Artificial Disc Replacement Surgery

Artificial Disc Replacement Surgery

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Overview

Spine (vertebral column) is the central structure of our body that helps in keeping us upright. It consists of bony vertebrae, which are separated by cartilaginous intervertebral discs. The discs acts as a shock absorbers and prevent the two vertebrae from grinding into each other. There are 33 vertebrae divided into 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal vertebrae. The vertebral column houses an enclosed cavity known as the spinal canal. The spinal cord is an elongated tubular bundle of spinal nerves that runs from C1 vertebra to L1 vertebra within the spinal canal. It originates from the base of brain and ends in the form of a horsetail (cauda equina). There are 31 pairs of spinal nerves that emerge from the spinal cord in between the vertebrae. The entire vertebral column is supported by various ligaments, tendons and muscles. All these soft tissue structures protect the delicate spinal cord and provide flexibility to your spine.

What is artificial disc replacement surgery?

Artificial disc replacement is a major surgical procedure to replace the old worn out or diseased disc with an artificial implant that mimics the functions of a normal disc. The artificial disc is either made up of steel, plastic or a combination of two. It effectively carries the lumbar load and restores spinal mobility. The surgery aims at relieving symptoms caused due to degenerated disc impinging the spinal cord or spinal nerves.

Who are candidates for artificial disc replacement surgery?

The patients who meet the following eligibility criteria can go ahead with a disc replacement surgery-

  • Severe back pain not resolved by conservative management (rest, medications and physical therapy)
  • Back pain mainly caused due to 1 or 2 intervertebral discs.
  • No bony compression of the spinal nerves
  • No other significant joint disease
  • Not obese
  • No previous spinal surgeries
  • No deformities of the spine e.g. scoliosis

What happens before artificial disc replacement surgery?

  • The surgeon will perform a preoperative evaluation a few weeks before the surgery is planned.
  • Review of medications will be performed and in case the patient is taking any blood thinning medicine, it will be discontinued.
  • Blood tests, spinal x-rays, MRI of spine, electrocardiogram (ECG), etc. should be performed as advised by the doctor.
  • In case the reports suggest any kind of infection, severe diabetes mellitus, high blood pressure, severe heart or lung disease or any other active metabolic disorder, then surgery is deferred until the condition is resolved.
  • If you are generally healthy and there are no underlying medical complications, you can go ahead with the surgery.
  • You have to fast for several hours before surgery. Do not eat or drink anything 12 hours before surgery or as directed by your doctor.

What happens during artificial disc replacement surgery?

  • A team of surgeons consisting of orthopedic surgeon, vascular surgeon and sometimes even a neurosurgeon will perform the surgery.
  • You will be asked to lie down on your stomach and the surgical area will be shaved, cleaned and sterilized.
  • Because it is a major surgical procedure, you will be given general anesthesia.
  • The surgeon begins with making an incision on your abdomen. The vascular surgeon assists the orthopedic surgeon in moving the abdominal contents such as organs and blood vessels to a side. This is done to have a clear view of the spine.
  • Next, the surgeon removes the damaged disc and replaces it with an artificial disc.
  • The organs and blood vessels are moved back to their original place.
  • The incision is closed and sterile bandage is applied.

What happens after artificial disc replacement surgery?

The surgery usually takes 2 to 3 hours. After completion of the surgery, you will be moved to the recovery room for observation. Once you regain consciousness, vitals (blood pressure, respiratory rate, body temperature and pulse rate) will be monitored and thereafter, you'll be shifted to your hospital room. Next day your doctor will ask you to stand and take a few steps. Walking can be initiated with the help of crutches or walkers. Expect some soreness at the site of incision. But, this will also gradually wean off in a few days. For immediate relief from soreness and pain, apply an ice pack to the affected area.

You will be discharged home after 2-3 days. Gradually resume your normal activities once you get back home. Do not stress yourself and take adequate rest intervals between work. Avoid strenuous activities such lifting heavy weight, jumping, running etc. You will be advised to wear a back brace for the next 4 to 6 weeks. Your doctor will prescribe some supplements for bone strengthening and pain relief medications. Complete recovery post-surgery usually takes around 3 months.

Physical therapy rehabilitation

Physical therapy plays an important role during rehabilitation. Your doctor will recommend physical therapy almost 4 weeks after surgery. The rehabilitation plan consists of

  • Stretching: Gentle stretching exercises for upper and lower extremities to improve blood circulation.
  • Strengthening exercises: Simple strengthening exercises for back and neck muscles can be performed. However, special care is required when performing spinal flexion exercises.
  • Pain management: ice packs can be used to relieve pain. Additionally, pain relieving physiotherapy modalities such as ultrasound and TENS (transcutaneous electrical nerve stimulation) can also be used.
  • Technique correction: daily activities should be performed with the correct technique to reduce unnecessary stress on the back, e.g. always turn to your side before getting up from the bed.
  • Posture correction: due to prolonged pain, patients tend to have a stooping posture. It is important to adopt correct posture after surgery to avoid stress on the operated spine.

Artificial disc replacement surgery preserves most of the natural range of motion of the spine. After completing the physical rehabilitation program most of the patients will have little or no residual pain and regain complete mobility of the spine.

What is the success rate of artificial disc replacement surgery?

Studies have reported 87.5% success rate after disc replacement surgery with no device failure or major complications.

What are the complications of artificial disc replacement surgery?

  • Infection in and around the artificial disc
  • Dislocation or dislodgement of the artificial disc
  • Breaking up of small pieces of metal or plastic (debris) from the disc
  • Narrowing of the spinal canal due to debris collection
  • Loosening of the implant
  • Stiffness of the spine
  • Excessive pressure on the adjacent spinal segments (one above and below the operated segment) increasing the chances of disc degeneration at adjacent level
  • Blood clots
  • Nerve damage during the surgery may cause tingling, numbness and weakness in the legs.
  • Allergic reaction to anesthesia.
  • There is increased risk of complications in patients in whom artificial disc replacement is performed at multiple spinal levels. In case you experience anything unusual post-surgery, such as high fever, severe pain, spinal rigidity, inability to move a body part, tingling, numbness, difficulty breathing etc. make sure to discuss it with your surgeon.

Tips for healthy spine

  • Avoid lifting heavy objects. In case you need to lift, bend your knee to reach the object rather than bending your back. Stand close to the objects you are lifting.
  • Avoid prolonged standing.
  • Avoid wearing high heels. Wear shoes with well-cushioned soles.
  • Always sit with your back fully supported. While working on computers, ensure keeping a stool under your feet.
  • Avoid smoking.
  • Maintain ideal body weight. Keeping yourself active and keeping a calorie count will certainly help you in achieving ideal weight.

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