Total Disc Replacement
One goal of this procedure is to relieve the pain caused by pinched nerves or discogenic pain in the lumbar spine by replacing a diseased or damaged disc with specialized metal and polyethylene implants.
Total disc replacement, also sometimes known as an artificial disc replacement, is a procedure that aims to maintain a normal intervertebral disc height while restoring the range of motion a person would have with a healthy disc. Damaged or diseased discs may place pressure on nearby nerve roots, resulting in significant back pain.
Total disc replacement is performed to replace degenerated discs in the lower back with artificial discs that are usually made of metal. These artificial discs attach to the vertebrae both above and below the disc that requires replacement, restoring stability to the spine. During a total disc replacement surgery, the damaged or diseased disc in the lumbar spine is removed through an abdominal incision. The primary goal of this procedure is to relieve pain, weakness and other symptoms caused by compressed nerves in the lower back.
Reasons for Total Disc Replacement
A total disc replacement surgery may be recommended for patients who have severe lower back pain that is caused by one or two damaged intervertebral disks in the lumbar spine. While many patients with lower back pain experience relief from lumbar fusion surgery, the results of that surgery vary somewhat. Some patients still experience persistent back pain after undergoing spinal fusion surgery, often because the fusion prevents a full range of movement in the spine. Total disc replacement surgery is considered an effective alternative to spinal fusion surgery, although total disc replacement surgery is still somewhat less common than spinal fusion.
Candidates for Total Disc Replacement
To determine who is a good candidate for total disc replacement surgery, several tests may be required. This often includes imaging studies such as MRI and CT scans and X-rays. These tests can help pinpoint the exact location of the source of the pain. Certain patients may be deemed unsuitable for this procedure, particularly if they have a history of major lumbar spine surgery, substantial facet joint injury or spinal deformities such as scoliosis or spinal stenosis. Additionally, good candidates should not be significantly overweight.
The Total Disc Replacement Procedure
During a total disc replacement procedure, a small incision is made in the abdomen to gain access to the affected area of the spine. The diseased or damaged disc will be removed from its location between the two vertebral bodies through this incision. The end surfaces of the vertebral bodies will then be cleared of any diseased disc cartilage and prepared for the prosthesis. The vertebral bodies are next gently pulled apart, relieving pressure on the compressed nerve roots and readying the space for the artificial disc replacement.
An artificial disc replacement must be appropriately sized to fill the space between the vertebrae. After it is tapped into position, a polyethylene sliding core is inserted between the end plates. The spine is returned to a normal position, with the artificial disc providing necessary stability to the area. The position of the prosthesis will be carefully evaluated visually, as well as with X-rays images. Following the procedure, patients should be able to move more comfortably.
Risks of Total Disc Replacement
Although total disc replacement is considered effective for reducing pain by removing unhealthy discs, all forms of surgery do carry some risk. The complications that may be associated with total disc replacement include:
- Continued lower back pain
- Adjacent disc disease
- Rejection of the artificial disc by the body
Recovery from Total Disc Replacement
Most patients can stand and walk the day after a total disc replacement surgery. Because bone healing is not required after this procedure, patients are typically able to move their midsection comfortably as well. After undergoing a total disc replacement, patients are usually required to spend 2 to 4 days in the hospital.
Basic rehabilitation exercises can be helpful during the first several weeks after surgery and typically include walking and stretching. Restrictions are placed on activities that can cause unnecessary strain on the lower back. Patients will usually see dramatic improvements in their lower back pain several weeks after the surgery, although total disc replacement surgery may not entirely eliminate the symptoms. A complete recovery from this procedure can take from several weeks to several months, depending on the individual patient.