Lumbar Disk Replacement
What is a lumbar disk replacement?
A lumbar disk replacement is a type of back or spine surgery. Your spine is made up of bones called vertebrae that are stacked on top of each other. Disks between the vertebrae work like cushions to allow the vertebrae to rotate and move without the bones rubbing against each other. The lumbar vertebrae and disks are at the bottom of your spine. Lumbar disk replacement involves replacing a worn or degenerated disk in the lower part of your spine with an artificial disk made of metal or a combination of metal and plastic.
Lumbar disk replacement is generally seen as an alternative to the more common spinal fusion surgery. Fusion permanently joins 2 vertebrae together. Lumbar disk replacement is a major surgery that requires general anesthesia and a hospital stay.
Why might I need a lumbar disk replacement?
The main reason you would need a lumbar disk replacement is to treat low back pain. Still, not everyone with low back pain is a good candidate for a lumbar disk replacement surgery. Your doctor will need to do some tests to see if it’s the right procedure for you.
In general, lumbar disk replacement surgery might be recommended if:
- Your back pain mostly comes from only 1 or 2 disks in your lower spine
- You have no significant joint disease or compression on the nerves of your spine
- You are not excessively overweight
- You haven’t previously had spinal surgery
- You don’t have scoliosis or another spinal deformity
What are the risks of a lumbar disk replacement?
Like all surgeries, lumbar disk replacement poses some risks. 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 around it
- Dislocation or dislodging of the artificial disk
- Implant failure or fracture (break)
- Implant loosening or wear
- Narrowing of the spine (stenosis) because of the breakdown of spinal bones
- Problems due to a poorly positioned implant
- Stiffness or rigidity of the spine
- Blood clots in your legs due to decreased activity
There may be other risks, depending on your specific medical condition. Be sure you understand the risks and benefits of lumbar disk replacement and discuss any concerns with your surgeon before the procedure.
How do I get ready for a lumbar disk replacement?
Along with a physical exam and medical history, you may need X-rays, an MRI or CT scan, and blood tests. These help the doctor identify the true nature and extent of your back pain and spinal damage. They may also be needed to get a better view of the spine and decide whether the surgery is right for you.
You may be asked to stop smoking as part of getting ready for spine surgery.
Tell your doctor about all prescription and over-the-counter medicines and any vitamins, herbs, and supplements that you are taking. Some of these may affect things like healing and blood clotting, so you may need to stop taking them before the procedure.
You may be told to not eat or drink anything for several hours before the surgery. You will probably have to stay in the hospital for a few days. You may not be allowed to drive for some time after surgery. For a short time after surgery, you may need some help at home with things like bathing, dressing, cleaning, and shopping. You may want to arrange this ahead of time.
Talk to your healthcare provider so you know exactly what you need to do before your procedure.
What happens during a lumbar disk replacement?
You will have an IV line put into a vein in your hand or arm through which an anesthetic is given. The medicine will put you into a deep sleep and keep you from feeling pain during the surgery. You will be lying on your back for this surgery.
A team of surgeons (usually a vascular surgeon and an orthopedic or neurosurgeon) will do 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 and put the new artificial disk in place. Your organs and blood vessels are put back in place and the incision will be closed.
You will be taken to a recovery area for close monitoring until you are awake from the anesthesia. You will still have an IV line and may also have a catheter in your bladder to make urination easier. When you are fully awake and alert, you will be taken to your hospital room.
Talk with your healthcare provider about what you can expect your lumbar disk replacement procedure to be like.
What happens after a lumbar disk replacement?
You will probably need to stay in the hospital for a few days after your surgery. Because a lumbar disk replacement doesn’t require bone to heal, the recovery period may be faster than with other back surgeries. You’ll be given pain medicines if you need them, and may be encouraged to stand and walk within the first day after surgery. Your IV and bladder catheter will be removed within a few days of surgery.
You will be shown how to move properly and how to do exercises, such as gentle trunk twists. This will keep your spine limber and help you have a quicker rehabilitation and recovery. As your recovery progresses, you’ll be encouraged to walk and stretch. You’ll need to avoid any jarring activities or motions for quite a while. 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. Also talk to your healthcare provider about instructions you need to follow after surgery, what you can and cannot do, how to care for your incision, signs of problems you need to watch for, and when you need to follow-up with the doctor.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
Weighing the Risks, Benefits of Back Surgery
Millions of people experience back problems that cause pain or disability. Of these, a small number will seek relief through surgery.
The reasons for back surgery typically vary with a person's age:
Teens may consider surgery to correct deformities. These include scoliosis, or curvature of the spine.
Adults ages 20 to 50 most likely have problems with disks that have degenerated or slipped out of position. This can cause severe back and leg pain.
Older adults may have spinal stenosis. This is a narrowing of the spinal canal that can press on nerves leading to the legs.
Seldom a first choice
Surgery is the first or only option in just a few cases — for example, when a person is in severe pain, has back instability from trauma, or has nerve problems, such as loss of motor or bladder control.
For a less-severe problem, most doctors and patients prefer to try other treatments first. These include exercise and education, physical therapy, medication, and nerve-block injections. If the problem persists, they may weigh the risks and benefits of surgery.
If you choose to have spine surgery, it will probably be one of 3 types:
Decompression, in which bone or other tissue is removed to take pressure off a nerve or the spinal cord. In a laminectomy, for instance, the surgeon removes part of the bone surrounding the spinal cord. Decompression is also used to relieve spinal stenosis.
Stabilization or fusion, in which a surgeon uses bone grafts or metal rods and screws to fuse vertebrae together, making a strong bridge across a missing or damaged disk.
Corrective procedures, which use spinal fusion and other techniques to straighten deformities, such as scoliosis.
Less invasive techniques have reduced the size of the incision and the amount of blood lost. They have also reduced the normal recovery time for some common procedures. Disk surgeries, for example, now can be performed under a microscope, or using magnified glasses, using an incision that's only slightly more than an inch long.
If you have a microdiscectomy, you may be on your feet within a day or 2, in physical therapy within a week, and back at work in 2 to 4 weeks.
Recovery after fusion surgery can take 8 to 10 weeks or longer.
How fast you recover from any back surgery depends on several things, including your age and general physical condition.
When back problems occur, talk with your primary-care doctor first. Ask to be referred to a spine specialist if your condition doesn't improve after 6 to 8 weeks of treatment.