A lumbar disc replacement is a surgical procedure to remove a damaged disc in the lower spine and replace it with an artificial lumbar disc. The lumbar spine is made up of the 5 vertebral bones and intervertebral discs between the rib cage and the pelvis. When one of these discs is damaged or pinches surrounding nerves, removing the diseased disc and replacing it with an artificial lumbar disc can relieve pain and restore spinal mobility.
A lumbar disc replacement is an excellent treatment choice for people who have certain kinds of lower back problems and who have not found relief from supportive treatments, physical therapy or other medical care. You may be a candidate for lumbar artificial disc replacement if you have any of the following symptoms of conditions:
The best way to know if you need lumbar disc replacement is to speak with an expert in spine surgery who routinely performs lumbar artificial disc replacement procedures.
Importantly, many spine surgeons focus almost exclusively on spinal fusion, another surgical treatment for chronic low back pain. However, since lumbar artificial disc replacement can preserve spinal movement and lumbar fusion does not, it is best to speak with a surgeon who performs both lumbar disc replacement and lumbar spinal fusion to fully discuss your options. Learn more in our disc replacement vs. spinal fusion comparison guide.
Lumbar artificial disc replacement can be remarkably effective in reducing pain in people with degenerative disc disease. Nerves and nerve roots are no longer pinched because the diseased intervertebral disc has been removed. Bone spurs are smoothed so they can no longer rub against sensitive structures. The normal distance between the spinal bones is restored. These interventions combine to relieve chronic low back pain.
Perhaps the greatest additional benefit of lumbar artificial disc replacement surgery is that it can restore or preserve motion in the spine. Both spinal fusion and artificial disc replacement—the two surgical treatment options for degenerative disc disease—can relieve low back pain; however, only lumbar artificial disc replacement preserves the lumbar spine’s ability bend, flex, and rotate. Instead of fusing the two spinal bones together in spinal fusion surgery, the new artificial disc functions in many ways like a natural, healthy disc. After lumbar artificial disc replacement, patients can usually return to many of the activities they once enjoyed. After spinal fusion, spinal range of motion is more limited, and the patient’s ability to move the spine normally is also limited.
Overall, the risk of serious complications from lumbar artificial disc replacement are low. Every surgery carries some risk of a reaction to general anesthesia, bleeding, nerve damage, or infection. Uncommonly, the artificial disc can move out of its intended position. If this happens, a second surgery may be needed to reposition the implant. While people were once concerned about artificial discs wearing out, modern artificial lumbar discs have been shown to last for decades without wearing out or causing problems. The risk associated with lumbar artificial disc replacement surgery is lower when it is performed by an expert spine surgeon with ample experience performing disc replacement surgeries.
Your spine surgeon will examine your imaging studies (e.g. MRI) to determine the extent of the damaged intervertebral disc. While you are lying on your back under general anesthesia, the surgeon will make an incision in your abdomen. Your surgeon will then carefully move your organs and muscles so that the spine is visible. Once the area is prepared, your spine surgeon will then remove all of the damaged lumbar disc, including any parts of the disc that are pressing on nerves or nerve roots. The two vertebral bones, also known as spinal bones, are prepared to accept the artificial lumbar disc. If there are osteophytes (bone spurs), your surgeon will smooth them away. Your spine surgeon will make the space between the two vertebral bones slightly larger to approximate the natural distance between them. The bottom side of the upper spinal bone and the upper side of the lower bone will be prepared to accept the artificial disc. The artificial lumbar disc is then carefully inserted into the spine in proper alignment. The organs and muscles are then placed in their regular positions and the incision in the abdomen is closed with hidden absorbable sutures.
You should prepare for lumbar disc replacement surgery in the same way you would prepare for any surgery. You should meet with a physician for a pre-op evaluation. During this visit, the doctor will take a history, perform a physical examination, run some routine bloodwork, and perform an electrocardiogram, also known as an ECG. If everything looks good on this evaluation, you can proceed to surgery.
There are some things you can do to prepare for lumbar disc replacement surgery that will may recovery easier and lead to better outcomes. If you smoke, stop! It interferes with healing and recovery and makes the surgery riskier. If you have diabetes, make sure your blood sugars are under good control. If you take aspirin or blood thinners, ask your doctor if you should temporarily stop taking them, how far in advance you should stop taking them, and when you should start taking them again after surgery.
A major part of preparing for lumbar disc replacement surgery is preparing for recovery. The more you prepare before surgery, the easier recovery from lumbar artificial disc replacement surgery will be. Before the day of surgery, make sure you have a full supply of any prescription medications you take. You should also make sure you have access to healthy, easy-to-prepare foods. Your activity will be limited for a few weeks after surgery, so make sure any chores that require lifting are done ahead of time, can be put off, or done by someone else who is helping you recover.
Most people require at least one night in the hospital after lumbar disc replacement surgery. Fortunately, you will be able to perform some tasks like walking the day after lumbar disc replacement surgery. Heavy lifting, on the other hand, will not be allowed for a few weeks. People who work in jobs that do not require physical exertion may be able to return to work within 2 – 3 weeks.
Your surgeon’s office should provide detailed instructions to follow during recovery from lumbar disc replacement surgery. These will include how to handle bathing and hygiene, dressing changes, activity restrictions, medications, and the timing of follow-up appointments.