Lumbar total disc replacement
Overview of surgery:
In younger individuals (below 60 years) a painful and degenerated disc from the lower back can be removed and replaced with an artificial disc. The artificial disc (made of metal and lined with plastic) retains movement at the operated level of the spine. As opposed to spinal fusion which stops movement at the involved region of the spine. Retention of spinal movement also has the advantage of reducing the stresses on the adjacent intervertebral discs
Steps of the surgery:
- The surgery is performed under general anaesthesia, with the patient lying on the back
- The spine is accessed through an incision on the skin over the lower abdomen. The spine is exposed by moving the intestines and large blood vessels aside. The involved disc(s) is completely removed and the resultant space is filled with an artificial disc made of cobalt-chromium and having a plastic liner
- The incision (cut) is closed with dissolvable sutures. A drain tube will remove the blood that collects at the surgical site. A urinary tube may be used to drain the bladder.
The Success rates and the outcomes:
- This surgery is used to treat a very difficult problem- chronic low back pain resulting from disc degeneration. Although the results are not uniform, around 70-75% of patients have relief of symptoms after surgery and are able to function better. However, this procedure is indicated in a few carefully selected patients only.
Your pathway to recovery:
Following surgery, the patient will be moved to the recovery room. Adequate pain relief and intravenous fluids will be provided. When the patient is comfortable, he/she will be transferred to a high dependency ward for an overnight stay or moved back to the ward.
Most patients will be encouraged to walk the day after surgery with or without a back brace. Normal diet or a soft diet is usually advised after 24-36 hours.
The duration of stay in the hospital may extend from 3-6 days depending on comfort and ability to walk and the surgeon will decide on the date of discharge.
Allergic reactions to medications and conditions like pneumonia, stroke or heart attack, though rare and not directly caused by the surgical treatment, may have serious consequences.
Surgical complications can include bleeding, infection, spinal fluid leak, injury to the veins and arteries near the spine, injury to the spinal cord and nerves and its surrounding protective layer (dura). Injury to the spinal cord or the nerves during surgery can result in varying degrees of muscular paralysis, alteration of normal sensations and loss of bowel and bladder control which may be permanent or may recover over a period of