How is Lumbar Artificial Disc Replacement Performed (A Step by Step Guide)

Lumbar artificial disc replacement is a type of spine surgery used to treat nerve-related symptoms caused by a worn or damaged disc. Spinal discs between the vertebrae, or bones of the spine, act as cushions and allow the vertebrae to move and rotate smoothly.

During lumbar disc replacement surgery, a damaged disc in the lower spine is removed and replaced with an artificial disc. This procedure is designed to relieve symptoms while maintaining the motion of the spine at that level. It is an alternative to standard lumbar fusion surgery.

Brief history of lumbar artificial discs

Swedish surgeon Ulf Fernström designed and implanted the first artificial disc in the 1960s. This round stainless steel device was implanted in both the lumbar and cervical (neck) spine.

In the early 1980s, German surgeons implanted the first commercially available artificial disc, the SB Charite. This was more similar to current artificial discs, with a sliding plastic core between two metallic endplates, which attached to the adjacent vertebrae.

The next major development occurred in the late 1980s with the ProDisc-L. This device had two metallic plates with a non-mobile plastic core. The ProDisc-II was released in the late 1990s. Since then, other devices have come onto the market.

Choosing a surgeon for lumbar artificial disc replacement

If you are considering a lumbar artificial disc replacement, you should first check with your health insurance company to see if the procedure is covered and which surgeons are in your plan’s network.

Lumbar artificial disc replacement is a specialized surgery, so you want to choose a surgeon who has the right combination of training and experience to perform this procedure well. The surgeon should:

Be board-certified or fellowship-trained.

Dr. Thomas Schuler, a spine surgeon with the Virginia Spine Institute, recommends that you choose a surgeon who is board-certified or has done fellowships in spinal surgery, in addition to their primary residency of neurosurgery or orthopedic surgery. These indicate that they have a high level of knowledge, experience, and competency.

Dr. Grant Shifflett, a spine surgeon with California-based DISC Sports & Spine Center says companies that make artificial disc devices also offer advanced training in disc replacement. “I think it’s wise for any surgeon interested in performing disc replacement surgery to attend these training programs to learn important tips and tricks,” he says.

Have a strong track record of successful artificial disc replacements

Surgeons gain experience with each successful procedure they perform. When meeting with a surgeon, it is fine to ask about their experience, such as:

• How many artificial disc replacements have they performed in the past year?
• What percentage of these cases had a positive outcome?
• Did any of the artificial disc replacements fail or need to be corrected?

“While it’s not imperative for a surgeon to have done a million of these operations,” says Shifflett, “I think it is worthwhile to ask your surgeon how many they have done and their familiarity with the procedure.”

Routinely perform other types of spine surgery

If you choose a surgeon who mainly does lumbar fusion surgery, they may recommend that procedure for most of their patients because that is what they are familiar with. However, this may not be the best option for you.

“People need to make sure their surgeon is well-versed in all treatment options,” says Schuler, “so that they’re not just picking the one that they know how to do.”

Be a good fit for you

In addition to having the right combination of training and experience, a spine surgeon should also be a good fit. Schuler says when you meet with a surgeon, you should “feel comfortable with them, and that they understand your needs and goals, and are not pushing you into an operation.”

Qualifying for lumbar artificial disc replacement

Shifflett says most people are potential candidates for a lumbar artificial disc replacement. However, a surgeon will need to review a patient’s medical history, physical exam results, and spinal imaging before deciding how successful this procedure might be for them.

“Young, active patients with single-level degenerative disc disease are excellent candidates,” says Shifflett. These people are often looking to preserve motion in their spine and have no other spine problems. “Those who have had multiple disc herniation are also candidates,” he added.

In general, your surgeon might recommend lumbar artificial disc replacement if:

• Your symptoms are caused by one or two worn or damaged discs in the lower spine
• You don’t have severe disease of the facet joints on the back of the vertebrae or compression of the spinal nerves due to bone spurs, or a type of excess bone growth
• You don’t have a major deformity of the spine, such as scoliosis
• You have not had a previous major surgery on the lumbar spine
• You are not excessively overweight
• You do not have very low bone density (osteopenia or osteoporosis)
• You do not have a known allergy to metals or other components used in the artificial disc device

Your insurer may also have additional requirements for whether your health plan will cover this procedure, such as:

• Being 18 to 60 years of age
• Having tried conservative treatment for at least six months with no improvement, including physical therapy, home exercise and core strengthening program, anti-inflammatory or other medications, or chiropractic care

Schuler says that for most people, surgery will not be the first option when dealing with disc-related low back pain. “If you have significant limitations in your function because of your symptoms, and you’ve exhausted your appropriate non-surgical treatments, only then should you be considering surgery,” he says.

Artificial disc replacement surgery is also not a magic wand that fixes everything overnight. It requires a lifetime commitment to regular exercise, proper nutrition, and good posture at work and home.

“If somebody is going to even consider a disc replacement over a spinal fusion,” says Schuler, “they need to say, ‘I’m going to stay committed to doing what I need to do to get better.’”

Patient preparation before surgery

Your surgeon will talk to you about things you need to do in order to prepare for your artificial disc replacement surgery. These may include:

• Have X-rays, an MRI or CT scan, or blood tests done.
• Continue to eat a healthy diet and stay active to the best of your ability.
• If you smoke cigarettes, consider stopping completely. Smoking can impair your recovery after surgery.
• Arrange for a family member or other caregiver to help take care of you after surgery. If you have young children or another person who depends on you, you will also want to find someone to take care of them during your recovery.
• Prepare for your recovery period by completing your errands, cleaning your house, and stocking up on groceries that require little preparation.
• Stop taking anti-inflammatory medications (such as ibuprofen, Aleve, Advil) at least seven days before your surgery.
• Do not eat or drink anything for several hours before your surgery.
• Take your regular prescription medications, unless your surgeon advises you otherwise. You should tell your surgeon prior to your surgery which medications you are taking.
• Bring a copy of your MRI or X-rays, if requested by your surgeon.

Step-by-step surgical procedure

Lumbar artificial disc replacement surgery takes about two to three hours, although some surgeries may take longer. This procedure involves the following steps:

Preparing for disc replacement

• You will be given a medication (anesthetic) to put you into a deep sleep and keep you from feeling pain during the surgery.
• The surgeon will make a small cut (incision) in your abdomen. They will then move your organs and blood vessels to the side in order to access the front of your lower spine.
• The surgeon will use X-ray visualization to identify the midline of the damaged disc that will be removed.
• They will then mark the midline with a metal pin that can be seen on X-ray imaging.

Removing the damaged disc

• The surgeon will remove the damaged lumbar disc, including removing cartilage and soft tissue from the endplates of the vertebrate. This is called a discectomy.
• If there is unevenness on the endplate surface, the surgeon will correct this so the artificial disc device fits properly.
• The surgeon will mobilize the space between the two vertebrae to maintain enough room for the artificial disc device to be implanted.

Sizing the artificial disc device

Implanting the device and closing

• The surgeon will first prepare the artificial disc device and then implant it in the spine. The position of the implant is checked using X-ray imaging.
• After the implant is in place, the surgeon will put your organs and blood vessels back in place and close the incision.
• After surgery, you will be taken to an area for recovery. You will be monitored here until you are fully awake and then taken to your hospital room.
• You will remain in the hospital for one to three days, depending on how well-controlled your pain is and how long it takes you to regain your ability to function.

Outlook for lumbar artificial disc replacement

Shifflett thinks artificial disc replacement technologies will continue to grow and evolve, with many people seeking out this treatment for worn or damaged discs.

“Our population is more and more active and wants to stay that way,” he says. “I think there will always be the desire to return the body to as close to its normal function as possible.”

Companies continue to develop new disc technologies that provide both natural motion and support, as well as more sizing options. Shifflett thinks it is possible that these advances in technology may one day make disc replacement an option for people who don’t qualify right now.

However, these new technologies take time to develop. They need to undergo extensive testing before they can be implanted widely in patients with degenerative discs. This includes testing them in clinical trials that look at how safe and effective the devices are.

Scientists are also working on other treatments that may allow doctors to heal damaged discs without needing to replace the disc. One of these is stem cell therapy, a type of regenerative medicine. This is still investigational, but many spine centers offer this treatment. Some studies suggest that this treatment can relieve pain in some people with degenerative disc disease.

Schuler says stem cell therapy is the ultimate in motion preservation because you’re using a person’s own biology to heal the disc. “It doesn’t take a 40-year-old disc and make it 20,” he says, “but it makes it functional and it can take the pain away.”

Originally published at https://spinenation.com.