The main advantage to an artificial lumbar disc replacement is the preservation of movement in the affected segment or segments, exactly the opposite of what occurs following a vertebral fusion, which calls for the connection of the vertebral discs and ultimately a loss of natural intervertebral movement.
The other added advantage of an artificial disc replacement is the prevention of adjacent disc degeneration. In vertebral fusions, the resulting loss of movement in the affected segment requires the other vertebral discs to compensate for the lack of movement in the fused vertebra. This requires them to support greater tension and thus puts them at a higher and more probable risk of future disc degeneration, leading to possible lumbar discogenic pain and vertebral changes that could require re-intervention at a later date; however, in artificial disc replacement surgery, the artificial disc replicates normal intervertebral movement and the other vertebra are not required to support greater than normal loads, keeping adjacent disc stress much lower than in the case of a vertebral fusion.
Are you a candidate for artificial lumbar disc replacement?
Although we can see dramatic results after lumbar disc replacement on the internet, we must be very cautious when opting for this type of surgery and consider candidates ideal on a case by case basis. We must inform them that not all people with back pain or disc degeneration are candidates for this type surgery. Furthermore, it is recommended that we always follow the advice of a trained and experienced professional who has performed various types of lumbar procedures since this will him or her to best determine, based on his or her own experience, which procedure will yield the best results. This will also allow the patient to avoid the trend of surgeons who are only comfortable with one type of procedure or who do not personalize the surgical solution to each individual case. As in other aspects of life, there is no one-size-fits-all solution. Talk with your surgeon about the most appropriate procedure for you.
In any case, the ideal candidates for this surgery are those patients who:
Present no scoliosis.
Are not obese.
Have not previously been fused by anterior or posterior approach.
Have a history of back pain of primarily discogenic origin that has not improved following at least six months of conservative treatment.
Show no signs of nerve compression due to foraminal bony elements.
Lumbar Total Disc Contraindications:
1. Facet arthrosis
2. Central spinal stenosis
3. Lateral recess spinal stenosis
9. Deficient posterior elements
10.Herniated disc with radiculopathy
12. Previous fusion
The surgery is performed using an anterior approach (via an abdominal incision). This aids in avoiding possible injury to the posterior spinal muscles, which often leads to pain in the postoperative period. In any case, it is a somewhat complex surgery and must take into account not to injure the iliac vessels and the autonomic nervous elements that could lead to sexual dysfunction in men; both of which in experienced hands are very rare complications.
The postoperative hospital stay is 4-5 days.
Results: Taking all appropriate factors into consideration can lead to a very successful procedure and the patient can expect a full recovery to pre-operative state usually after a few weeks.
Dr. Vicenç Gilete, MD, Neurosurgeon & Spine Surgeon.
Neurosurgery volumes I–III. Edited by Robert H. Wilkins and Setti S. Rengachary. McGraw-Hill.
Handbook of Neurosurgery. Mark S.Greenberg, Seventh Edition. Thieme.
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