In the past, disc degeneration was often treated by spinal fusion surgery. However, with the advancement of medical technologies and practices, lumbar total disc replacement surgery has emerged as a viable alternative to spinal fusion. The 2021 Position Statement from the International Society for the Advancement of Spine Surgery on Cervical and Lumbar Disc Replacement confirms that lumbar total disc replacement surgery is an effective alternative surgery that helps relieve back pain while still preserving motion.
Candidates for Lumbar Disc Replacement
Lumbar disc replacement is a motion-preserving procedure that has benefits when compared to traditional spinal fusion for those who qualify as good candidates. However, not everyone with low back pain will need or should immediately consider lumbar disc replacement surgery.
Lumbar total disc replacement is generally reserved for patients who have degenerative disc disease, a herniated or recurrent herniated disc, or a bulging disc. However, for any back pain, patients should first try non-surgical treatment, such as rest, medication, physical therapy, and epidural injections. If the non-surgical treatment does not result in pain relief, patients can then be evaluated for lumbar disc replacement surgery. It’s recommended to visit an experienced disc replacement surgeon for this evaluation.
For some spinal conditions, lumbar total disc replacement is not recommended. Instead, spinal fusion may be the more appropriate procedure. For example, it is not ideal for those who have scoliosis, significant facet joint disease, spinal fractures, osteopenia, or osteoporosis. It is also not recommended for patients with previous spinal surgery complications, autoimmune disorders, allergy to some metals, or patients who are obese.
A comprehensive evaluation that will help determine the primary cause of your back pain. A spine surgeon may recommend several tests, including MRI scans, CT scans, X-rays, and bone density (DEXA), to help determine if disc replacement is the best treatment option for your needs. If you do not qualify for lumbar total disc replacement surgery, your surgeon will continue to help you find a treatment option that better suits your individual condition.
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What is lumbar disc replacement?
Lumbar disc replacement surgery is also known as lumbar total disc replacement (LTDR), artificial disc replacement (ADR), or disc replacement surgery. Lumbar disc replacement is intended to relieve disabling low back pain, with or without leg pain, by replacing damaged or diseased discs with an artificial disc. These discs are often made of metal in combinations with medical-grade plastic. Lumbar total disc replacement replaces both the annulus and the nucleus of the disc. The artificial disc is designed to mimic the form and function of the spine’s natural disc allowing for more natural motion
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What are the benefits of lumbar disc replacement?
The benefits of lumbar artificial disc replacement can include:
- Decreased pain and discomfort
- Reduced recovery time versus a spinal fusion surgery
- Preserved flexibility and range of motion
- Less stress on adjacent discs above and below the implant
- Less likelihood of future additional surgery
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Where is lumbar disc replacement performed?
Lumbar disc replacement can be performed in the lumbar spine including L5-S1. Disc replacement is not performed in the thoracic spine.
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What happens during lumbar disc replacement surgery?
Lumbar disc replacement surgery begins with general anesthesia. The surgeon makes an incision in the front of the abdomen and carefully moves organs and blood vessels to the side until the lumbar spine has been exposed. Next, the spine surgeon will remove your problematic disc and insert an artificial disc implant into the space. The procedure takes approximately one to two hours. The artificial disc allows for flexion-extension, side bending and rotation through the device, therefore preserving the spine's normal range of motion and flexibility.
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Can you have more than one lumbar disc replacement?
Yes, lumbar disc replacement can be performed at multiple levels. Single level lumbar disc replacement was FDA approved October 2004; Two level lumbar disc replacement was FDA approved in April 2020.
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Are lumbar disc replacement implants FDA approved? Which implant will my doctor use?
Yes, there are several FDA-approved disc replacement devices available in the U.S. It’s important to discuss what device options are appropriate for you, as there are several factors a surgeon considers when determining which device to use. The physician will determine which implant is appropriate for you by examining your spinal anatomy, vertebrae size, disc height, and overall spinal stability.
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How do I know if I qualify for lumbar disc replacement surgery?
Some of the common conditions that may make you a candidate for disc replacement surgery include:
- Lower back pain with or without leg pain
- Conservative treatment without significant relief of pain
- Degenerative disc disease
- Herniated lumbar discs or recurrent herniated discs
- Previous disc surgery with continued pain
- Qualifying for a spinal fusion
Your doctor will be able to discuss with you whether lumbar disc replacement surgery would be a solution for your specific condition.
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I was told I need a spinal fusion. How do I know if I am a lumbar disc replacement candidate
If you are interested in finding out if you are a good candidate for this procedure, you should get a second opinion. It’s important to discuss artificial disc replacement surgery with a surgeon experienced in both fusion and disc replacement surgery to determine if you are an appropriate candidate for disc replacement surgery.
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Are there any conditions that lumbar disc replacement will not work for?
Not everyone with back pain is a disc replacement candidate. The causes behind back pain can be quite complex and interconnected across the disc and surrounding bone. In some instances, spinal fusion may still be the preferable option. For example, conditions such as scoliosis, ankylosing spondylitis, spinal fractures or significant facet joint disease may not qualify for disc replacement. It is also not recommended for patients with previous spinal surgery complications, autoimmune disorders, metal allergies or patients who are morbidly obese.
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Can I have a cervical disc replacement if I am allergic to metals such as nickel
If you think you have a metal allergy or nickel allergy you should let your surgeon know at your consultation so you can be tested. If you have a metal allergy to nickel, you cannot have a lumbar disc replacement. Currently, the lumbar implants available contain small amounts of nickel.
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What is the recovery process like after lumbar disc replacement?
Most patients are up and walking a few hours after surgery and can go home from the hospital 1-2 days after surgery. Before discharge, therapists work with patients and instruct them on proper techniques for getting in and out of bed and walking independently.
After surgery, most lumbar disc replacement patients will wear a soft lumbar corset to provide additional lumbar support for 2-3 weeks, if necessary. In general, patients are not required to wear a formal back brace.
Patients usually start physical therapy a few weeks after surgery. Patients recover quickly, and most return to non-strenuous jobs 2-4 weeks after surgery. Patients can gradually begin to bend, twist, and lift after 4-6 weeks as the pain subsides, and the back muscles get stronger.
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Is lumbar disc replacement covered by insurance?
Yes, single-level lumbar replacement is now covered by most insurance plans. There are some plans that do not cover lumbar disc replacement, such as Medicare and Medicaid. You should contact your insurance company to learn more about your specific coverage.
About Lumbar Total Disc Replacement at Texas Health Center for Diagnostics & Surgery
The Center for Disc Replacement is a specialty program located in Plano, Texas at Texas Health Center for Diagnostics and Surgery. Spine surgeons on the hospital’s medical staff are pioneers of artificial disc replacement surgery, having performed thousands of artificial disc replacement procedures. The spine surgeons at the Center for Disc Replacement participate in and are committed to clinical research that allows early access to the latest arthroplasty technologies and have authored numerous publications about disc replacement technology.
If you’re considering lumbar total disc replacement surgery and are interested in finding out if you are a candidate for this procedure, contact our program director today who can talk with you about the process, answer any questions you may have, and discuss whether this type of surgery could be an option for you.
Not local to Texas? Many of our patients live outside the Dallas-Fort Worth area, even in other states, and travel to Plano for their disc replacement surgery. We are happy to help coordinate this process with you.
To make an appointment of for additional information, contact us at 844-544-9501 or TheCenterforDiscReplacement@thcds.com.