Lumbar Disc Replacement
Lumbar disc replacement, or lumbar arthroplasty is a surgery of the lower back where a degenerated disc is replaced with a motion preserving mechanical device that mimics the natural motion previously provided by the disc.
Our spine has three sections – cervical (upper spine/neck), thoracic (mid-back) and lumbar (lower back). The spine consist of a series of bones called vertebrae with a disc located between each vertebra. These discs serve as a cushion or shock absorbers, absorbing the impact of everyday motion. They consist of an outer annulus and a softer gelatinous material in the center. As we age, it is common for the discs to become worn and compressed. This is called degenerative dis disease (DDD). Estimates suggest that 40% of adults over the age of 40 and 80% of adults over 80 suffer from this degeneration. Low back pain is a very common symptom of DDD and is one of the most common reasons people see their primary care physician. A variety of non-surgical treatments are available to relieve pain and enhance mobility. However, about 10-20% of adults with lumbar DDD do not obtain long standing relief from non-surgical treatments and in those cases, a surgical treatment can be considered.
Historically, spinal fusion has been the most common and primary surgical treatment for DDD. Lumbar Disc Replacement (LDR) or lumbar arthroplasty is a procedure that has been around for 30 years continues to evolve with better implants and more widespread acceptance with patients and insurance companies. Lumbar arthroplasty involves an anterior approach providing access to the front of the disc space. The surgeon removes the degenerated disc and replaces it with an artificial disc which preserves natural motion of the spine. A spine fusion procedure, conversely, replaces the degenerated disc with bone graft or cage that permanently joins two vertebrae together as one solid unit of bone thus reducing movement. This procedure acts to decrease pain by restricting painful movement of the arthritic spine.
Benefits of Lumbar Disc Replacement
The benefit of Lumbar Disc Replacement is the preservation of the natural motion of your spine. The implanted artificial disc, which is made of two titanium “endplates” with a mobile composite center replicates the motion of the natural disc. Spine fusion on the other hand limits movement across the fused segment. This transfers motion to the adjacent segment causing added stress and strain. Added stress and strain can lead to accelerated degeneration of the adjacent level (above or below the fused level), creating the possibility of additional pain and degeneration.
Additional benefits of lumbar disc replacement include much faster recovery time. Often lumbar disc replacement patients are performing normal activities within weeks of surgery compared to months with a spinal fusion. No bracing is required with an arthroplasty whereas with a spine fusion a brace is recommended for up to three months.
Candidates for Lumbar Disc Replacement
Candidates for lumbar disc arthroplasty typically are patients with degenerative disc disease who have participated in conservative, non-surgical treatments but have not seen significant relief. Not all back pain patients are candidates for lumbar disc replacement surgery. Patients with instability, fractures, scoliosis, severe facet joint disease, post laminectomy and other etiologies are often not good arthroplasty candidates. As previously mentioned, motion preservation is a benefit of lumbar disc replacement. However, for some patients with instability or other problems mentioned above, a spinal fusion may be the optimal treatment. Good bone quality is also a prerequisite for lumbar disc replacement.
In summary, Lumbar Disc Replacement is often a good alternative to traditional spine fusion for the treatment of degenerative disc disease and/or mechanical back pain. I’m proud to offer this treatment for the right patients in my practice. If you would like more information or feel like lumbar disc replacement surgery is right for you, please don’t hesitate to make an appointment. I’d be honored to discuss your symptoms and see if lumbar disc replacement is right for you.
1. Medical Advisory Secretariat. Artificial discs for lumbar and cervical degenerative disc disease -update: an evidence-based analysis. Ont Health Technol Assess Ser. 2006;6(10):1-98. Epub 2006 Apr 1. PMID: 23074480; PMCID: PMC3379529.