06-09-2021

Lumbar disc replacement: advantages over fusion surgery

When a herniated lumbar disc requires surgery, at Instituto Clavel we are committed to using artificial disc replacement surgery (ADR) whenever possible, because of the advantages it offers to the patient. In this article, we explain in detail what those advantages are compared to the alternative of lumbar fusion surgery. 

There are various options for treating lumbar disc herniation or lumbar degenerative disc disease. The most common approach is to begin with conservative treatment using pain relief medication, physical therapy, and in some cases, epidural infiltrations in the lumbar spine. If these conservative treatments do not succeed and the patient continues to suffer from pain, then we consider a surgical treatment option. 

At Instituto Clavel, we always carry out a totally personalized diagnosis of each patient to find the most appropriate treatment for each case. If surgery is determined to be the most beneficial treatment, there are various surgical options: lumbar microdiscectomyartificial disc replacement surgery, or lumbar fusion surgery. 

The first, microdiscectomy, is indicated in those cases in which the hernia compresses the nerve root, causing pain radiating down through the leg, and it is not necessary to replace the disc. In this surgery, performed through a small incision using a surgical microscope, the damaged portion of the herniated disc is extracted to relieve the compression on the nerve root and thus eliminate the pain. 

Sometimes microdiscectomy may not be enough, especially when the pain in the lower back is greater than the pain radiating down the leg, or when the disc is very worn. In these cases, it will be necessary to use one of the other surgical treatment options, either lumbar artificial disc replacement or lumbar fusion surgery. Of these two options, whenever possible, at Instituto Clavel we choose artificial disc replacement (ADR), also known as arthroplasty, because of the greater benefits it offers to the patient. We explain below what those benefits are in comparison with lumbar fusion surgery: 

Benefits of lumbar disc replacement surgery 

 

1. Minimally invasive

At Instituto Clavel, we perform this surgery using the minimally invasive anterior approach, making a small incision in the abdomen. This way it is not necessary to open the back muscles and there is no need to manipulate the nerve structures, which greatly reduces the risk of nerve damage and the postoperative pain.  Lumbar fusion surgery can also be performed using the anterior approach to gain these same advantages, and in those cases where a lumbar fusion is necessary, at Instituto Clavel we prefer to use this approach rather than the classic posterior approach. 

2. Faster recovery

When the surgery is performed using the anterior approach, the recovery process is much faster and easier on the patient. Patients usually begin to walk the day after surgery, or two days at the most, and they can normally return to work after 3 weeks, if their job does not require physical labor. For jobs requiring more physical effort, the patient can expect to return to work about 6 weeks after surgery. 

3. Spinal mobility is conserved

In disc replacement surgery, the damaged disc is removed and replaced with an artificial disc implant that imitates the movement of a healthy natural disc, so the patient still has mobility in the lumbar spine. This means that you can expect to return to your normal daily activities and even, in up to 70% of cases, return to sports activities. 

4. Lower risk of degeneration of the adjacent discs

In lumbar fusion surgery, because the disc space is immobilized, over time there will be greater stress on the adjacent discs, above and below, which can cause them to degenerate more rapidly. In fact, after spinal fusion surgery, as many as 10-15% of patients eventually need another surgery in the following years. When a lumbar disc replacement is performed, the vertebrae are not immobilized, so the risk of the adjacent discs being damaged over time is much lower. 

5. Less bleeding during surgery

With the anterior approach there is no need to cut the muscles of the posterior lumbar area that are more prone to bleeding, so it reduces blood loss and the likelihood of need for a transfusion. 

6. High success rate

90% of patients experience a significant reduction in pain after the operation. Most patients find their quality of life has improved and they are able to resume activities that they could not enjoy before because of the pain caused by their lumbar disc herniation. In addition, the risk of complications from the operation is less than 3%. 

Find out more about disc replacement surgery here 

We also offer you this video in which Dr. Pablo Clavel, neurosurgeon and Director of Instituto Clavel, explains more using the anterior approach in arthroplasty surgery

It is important to note that when it is not possible to perform ADR surgery due to certain conditions of the patient (less than 20 years old, pregnant, elderly), we also perform fusion or arthrodesis surgery at Instituto Clavel.

The difference is that we can perform spinal fusion surgery using less invasive options than traditional open surgeries, specifically, lateral lumbar fusion (XLIF or OLIF), anterior fusion using the same approach as in disc replacement (ALIF), or posterior approaches using minimally invasive techniques such as the TLIF-MIS to reduce the inconvenience of posterior approaches. 

As specialists in spine surgery, we are here to help you if you have any questions or need a personalized assessment of your case. Please don’t hesitate to contact us, we will be happy to help you on your way to regaining your quality of life! 

 

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