01-12-2019

Everything you need to know about disc replacement surgery

Disc replacement surgery, or ADR, is a procedure in which a damaged or unhealthy disc is replace by an artificial disc implant. Here at Instituto Clavel we would like you to know all about this surgery, including its advantages and risks.

When patients suffer chronic pain due to degenerative cervical or lumbar disc disease, and have not be able to find relief through conservative treatments, two types of operations can be performed: lumbar or cervical fusion surgery in which the vertebrae are fused by means of screws and/or plates causing the vertebrae to be immobilized, or disc replacement surgery (ADR) in which the damaged disc is replaced by an artificial disc prosthesis.

Many surgeons consider fusion surgery to be the surgery of choice, but at Instituto Clavel, as specialists in the spine, we have verified that ADR surgery is an option that offers many advantages over fusion.

The main reason is that with total disc replacement surgery, it is possible to eliminate the pain-causing agents; the degenerated nucleus, the fissured ring, the sinuvertebral nerve endings, as well as the eroded endplate. In addition, the improvements in recent years in the material of the prostheses, make it more effective.

For these reasons, and other benefits we will describe below, ADR is the surgery we recommend whenever it is appropriate for the case, and it is one of the surgeries we perform most often.

Advantages of ADR compared to fusion surgery

  • In ADR surgery, the vertebrae are not immobilized, conserving joint mobility.
  • With this surgery the risk of degeneration in the adjacent discs is greatly reduced in comparison with fusion surgery, reducing the possibility of needing more surgery in the future. 
  • ADR surgery is minimally invasive, as it is performed with an anterior approach to the spine; this means that it is not necessary to open the back muscles or manipulate the nerves, so the risk of damage to the nerves or chronic pain is greatly reduced.
  • Osteotomies, which can provoke a significant loss of blood, are not performed.
  • Because the vertebra recovers complete mobility, the patient’s quality of life is significantly improved, allowing them to return to sports, and reducing pain considerably.

ADR surgery at Instituto Clavel

Before undergoing the surgery, the patient must request an appointment at the Instituto Clavel so that the surgeon can learn about their medical history and can advise them on the best option in a personalized way.

In this way, the patient and the doctor jointly evaluate the option of undergoing this surgery. If the patient decides to move forward, the protocols of our Preparation, Empowerment, and Recovery (PER) program are activated, to facilitate the entire process and reduce patient stress.

A date for the surgery will be assigned and the patient be admitted to the hospital on the same day of the operation. It is necessary to abstain from eating or drinking for 6 hours prior to the operation. The surgery itself usually lasts about an hour for 1 level cervical or lumbar, and each additional level is about thirty minutes more. Once the surgery has concluded, the patient is transferred to the reanimation area in which he will remain for about two hours, prior to being transferred to his hospital room. The average hospital stay is usually between 1 and 3 days, depending on the type of surgery.

Recovery from ADR surgery is a gradual process in which, as is normal, the patient may notice discomfort. Between 7 to 10 days after the operation, the patient will have a follow-up appointment with our nursing staff to see how the incision is healing, and have sutures removed if appropriate.

During the first week after surgery, we recommend that that the patient take walks, and avoid physical stress, and after that week, continue walking as the best exercise for recovery. In general terms, you should avoid making any unnecessary exertions, and be careful to avoid bad postures during the first 3 months after surgery, especially the first month. The patient will be able to start swimming one month after surgery; running and cycling after the first three months.

After about 3 weeks, the patient can return to work if it does not involve physical labor. If the patient’s work requires physical effort, they can usually return to work about 6 weeks after surgery. Alternatively, it is recommended that the patient undergo supervised rehabilitation sessions at a specialized physiotherapy center. At Instituto Clavel our medical team works hand in hand with the professionals at FisioSpine to offer a rehabilitation adapted to each case.

Possible risks or complications of the surgery

Although it is minimally invasive, ADR, like any other surgery may entail some risk to the patient. We describe these risks below:

  • Damage to nerve structures: Although not impossible, nerve damage is much more rare than in the case of traditional posterior approach surgery, because during most of the operation the surgeon does not work near the nerves. 
  • Damage to the vascular structures: the most delicate moment of the operation is the dissection of the large veins that run along in front of the spine. For this reason, the possibility of hemorrhage and need for transfusion are risks to be aware of. However, this is a controlled risk, as these structures can be repaired during the operation should any damage occur and the patient usually suffers no ill effects because the problem is resolved immediately. Even in the case of a complex lesion, we have vascular surgeons always on hand who perform this kind of surgery.
  • Infection: As any other surgery, this one is not exempt from the possibility of infection, but it is infrequent because the surgery is fast, the incision is minimal and easily treated.

With respect to minor postoperatory complications, these are the most common:

  • Postoperative constipation: keep in mind that since the access route is abdominal, the bowel movement or peristalsis is slowed down during the first days, so constipation during 3 or 4 days is usually perfectly normal and can be treated without problems with mild laxatives if needed. The reintroduction of feeding after surgery is carried out progressively from liquids to normal solid foods during the first 48 hours. 
  • Soreness in the buttocks and thighs: this is relatively common during the first weeks as the patient becomes more mobile. However, this type of pain is easily controlled by medication. 

At Instituto Clavel we have all the tools and latest technology needed to carry out this type of surgery safely and effectively

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