10 Dec An Overview of Artificial Disc Replacement
A new innovative procedure for painful, worn-out spinal discs is artificial disc replacement (ADR). With this spinal procedure, the surgeon uses an anterior (from the front abdominal region) approach to replacing a painful disc with a plastic and/or metal prosthesis. The artificial disc replacement is currently approved by the FDA for replacing discs in the lower back (lumbar) region.
Who is a candidate for artificial disc replacement?
Artificial disc replacement is mainly considered for patients who have only one-level degenerative disc disease (affecting only one disc). Prior to the development of ADR, surgeons used spinal fusion as the main treatment for painful degenerative disc disease that did not respond to usual treatment. ADR is not used for patients who suffer from spinal instability, nerve compression, or spinal fractures.
What are the benefits of artificial disc replacement?
The advantages of ADR include preserved range of motion at the disc level and faster recovery time compared to spinal fusion. In addition, ADR is a simple procedure with long-term benefits for the patient.
How is the artificial disc replacement done?
When you arrive at the surgical center, you will change into a gown, and the nurse places an IV line in your arm. General anesthesia is used, so you will be asleep for the surgery. After being positioned on the special radiolucent table, the surgical area (abdomen) is cleaned with an antiseptic. After administering a local anesthetic to the skin and deeper tissues, the surgeon makes a small incision just to the left of the umbilicus (belly button). The surgeon uses a small retractor to move the abdominal muscles, peritoneal sac, and intestines.
After visualizing the disc in question, the surgeon uses special instruments to restore normal disc height and remove the damaged disc. The artificial prosthesis is carefully placed into the spinal space, using x-ray guidance to confirm position. After removing any debris, scar tissue, and bone spurs, the incisions are closed with strong sutures. The skin is usually covered initially with a surgical bandage, but later on, it is left open to air.
What can I expect immediately after surgery?
The total surgery time for ADR is around 2-3 hours. Most patients stay in the hospital 2-4 days and then go home. Immediately after your surgery, you are monitored by a nurse in the recovery room for 1-3 hours. Once you are alert and awake, the nurse will ask you questions about your pain and comfort level. Medications are administered for pain and to prevent infection. Once you are stable, you are moved to a hospital room, where a physical therapist works with you to get in and out of bed.
What can I expect during rehabilitation?
Because this is a serious surgery, you will need help waling for a few days (walker or assistive device). The physical therapist works with you to improve strength and flexibility. In addition, you must avoid bending, twisting, or lifting for 2-4 weeks to avoid strains and injury.
What are the restrictions after surgery?
Some rehabilitation considerations include:
- Brace – Some patients use a lumbar corset to offer additional back support during the postoperative period.
- Wound care – Keep the surgical wound clean and dry, and return to the surgical center in 7-14 days for suture removal.
- Shower/bath – You are permitted to shower, but must keep the abdominal incision covered with a bandage. After showering, change the bandage and dry the surgical area.
- Driving – You should avoid driving for 14 days, and do not drive as long as you are taking pain medicines.
- Return to work/sports – You must rest for 2-3 weeks and gradually return to usual activities. Continue to work with the physical therapist who will notify you of when it is alright to return to work or sporting activities.
Is the ADR procedure successful?
According to a recent clinical study, lasting and significant pain relief was attained by the 97.4% of participants following an artificial disc replacement. In addition, 95% of patients resumed sports activities with improved athletic performance.
Siepe CJ, Wiechert K, Khattab MF, et al. (2007). Total lumbar disc replacement in athletes: clinical results, return to sport and athletic performance. Eur Spine J, 16(7), 1001-1013.