Lumbar Disc Replacement Surgery

Overview

Lumbar Spine

The lumbar spine consists of 5 bones called lumbar vertebrae

• Each lumbar vertebra is formed by a round block of bone, called a vertebral body, and a bony arch attached to the back of each vertebral body
• The bone arch has two parts: two pedicle bones and two lamina bones
• When the vertebrae are stacked on top of each other, they form a hollow tube that surrounds the spinal cord and nerves. The laminae provide a protective roof over these
• Lumbar Spine
• An intervertebral disc sits between each pair of vertebrae. It is like a cushion enclosed by a thick capsule, and works as a shock absorber. The centre is spongy
• Due to wear and tear over the years, the disc degenerates and herniates backwards into the spinal canal, compressing nerves and putting stress on the adjacent facet joints
• Degeneration also causes bone spurs to develop. When these spurs press into the spinal canal, they may compress the nerves

• An artificial disc replacement (ADR) is a mechanical device or implant used to replace a diseased or damaged intervertebral disc
• This guide will help you understand the problem, treatment options, nature of operation and possible complications of surgical treatment
• The goal of surgery is to replace the diseased or damaged disc while preserving your normal spine mobility
• After removing the affected disc, the ADR is inserted in the empty disc space
• Artificial disc replacement mimics some functions of a healthy disc and may also prevent premature breakdown of adjacent lumbar discs
• It also opens up the space around the spinal nerve roots where they pass through the neural foramina
• ADR also protects the spine during strenuous activities that put strong force on the spine, such as jumping, running, and lifting

Types of Lumbar Disc

• The lumbar artificial disc has several different designs. They are made of metal, ceramic, and plastic. Your surgeon will decide which type is suitable
• ADR does not interfere with magnetic resonance imaging (MRI) or metal detectors

 Lumbar Disc Replacement Surgery

• Your surgeon will decide if you are a suitable candidate for lumbar artificial disc replacement
• Certain factors put you at increased risk for problems during or after the operation. It is best to reduce or eliminate as many of these risk factors as possible. For example, the use of alcohol or other drugs (including tobacco)
• To ensure that you are in the best medical condition prior to the surgery you may require to be examined by an anesthesiologist who will evaluate and counsel you regarding anesthesia

Operative Procedure

• Prior to your operation you will be fasted for minimum of 8 hours. The anesthesiologist will administer the anesthesia. Once under anaesthesia you will be positioned for surgery. Using a surgical microscope, the affected disc is removed
• The surgeon will also shave off any osteophytes (bone spurs)
• A fluoroscope (using x-rays) is used to guide insertion of the artificial disc device into the prepared disc space. The surgeon is able to see where the implant goes as it is inserted. This makes the procedure much safer and much more accurate

Post Operative Recovery

• While you are in the hospital, a physical therapist will see you and advise you about ways to move
• Your surgeon may prescribe outpatient physical therapy within one to two weeks after surgery
• Active treatments are used to improve flexibility, strength, and endurance. You will begin a series of strengthening exercises to help tone and control the muscles that stabilise the trunk and back
• You may have immediate relief from your painful symptoms, but many people notice a gradual improvement over the next weeks to months
• Your hospital stay will depend on how quickly you recover
• Your surgeon will continue to follow-up with you. X-rays will be done from time to time to make sure the implant is still in its proper place
• Your surgeon will let you know when you can return to work. Depending on the type of work you do, this should be in about two to four weeks
• If your job requires moving and lifting heavy items, you may need a longer period of recovery

Complications

• All types of spine surgery, including artificial discreplacement, have certain risks and benefits
• Complications from any kind of surgery can also occur from anesthesia, infection, and bleeding
• Medical complications arising from spinal surgery are rare but could include stroke, heart attack, spinal cord or spinal nerve injury, pneumonia, or possibly death

This list is not exhaustive and only includes the most common/serious potential complications.

• Thrombophlebitis
• Infection
• Nerve damage or paralysis
• Spontaneous ankylosis (fusion)
• Retrograde ejaculation (men only)
• Ongoing pain
• Problems with the implant. Long-term studies to assess the safety and effectiveness of artificial disc replacements are ongoing. So far results show a low rate of complications