these tests safe? Will I be exposed to a lot of radiation?

MRI uses no radiation. X-rays and CT do involve radiation, but they are used thoughtfully and only when the information is important for diagnosis or planning. If a CT is recommended, it is usually because it provides details that can improve surgical precision and reduce risk.

What if a test shows I am not a good candidate for ADR?

That outcome is still a win because it prevents you from having the wrong procedure. If testing suggests ADR is not the best option, the same information helps Dr. Cuéllar recommend a safer alternative, which may include fusion, another motion-preserving approach when appropriate, or continued non-operative care.

Schedule A Consultation To Review Your Tests And ADR Options

If you already have imaging, or you have been told you might need surgery, a thorough review can help you understand what your tests show and what your next step should be.

Dr. Jason M. Cuéllar evaluates patients for cervical and lumbar disc replacement at Cuéllar Spine, with offices in Jupiter, Palm Beach Gardens, and Aventura. His team frequently reviews cases for individuals who travel from across South Florida and beyond for motion-preserving spine surgery.

Your existing tests will be reviewed carefully. Only the studies that are truly necessary will be ordered. And whether you are a candidate for cervical ADR, lumbar ADR, fusion, or continued non-operative care, you should leave the consultation with a clear understanding of your options and a plan tailored to your spine and your life.