One of the current treatments for a herniated disc is the removal of the damaged disc and a spinal fusion. However, a new technique has appeared on the horizon with the potential to relieve the pain of a herniated disc without some of the negatives associated with spinal fusion surgery—artificial lumbar disc replacement.
Although some people experience significant pain relief with a fusion—a reported 80 percent of those operated on— others have less relief. The main problem with spinal fusion is that it prevents normal motion of the spine.
Total artificial disc replacement involves inserting a mechanical “disc substitute” that allows normal motion in the spine, because the artificial disc replicates natural spinal function.
Who is Most Likely to Benefit from Total Disc Replacement?
Various scans—X-rays, CT scans, and MRIs are usually taken to determine whether a patient is a good candidate for a total disc replacement. Many physicians feel that the best candidate is one who:
- Is experiencing back pain caused by one or two discs in the lumbar spine
- Does not have facet joint disease or bony compression on the nerves
- Is not significantly overweight
- Has not had lumbar spinal surgery previously
- Has no spinal deformity (scoliosis, for example)
How is the Surgery Performed?
The disc replacement surgery is done through an abdominal incision, similar to the approach used for an anterior lumbar interbody fusion. The organs and blood vessels are carefully moved aside to allow access to the spine without moving the nerves. The surgery is usually done by both a vascular surgeon and a neurosurgeon working together. One of several available disc prostheses is inserted into the disc space to perform the function of the disc prior to the damage occurring to it. The artificial disc may be made entirely of cobalt, chromium, or titanium alloy or a combination of metal and medical grade polyethylene plastic.
Recovery and Rehabilitation
With an artificial disc, no bone healing is required, so the patient is encouraged to get up and walk the day after the surgery and also to move the midsection of the body. This early motion may accelerate the recovery time. Several weeks of exercise –mostly walking and stretching—are prescribed.
While disc replacement has been found to reduce back pain, it usually does not completely eliminate it, so it is important that the patient have realistic expectations.
Because this is a new procedure, the long-term effects are not yet known.
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