(Artificial Disk Replacement in the Lumbar Spine)
A lumbar disk replacement is a type of back surgery. It involves replacing a worn or degenerated disk in the lower part of your spine with an artificial replacement made of medical-grade metal or a combination of medical-grade metal and medical-grade plastic.
Lumbar disk replacement is a relatively new procedure to relieve back pain. It gained FDA approval in 2004. It is generally seen as an alternative to the more common spinal fusion surgery that joins two vertebrae together. Lumbar disk replacement is a major surgery that requires general anesthesia and a 2-day to 4-day hospital stay.
Reasons for the procedure
Not everyone with back pain is a good candidate for a lumbar disk replacement surgery. Your doctor will perform a number of tests to determine if it’s the right procedure for you.
Lumbar disk replacement surgery might be recommended if:
The source of your back pain mostly comes from only 1 or 2 disks in the spine.
You have no significant joint disease or compression on the nerves.
You are not excessively overweight.
You haven’t previously had spinal surgery.
You don’t have scoliosis or another spinal deformity.
Your doctor will also look at other factors when determining if you need a lumbar disk replacement surgery, a lumbar fusion surgery, or another course of action.
Risks of the procedure
Like all surgeries, lumbar disk replacement poses some risks. Because it is a highly invasive surgery, the risks may even be greater than for some other procedures. A disk replacement requires greater access to the spine than standard lumber fusion surgery. This also makes it a riskier procedure.
Some of the potential risks of this surgery include:
Infection of the artificial disk or the area surrounding the artificial disk
Dislocation or dislodgement of the artificial disk
Implant failure or fracture
Implant loosening or wear
Narrowing of the spine (stenosis) because of the breakdown of spinal bones
Problems associated with a poorly positioned implant
Stiffness or rigidity of the spine
Some people, especially those with problems in several disks of the spine, joint disease, obesity, or who have had spinal surgery, face additional risks for a lumbar disk replacement and should probably not have the procedure.
There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your surgeon before the procedure.
Before the procedure
Your doctor may perform many tests to determine if the nature of your back pain is suitable for a lumbar disk replacement surgery. This may begin with X-rays to identify the true nature and extent of your back pain and spinal damage. In some cases, imaging tests, such as magnetic resonance imaging (MRI) or computerized tomography (CT), are necessary to get a better view of the spine and pinpoint on the best treatment.
If you are taking any medication, talk with your doctor about what medications you should or shouldn’t take leading up to the procedure. You will probably be told not to eat or drink anything for a number of hours before the procedure.
During the procedure
Here is a general overview of how lumbar disk replacement surgery is done:
You will check into the hospital and change into a medical gown.
You will be brought to a surgical suite and placed under general anesthesia.
A team of surgeons (usually a vascular surgeon and an orthopedic or neurosurgeon) will perform the procedure together.
The surgeon will make an incision in your abdomen.
Your organs and blood vessels will be moved to the side to allow access to your spine.
The surgeon will remove the damaged disk or disks.
The surgeon will put the new artificial disk in place.
The incision will be closed and you will be wheeled into a recovery suite for close monitoring.
After the procedure
You can expect to stay in the hospital for 2 to 4 days after your lumbar disk replacement surgery. Because a lumbar disk replacement doesn’t require bone to heal, the recovery period may be faster than with other back surgeries. You may be encouraged to stand and walk within the first day after surgery.
You will probably be shown how to do exercises for your midsection, such as gentle trunk twists. This will keep your spine limber and lead to quicker rehabilitation and recovery. As your recovery progresses, you’ll be encouraged to walk and stretch. You’ll want to avoid any jarring activities or motions for quite awhile. Your recovery may take from a few weeks to a few months.
A lumbar disk replacement generally improves pain, but it does not eliminate it completely. Talk with your doctor to get a realistic idea about what you can expect after this surgery.
More Patient Input, Better Spine Outcomes
Not long ago, researchers measured spine surgery outcomes based on technical expertise, fusion rates, deformity correction and equipment failure. But that only told half the story, says health services researcher Richard Skolasky, an associate professor of orthopaedic surgery and director of The Johns Hopkins Hospital’s Spine Outcomes Research Center. “Patients,” he says, “are the experts in their own experience.
Survey Shows Spine Surgeons Need to Screen More Patients for Anxiety and Depression
In a report published in the Journal of Spinal Disorders and Techniques, a Johns Hopkins team says that only 10 percent of orthopaedic surgeons and neurosurgeons follow professional guidelines that recommend routine psychological screenings of patients prior to major surgery for severe back and leg pain.