Lumbar disc replacement surgery is a spine surgery procedure to remove a damaged disc in the lower back and then fill the newly open space with an artificial disc. Removing the diseased or damaged disc often relieves nerve or spinal compression that is causing symptoms. However, the empty space that now exists between vertebral bones cannot be left empty, so it is filled with an artificial medical device called an artificial lumbar disc. An artificial lumbar disc maintains the proper spacing between the vertebral bones, gives the spinal column strength and support, but also allows the vertebral bones to move in relation to each other. This last feature means that lumbar disc replacement surgery preserves motion and flexibility in the lumbar spine.
While a spine surgeon will be able to confirm your diagnosis, you can suspect you need a lumbar disc replacement if you have had lower back pain for at least six weeks that has not resolved after trying conservative treatments like rest, heat, analgesics (i.e., pain pills), or injections around the spine.
You may need a lumbar disc replacement if you have degenerative disc disease, disc-related back pain and failed previous surgery.
Symptoms that could indicate that you need a lumbar disc replacement include:
Chronic low back pain that is present to some degree almost constantly
Low back pain with weakness, numbness, or tingling in one or both legs
Pain in the buttock that may or may not extend down the leg
Low back pain that gets worse with sneezing or coughing
Increasing pain when someone presses on the center of the lower back
Low back pain that gets better with walking
You are likely NOT a candidate for lumbar disc replacement surgery if your back pain is not caused by a diseased or damaged lumbar disc or if you have an existing illness that would make the artificial lumbar disc likely to fail, such as cancer that has spread to bone or severe osteoporosis.
The lumbar disc replacement success rate is quite high. When patient satisfaction is considered in the lumbar disc replacement success rate, percentages of satisfied patients are above 90%. Complication rates are low, especially in the hands of experienced spine surgeons. New artificial lumbar discs have the potential to last for decades—manufacturers guarantee them for 40 years in some cases. The devices rarely fail, if at all. When reoperation is used as the criterion for the lumbar disc replacement success rate, more than 90% of patients do not need a second surgery to correct the initial lumbar disc replacement surgery.
As with any surgery, there are certain risks with lumbar disc replacement. General risks include bleeding, infections, blood clots, and negative reactions to anesthesia. Specific lumbar disc replacement risks include implant malposition (i.e., either the artificial lumbar disc is improperly placed or it moves out of its original position), spine rigidity, infection very near the artificial lumbar disc, or one of the bones above or below the device fractures. Fortunately, lumbar disc replacement risks are uncommon, especially when the procedure is performed by a highly skilled spine surgeon. The best lumbar disc replacement surgeons use meticulous sterile technique, expertly place the artificial lumbar disc, and perhaps most importantly, correctly choose who is a candidate for best lumbar disc replacement surgery.
Most patients have one or two level disc replacement as an outpatient or maybe spend one night (and perhaps two) at the hospital after lumbar disc replacement surgery. Multiple lumbar disc replacements may require a longer hospital stay. Lumbar disc replacement surgery recovery time starts when you leave the operating room. In fact, you will start the recovery process the same day or day after of the procedure. Staff will show you how to get out of bed and move about safely, and you will be encouraged to do so as soon as you are able.
Lumbar disc replacement surgery recovery time varies from person to person, but it can take some time to return to full activity. Typically, activity is quite limited for the first two weeks of lumbar disc replacement surgery recovery. Patients certainly cannot perform any lifting of more than five or 10 pounds, and driving will not be possible. That said, after two weeks of lumbar disc replacement surgery recovery—and once being cleared by your spine surgeon—patients may be able to return to light office duties and other work that does not involve physical labor.
It is possible that total lumbar disc replacement surgery recovery time may take up to 12 weeks, so prepare for that possibility. More commonly, patients can resume most light physical activities within three to four weeks after lumbar disc replacement.
You may meet with a physical therapist on the same day or the day after lumbar disc replacement surgery. The physical therapist will simply show you best practices for protecting your lower back. Patients usually do not embark on a full lumbar disc replacement physical therapy protocol for at least two weeks after surgery. In the initial phase (after the first two weeks of lumbar disc replacement recovery), physical therapy includes a walking program, light stretching, and isometric exercises (exercises in which the muscles are activated, but stay the same length).
Later phases of a lumbar disc replacement physical therapy protocol include strengthening exercises for the core muscles and the legs, mainly. Water exercises (aquatic therapy) are often ideal because the water reduces total body weight on the spine, but also provides added resistance to movement. After six weeks of lumbar disc replacement recovery, the intensity of physical therapy increases so that people can return to their former level of strength and flexibility (or beyond).
Find a board-certified spine surgeon.
Board-certified neurosurgeons or orthopedic surgeons who have completed a spine surgery fellowship are best suited to perform lumbar disc replacement.
Choose a surgeon who performs both replacement and fusion.
Surprisingly, not every board-certified spine surgeon performs lumbar disc replacement surgery. Virtually all perform lumbar fusion, but that approach may decrease mobility and flexibility in your spine. By choosing a spine surgeon who has extensive experience in lumbar disc replacement surgery, you can ensure that you will receive the best treatment option for you, whether it is replacement or fusion.
Help your spine surgeon learn about you.
The process of determining whether you need a lumbar disc replacement is based on a number of factors. You can get the most out of your consultation if you bring your X-rays and MRIs, if you have had any taken. Digital results can be sent to the surgical practice electronically if you request it from the radiology center. Also, consider how your symptoms first started, if anything makes them better or worse, and how your low back pain affects your life. Be open and honest with your spine surgeon so that you can get the best care.
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