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Introduction
Procedure
Risks
Alternative Treatments
The lumbar spine is comprised of vertebral bodies (also known as vertebrae) that are separated by soft intervertebral discs, which act to cushion the spine, allow mobility, and provide stability.
A variety of reasons can lead to instability of the lumbar spine, which causes increased movement and malalignment between adjacent vertebrae, as illustrated in the figure below, where the image on the left depicts normal lumbar spine alignment and arrow in the figure on the right shows malalignment (also known as spondylolisthesis). Degeneration (wearing out) of an intervertebral disc can also occur without any overt evidence of malalignment or instability, but would cause similar symptoms and is treated in generally the same way.
Malalignment of the spine or degeneration of the disc can cause symptoms such as back pain which is worse with movement or weight-bearing and/or numbness/weakness in the legs that results from compression of one or more nerve roots.
Lumbar disc replacement (also known as lumbar artificial disc replacement or lumbar disc arthroplasty) treats abnormalities in the lumbar spine that arise from the spine abnormalities mentioned above.
In this procedure the diseased disc is removed, followed by placement of an artificial disc in the space between the vertebral levels (in the space previously occupied by the removed disc) in order to provide mobility and to prevent collapse of the vertebrae. Depending on the specific type of artificial disc used, it may be made from metallic components as well as other synthetic materials.
In patients who are candidates for lumbar disc arthroplasty, this procedure can address the underlying spine disease while still maintaning back mobility and may likely reduce the risk of further deterioration of adjacent vertebral levels.
After induction of general anesthesia, an incision is made in the lower part of the abdomen.
The muscle and other tissues are dissected in what is known as the "retroperitoneal approach" until the front part of the spine is reached. Retractors are placed to keep the muscle and other tissues out of the way and to reveal the bony spine. The intervertebral disc is then removed in its entirety as shown below.
The artificial disc is then placed in the space previously occupied by the disc. The incision is then closed prior to the termination of the operation.
Due to advances in medicine and technology, surgical procedures are generally considered to be safe, and a great majority of patients who undergo surgery will not experience any complications. However, there are certain risks involved in any procedure which are important to be aware of in order to make an informed treatment decision.
Risks Specific to this Procedure: The risks associated with this surgery include, but are not limited to, damage to spinal cord or nerve roots leading to increased pain or other neurologic problems, loss of bowel/bladder function, sexual dysfunction, weakness or paralysis, numbness, cerebrospinal fluid leakage requiring placement of lumbar drain, need for further surgery, and spinal instability at adjacent levels leading to need for future surgery or treatment. There is also risk of damage to any of the organs in the abdomen such as the bowel, nerves, and/or blood vessels leading to a variety of potential problems.
Infection: Invasion of tissue by bacteria or other germs occurs to some degree whenever a cut, incision or puncture is made. In most instances, through the natural defense mechanisms of the body, healing of the affected area occurs without difficulty. In some instances antibiotic medicines are prescribed and at times additional surgical measures may be necessary to combat infection.
Hemorrhage: The cutting of blood vessels causes bleeding and this occurs in every surgical incision. This bleeding is usually controlled without difficulty. At times, blood transfusions are required to replace blood loss. If blood transfusions are given, there are additional risks of liver inflammation, hepatitis, and the possibility of receiving Acquired Immune Deficiency Syndrome (AIDS). There is no absolutely reliable way to predict these unwanted reactions, some of which may be quite serious and even lead to death.
Drug Reactions: Unexpected allergies, lack of proper response to medications or illness caused by the prescribed drugs are possibilities. It is important for you to inform your physician and your anesthesiologist or certified registered nurse anesthetist of any problem you or your family have had with reactions to drugs and which medications you have taken in the past six months, including over-the-counter drugs, especially aspirin.
Anesthesia Reactions: There may be unusual or unexpected responses to the gases, drugs or methods used to anesthetize you which can lead to difficulties with lung, heart or nerve function. Eating or drinking before anesthesia increases the risks of vomiting which may cause significant complications. Inform your anesthesiologist or certified registered nurse anesthetist of problems you and your family have had with anesthesia.
Blood Vessel Inflammation and Clotting: It is impossible to predict the occurrence of blood vessel inflammation and clotting problems. If blood clots form, they can move from where they formed to other areas of the body and cause injury.
Injury to Other Organs: Because of the closeness of other organs to the area being operated on, there may be injury to other organs. The stress of surgery or the procedure may also harm other organ systems of the body.
The alternative management modalities for this procedure are physical therapy, pain management using medications or injections, certain alternative medicine therapies (acupuncture), spinal fusion, or expectant management with no treatment at all. If the decision is made to not have this procedure, there may be associated risks which need to be discussed with a physician.
