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Spinal Disc Replacement

A lumbar disc replacement is emerging as a new treatment option for some types of low back pain. Spinal disc replacement surgery has recently been FDA approved in the United States, and a growing amount of research is being performed throughout the world, mostly in Europe, on this new procedure. Lumbar disc replacement may soon be a standard treatment for some types of low back pain.

If you are interested in disc replacement surgery as a treatment for your spine condition, please contact us to determine what option is best for you, what your insurance will cover and any additional surgery costs.

The Problem: Degenerative Disc Disease

Degenerative disc disease is one type of back pain that is caused by wearing away of the cushion that rests between the vertebrae of our spine. The spinal column is made of stacked bones called vertebrae. These bones are separated by a cushion at each level called a spinal disc. The disc is a tough but pliable tissue that helps maintain the position of the spine, but also allows motion between the vertebrae. With this design we have the stability to stand upright, but also the flexibility to bend and twist. Unfortunately, these discs can cause problems as they wear away.

As the disc ages, it becomes more brittle and less flexible. The disc also becomes more prone to injury and degradation. Exactly what causes pain with lumbar disc degeneration is debatable, but we do know that some patients with worn out discs have typical symptoms of low back pain.

It is important to understand that aging discs is normal! MRIs of patients with no symptoms of back pain often show wearing away of the discs. It should not be considered abnormal to have wearing of the spinal discs. That said, some patients can develop symptoms of back pain, and it is possible that their symptoms come from the spinal disc degeneration. It is very important to have this carefully evaluated by your orthopedic surgeon before embarking on any treatment plan.

Low back pain is a significant cause of disability in the U.S. and worldwide. It is estimated that 70% to 80% of people will experience low back pain at some point in their lives.

Artificial Disc Replacement

Artificial disk replacement is a newer surgical procedure for relieving low back pain. Similar to hip or knee joint replacements, a disk replacement substitutes a mechanical device for an intervertebral disk in the spine. The device is meant to restore motion to the spine by replacing the worn, degenerated disk.

Lumbar Fusion and Disk Replacement Surgeries

Lumbar fusion surgery remains the "gold standard" for treating low back pain patients who are not helped by nonsurgical methods. Although many people with low back pain find relief with lumbar fusion, the results of the surgery vary. For example, a patient with spinal stenosis who has a fusion procedure may have a very different outcome from a patient who has a fusion to help back pain that is caused by disk degeneration.

In addition, some patients whose fusion surgeries heal perfectly still end up with no improvement of their back pain.

There are many reasons for the failure to improve after fusion surgery, but some doctors believe it may be due to the fact that fusion prevents normal motion in the spine. Artificial disk replacement has emerged as an alternative treatment option for low back pain.

Who Is a Candidate for Disk Replacement?

To determine who is a good candidate for disk replacement, the surgeon may require a few tests. These may include magnetic resonance imaging (MRI), discography, computed tomography (CT or CAT scan), and x-rays. These tests will also help the surgeon determine the source of the pain.

Good candidates for disk replacement have the following:

  • Back pain thought to be caused mostly from one or two intervertebral disks in the lumbar spine
  • No significant facet joint disease or bony compression on nerves
  • Not excessively overweight
  • No prior major surgery in the lumbar spine
  • No deformity (scoliosis)

Disc Replacement Surgical Procedure

The surgical implantation procedure is performed through an incision in the abdomen (similar to an anterior lumbar interbody fusion).

With this approach, the organs and blood vessels must be moved to the side. This allows your surgeon to access the spine without moving the nerves. Usually, a vascular surgeon assists the orthopedic surgeon with opening and exposing the disk space. Most surgeries take about 2 to 3 hours.

Disc Design

The disk replacement device may comprise the nucleus (center) of the disk while leaving the annulus (outer ring) in place, although this technology is still in an investigative stage.

In most cases, total artificial disk replacements substitute the annulus and nucleus with a mechanical device that will simulate spinal function. There are a number of different disk designs. Each is unique in its own way, but all maintain a similar goal: to reproduce the size and function of a normal intervertebral disk.

Some of the disks are made of metal, while others are a combination metal and plastic, similar to joint replacements in the knee and hip. Materials used include medical grade plastic (polyethylene) and medical grade cobalt chromium or titanium alloy.

Rehabilitation for Lumbar Disc Replacement

Most patients are encouraged to stand and walk by the first day after surgery. Because bone healing is not required following an artificial disk implantation, the typical patient is encouraged to move through the mid-section. Early motion in the trunk area may translate into quicker rehabilitation and recovery.

The typical hospital stay is 2 to 4 days, depending upon pain control and return to function. Basic exercises during the first several weeks after surgery include routine walking and stretching while avoiding hyperextension activities.

Patients can expect improvement of lower back pain and disability in weeks to months following surgery. The results from numerous studies, including FDA-regulated trials, reveal that disk replacement improves, but does not completely eliminate pain. It is critical that prior to surgery the patient and the treating surgeon develop realistic expectations of pain relief.

Research on the Horizon

The future of artificial disk replacement technology will likely include significant advancements in the design of implants, tools for diagnosis of the source of pain, and other approaches to regenerating the disk to normal function.

Where Are We Now?

A recent review in the journal Orthopedics Today reported the findings of several European studies. These studies found good results in about 75-85% of patients. This is about the results expected with spinal fusion. Unfortunately, these studies only lasted about one year, and thus the long-term results are not well understood. More research needs to be done before lumbar disc replacement is a standard option for degenerative disc disease, but it could be a future treatment.




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