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Lumbar Artificial Disc Replacement Surgery

What does “Lumbar Artificial Disc Replacement” mean?

Here is the translation of the individual words:

  1. Lumbar: the area of the spine located in the low back
  2. Artificial Disc Replacement: A manmade disc designed to act similar to a human disc

Altogether, “Lumbar Artificial Disc Replacement” means placing a manmade artificial disc in place of the human disc in the low back.

What is a Lumbar Artificial Disc Replacement (L-ADR)?

L-ADRs were first approved by the FDA in 2004. These devices can act similar to a normal human disc and create some motion between the vertebrae. Currently, there are two L-ADRs approved for use in the United States:

  1. Charite Artificial Disc Replacement made by DePuy
  2. Prodisc-L Artificial Disc Replacemen made by Synthes

Why is a Lumbar Artificial Disc Replacement (L-ADR) done?             

An L-ADR is sometimes used instead of a fusion to replace a degenerated disc in the low back. While fusions in the low back have been done for decades, L-ADRs are still considered new devices. While many spine surgeons believe that the motion of an L-ADR is better than a fusion which provides no motion, others are still waiting to see more scientific evidence.

The initial studies which were done with L-ADRs showed them to be safe and effective. However, the long-terms studies will take potentially decades to show that they are also safe and effective in the long-term.

Is a Lumbar Artificial Disc Replacement (L-ADR) surgery done through the back or the abdomen (belly)?

The L-ADR surgery is done through the abdomen. There are several reasons for that:

  1. The L-ADR devices are relatively large and would be difficult to fit into the space for the disc if the surgery was done from the back. Due to its size, the nerves could be injured while trying to place it in the spine.
  2. It is potentially better not to make a cut (incision) in the back and then move the muscles and remove bone to put an L-ADR into the spine. The surgery itself may cause back pain, which could make it hard to know if the pain came from the surgery or from a failure of the L-ADR to give pain relief from a bad disc.
  3. It is relatively simple to get to a diseased disc from the abdomen. The organs can be pushed out of the way without injuring them. The disc can then be seen and removed as a whole. It is technically relatively simple to put an L-ADR into the disc space using this approach.

How is the Lumbar Artificial Disc Replacement (L-ADR) surgery actually done?

Depending on which type of L-ADR is used, there are some differences in how the surgery is done. However, here are some of the general steps of the surgery:

  1. An intravenous catheter (IV) is placed in the patient and antibiotics are given.
  2. This surgery is done in an Operating Room.
  3. The patient is placed on their back (supine) on the operating room table.
  4. The Anesthesia provider puts the patient to sleep under General Anesthesia.
  5. The abdomen is cleaned with a surgical antiseptic and plastic covers (drapes) are placed around the area where the cut (incision) will be made.
  6. A cut (incision) is made through the skin of the stomach with a surgical knife.
  7. The first firmer structure under the skin is the rectus muscle and its fascia (envelops the muscle). The muscle and its fascia are carefully split so that the deeper structures in the stomach can be seen.
  8. Next, the rectus fascia can be seen. Fascia is a layer of thin but tough material which separates different structures. This fascia surrounds muscles, blood vessels, organs, etc.
  9. The fascia is also split to see the structure below it, which is called the peritoneum. This is a layer of tissue which forms a sac around the organs in the abdomen, such as the intestines, liver, spleen, etc.
  10. The peritoneum sac is now pushed aside with retractors (metal instrument designed to move tissue and organs) and the blood vessels in front of the spine are seen. These are the aorta, vena cava and their branches.
  11. Some of the blood vessels have to be moved to the side or tied off to see the diseased disc completely.
  12. A disc is identified and a small needle is put into the disc.
  13. An X-Ray is taken from the side. The disc with the needle placed in it can be seen. The discs are now numbered to make sure that the correct disc has the needle in it.
  14. The disc is now removed with a knife and several other surgical tools. This is the most delicate part of the surgery. The surgeon has to be careful to remove all the parts of the disc which can cause a problem.
  15. The space where the disc was located is measured to make sure the right size of L-ADR is chosen.
  16. Depending on what type of L-ADR is chosen, the vertebrae next to the disc may have to be prepared to accommodate it.
  17. The L-ADR is now carefully inserted. During this process, X-Rays are taken to make sure the device is in the correct position.
  18. The main part of the surgery is now done.
  19. The retractors are removed
  20. Sometimes a drainage tube (surgical drain) is placed to allow for any bleeding to drain out from the patient.
  21. The rectus muscle fascia is closed with stitches (sutures).
  22. The skin is closed with small stitches (sutures).
  23. Sometimes steri-strips (butterflies) are placed over the stitches.
  24. A bandage (dressing) is placed over the wound and taped down.
  25. The patient is awoken from Anesthesia and taken to the Recovery Room.
  26. Often another X-Ray is taken in the Recovery Room to show the position of the L-ADR.

How long does a Lumbar Artificial Disc Replacement surgery take?

An L-ADR on one disc takes approximately 1-2 hours to complete.

What is the recovery from a Lumbar Artificial Disc Replacement surgery like?

  1. The patients who undergo a L-ADR are admitted to the hospital for a 1-2 day stay on average.
  2. Once the intestines are shown to function well, and the pain is controlled, the patient is discharged home.
  3. The surgeon usually gives the patient specific instructions on what motion to limit or avoid in the low back. One fear is that too much motion done too early in the low back could move the L-ADR out of its ideal position.
  4. Sometimes a back brace is used as a reminder of the surgery and to limit the motion.
  5. The surgeon will often restrict the amount of weight a patient should lift to avoid stress on the site of the surgery.
  6. The surgeon will usually take another X-Ray in a few weeks to check on the L-ADR, its position and the amount of motion it gives the patient. These X-Rays are often taken by bending forward, backwards and side to side to show the motion of the L-ADR.
  7. Once the surgeon is happy with the results of the surgery, some or all of the restrictions on movement can be lifted.

What type of benefit can patients gain from a Lumbar Artificial Disc Replacement?

The symptoms from the diseased disc (pain, numbness, weakness) often begin to improve quickly, but it can take weeks to months to reach the maximum level of improvement. Some of the symptoms experienced before surgery may not improve completely.