Lumbar disc replacement is an alternative to other treatments, when dealing with cases of serious disc damage and chronic lower back pain.
The lumbar spine is a complex structure, divided into segments with moving parts. In each segment, there are three elements – an anterior disc and two facet joints in the back.
When any of these three elements suffers degeneration or damage, it can lead to chronic low back pain. In addition, if one of these elements is damaged, it indirectly affects the other two.
Diagnosing the exact cause of a patient's low back pain is not easy. Magnetic resonance images (MRI) and facet blocks can give clues, but physical examination is the key.
When a patient’s low back pain has become chronic, and all other treatment options have failed to provide relief, then surgery is an option to consider.
Lumbar disc replacement surgery without manipulating the back: How is it done?
The goal of ADR (Artificial Disc Replacement or lumbar disc replacement) surgery is to relieve low back pain, and at the same time, preserve the spine’s ability to move as naturally as possible. It consists of replacing one of the moving elements of the spine, the disc, with an artificial prosthesis that will allow the patient to move normally (sit, lift things, turn, squat, or bend over).
When the implant is placed through the anterior abdominal approach, lumbar disc replacement can be performed without manipulating the back muscles and nerves. Using a small incision in the anterolateral part of the abdomen, the surgeon accesses a corridor to the anterior face of the spine, making it possible to replace the largest damaged moving element (the disc) in a less invasive way.
In addition, this surgery has an advantage over immobilizing the vertebrae (fusion surgery), because there is less risk of damage to the adjacent segments.
At Instituto Clavel, whenever possible, we use the anterior approach in lumbar disc replacement surgery to reduce the risk of nerve injury, and help the patient have a faster recovery.
The prostheses themselves, are made of metal and other materials, similar to those used in hip and knee prostheses. They are adapted to the measurements of each patient, accounting for sex, size, and age.
What is the purpose of lumbar disc replacement?
As we mentioned earlier, the goal of lumbar ADR (lumbar disc replacement) is to partially, or completely, eliminate pain in the lumbar spine pain, and still preserve the patient's mobility, so that they can enjoy a better quality of life.
By using the anterior approach, collateral damage to muscle tissue and nerves is minimized, which means less postoperative pain.
When can this surgery be useful?
This surgery may be indicated for persistent low back pain that has lasted more than 3 months, and when an MRI reveals initial degeneration or instability of an intervertebral disc (hypermobility). This procedure is especially recommended in young patients with good bone quality, who have not found relief with conservative treatments.
When is it not recommended?
This surgery is not recommended in cases of patients who have metal allergies, fragile vertebral bodies, or severe facet disease, or if they have had previous lumbar fusion surgery.
How long is the hospitalization?
Patients remain in bed for just a few hours after the surgery, no drainage tubes are required, and they begin walking on the same day. They are discharged from the hospital after 48 hours. There are no stitches to be removed, and rehabilitation is performed on an outpatient basis.
What risks are involved?
Instituto Clavel is one of the centers that performs the highest number of these surgeries in the world, and the percentage of surgical complications is minimal. Because the procedure is performed through the abdomen, the possible risks include injury to large vessels, short-term gastrointestinal issues, and abdominal wall hernia (eventrations).
This surgery has proven effective in considerably reducing pain in 90% of the patients treated at our center, with a direct improvement in their quality of life.
Close to 70% of patients have been able to return to their exercise and sports activities without any limitations.
We hope this post has helped you understand more about the ADR surgical technique for treatment of spinal pain.
In comparison with the procedure performed by the posterior approach, anterior approach ADR has become a true turning point in surgical treatment for disc degeneration, because it manages to minimize both risks and postoperative pain.
At Instituto Clavel, we have a team of great professionals in Neurosurgery and Traumatology who are highly experienced in this procedure.
So, if you have more questions about anterior approach ADR, we encourage you to make an appointment with one of our expert doctors.
Dr. Pablo Clavel
Neurocirujano y director del Instituto Clavel
Categories: Spine treatments