Once you are under general anesthesia, your spine surgeon will make an incision in your abdomen and carefully move your organs and tissues aside to expose the diseased area of the spine. The diseased discs will be carefully removed. Your spine surgeon will place an artificial lumbar disc at the spine level that is being treated with artificial disc replacement. The speed of recovery is determined by the procedure that requires the longest recovery period. In hybrid lumbar surgery, that is the lumbar fusion portion of the procedure.
The main benefit of hybrid lumbar surgery is that you can receive the best parts of both lumbar artificial disc replacement and lumbar fusion surgery. Both components of the surgery relieve lower back pain and other symptoms of degenerative disc disease. However, artificial disc replacement allows the lumbar spine to remain flexible and mobile, while the fusion creates a sturdy link between two vertebral bones. Hybrid lumbar surgery allows patients to have an artificial disc in at least one lumbar level instead of having fusions at every lumbar spinal level.
A “traditional” spine procedure usually means fusion at every problematic spine level. The lumbar spine only contains five spinal bones and discs. Having a traditional spine procedure at two or more of these levels, i.e., lumbar fusion, would mean giving up considerable flexibility in the lower spine. With artificial disc replacement, the spinal bones above and below the implant have some freedom to bend, twist, and rotate. This is not so with lumbar spinal fusion; the spinal bones are forever fused into a single bone. When two or more spinal levels need surgery, this means two-fifths or more of the lower spine is immobile for the rest of the patient’s life. For most patients, having mobility in the spine means being able to do the things in life they enjoy, like tennis, golf, swimming, or playing with their grandchildren.
Studies have shown that hybrid lumbar surgery delivers excellent outcomes. Patients enjoy relief of back pain, less disability, greater ability to function, and they are left with a good deal of motion in the lower spine. Hybrid lumbar surgery (one fusion, one ADR) provides better pain relief and physical functioning than lumbar fusion at two level. The benefits of hybrid lumbar surgery last for many years.
Unfortunately, not everyone is a good candidate for hybrid lumbar surgery. Hybrid lumbar surgery is only an option for patients who can be treated with at least one artificial disc replacement in the lumbar spine. Patients who need spine surgery for lumbar disc disease but who are not candidates for ADR only have only surgical option: lumbar disc fusion at every spinal level.
Fortunately, if you are a candidate for artificial disc replacement in the lumbar spine, hybrid lumbar surgery is an excellent choice for all the reasons mentioned above: less pain, better function, and good range of motion in the lower spine. In fact, patients who are candidates for artificial disc replacement should consider ADR at all diseased levels. Again, not everyone will be a candidate for multiple-level artificial lumbar disc replacement, but it is something to discuss with your spine surgeon. Lastly, you should strongly consider choosing a spine surgeon who regularly performs artificial disc replacements. If you consult a spine surgeon who mostly performs spinal fusion and rarely, if ever, performs disc replacements, you could be limiting your options unnecessarily. In short, you may be a candidate for hybrid lumbar surgery or even multiple-level artificial lumbar disc replacement, but you may not be offered those options.
When in doubt, always seek a second opinion!
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