Lumbar Disc Replacement Surgery in Delhi, India

Lumbar disc replacement is a procedure performed to treat severe back pain and other symptoms caused by a damaged or degenerated lumbar disc in the lower back. Here are some reasons why this procedure may be necessary:

• Disc degeneration: Over time, the intervertebral discs in the spine may degenerate due to age, wear and tear, or injury, which can lead to chronic pain, limited mobility, and other symptoms.
• Herniated disc: It occurs when the soft inner material of a disc protrudes through the outer layer and puts pressure on nearby nerves. This can cause significant pain, weakness, numbness, or tingling in the lower back and legs.
• Failed non-surgical treatments: Before considering surgery, individuals typically undergo conservative treatments such as physical therapy, pain medication, or spinal injections. If these treatment options fail to provide sufficient relief, lumbar disc replacement may be considered as an option.
• Desire to preserve motion: Lumbar disc replacement is an alternative to traditional spinal fusion surgery. Fusion surgery involves removing the damaged disc and fusing the adjacent vertebrae together. In contrast, disc replacement aims to preserve motion and flexibility in the spine by replacing the damaged disc with an artificial disc implant.

Here are some potential benefits of lumbar disc replacement:

• Preserves motion: Unlike spinal fusion, which restricts motion at the fused level, lumbar disc replacement aims to maintain normal spinal movement. The artificial disc mimics the function of a healthy disc. This can potentially result in a more natural and less restricted movement of the lower back.
• Reduced risk of adjacent segment degeneration: Spinal fusion surgery can increase stress and load on adjacent levels of the spine, leading to accelerated degeneration of those segments over time. Lumbar disc replacement may help reduce the risk of adjacent segment degeneration by preserving normal motion and reducing stress on neighbouring discs.
• Faster recovery and rehabilitation: Compared to spinal fusion, lumbar disc replacement typically involves a shorter recovery period. Since the procedure aims to preserve motion, patients may experience less postoperative pain and stiffness.
• Potential for improved long-term outcomes: Studies have suggested that lumbar disc replacement can provide favourable long-term outcomes, including pain relief, functional improvement, and patient satisfaction. Some research indicates that disc replacement may be associated with better clinical outcomes compared to traditional spinal fusion, especially for certain patient populations.
• Avoidance of complications associated with fusion: Spinal fusion surgery carries risks such as pseudarthrosis (failed fusion), adjacent segment disease, and instrumentation failure. While lumbar disc replacement has its own potential risks, it eliminates the need for fusion and its associated complications.

The specific criteria for being a candidate for lumbar disc replacement may vary depending on the individual patient and the surgeon's judgment. However, some general factors that are typically considered include:

• Age: Candidates for lumbar disc replacement are usually between the ages of 20 and 60, although age limits may vary.
• Failed conservative treatment: Candidates should have already undergone an adequate trial of conservative treatments, such as physical therapy, medication, and injections, without achieving sufficient pain relief.
• Single-level degenerative disc disease: Lumbar disc replacement is commonly performed for patients with symptomatic disc degeneration at a single level in the lumbar spine.
• Intact spinal stability: Candidates should have no significant instability or abnormal motion in the affected spinal segment.
• Overall good health: Candidates should generally be in good overall health and without any significant medical conditions.

Preparing for the treatment involves a comprehensive evaluation of your medical history, physical exam, and diagnostic tests.

• Medical Evaluation: Undergo a thorough medical evaluation, which may include physical examinations, blood tests, imaging scans (such as X-rays, CT scans, or MRI), and an assessment of your medical history. This evaluation helps your surgeon assess your overall health and identify any potential complications.
• Medications and Supplements: Provide your surgeon with a complete list of all medications, supplements, and herbal remedies you are currently taking. Some medications, such as blood thinners, may need to be adjusted or discontinued before surgery to reduce the risk of excessive bleeding.
• Lifestyle Adjustments: Your surgeon may recommend certain lifestyle adjustments before surgery. These may include maintaining a healthy weight, quitting smoking, improving nutrition, and engaging in regular exercise to optimise your overall health and facilitate recovery.
• Pre-operative Instructions: Typically, you will be asked to refrain from having anything for a specified period before the procedure.
• Preparing Your Home: Make necessary adjustments to your living space to accommodate your recovery. Remove any tripping hazards, and consider purchasing assistive devices such as a grabber tool or a raised toilet seat if needed.

Here is a general overview of the procedure:

• Anaesthesia: The procedure is typically performed under general anaesthesia.
• Incision: The surgeon makes an incision in the lower back, typically in the midline.
• Accessing the spine: The surgeon moves the muscles and tissues aside to gain access to the affected lumbar spine. This may involve retracting or cutting through certain muscles and ligaments.
• Disc removal: The surgeon removes the damaged or herniated disc, taking care not to damage nearby nerves or structures.
• Preparation of the disc space: The surgeon prepares the space between the adjacent vertebrae to accommodate the artificial disc. This may involve removing any remaining disc material, reshaping the bony endplates, and creating an appropriate space for the implant.
• Placement of the artificial disc: The surgeon carefully positions the artificial disc implant between the vertebral bodies. The specific type of disc used may vary, but the implant is designed to mimic the function of a natural disc, providing stability and allowing for movement.
• Closure: Once the disc replacement is in place, the surgeon closes the incision using sutures or staples. The muscles and tissues that were moved or cut during the procedure are also repaired.

Like any surgery, lumbar disc replacement is associated with certain risks and complications, including:

• Infection: Infection is a possible risk with any surgical procedure. Although rare, it can occur in the surgical wound or around the implanted disc, leading to pain, swelling, redness, and potentially more severe complications.
• Nerve or spinal cord injury: During the surgery, there is a risk of damaging nearby nerves or the spinal cord. This can result in neurological complications, such as weakness, numbness, or even paralysis. The chances of nerve or spinal cord injury are generally low but still exist.
• Implant-related complications: The artificial disc used in the replacement surgery may face certain complications. These can include implant migration (shifting from its intended position), implant fracture, wear and tear, or loosening of the implant. These complications may require additional surgeries or interventions to address.
• Allergic reactions: In rare cases, patients may have an allergic reaction to the materials used in the artificial disc implant. This can result in localised or systemic symptoms ranging from mild to severe.
• Persistent or recurrent pain: While lumbar disc replacement aims to alleviate chronic back pain, there is a possibility that the procedure may not entirely resolve the pain. Some patients may still experience persistent or recurrent pain following the surgery, although it is generally less severe than before the procedure.
• Blood clots: Any surgical procedure carries a risk of developing blood clots, particularly in the legs (deep vein thrombosis). If a blood clot travels to the lungs (pulmonary embolism), it can be life-threatening. Measures are usually taken to minimise the risk of blood clots, such as early mobilisation and the use of compression stockings or blood-thinning medications.
• Anaesthetic complications: The use of general anaesthesia or spinal anaesthesia carries its own set of risks and potential complications, including allergic reactions, respiratory problems, or adverse reactions to the anaesthetic medications.

Here is a general overview of the recovery process:

• Hospital Stay: Following the surgery, patients typically stay in the hospital for a few days for close monitoring. Pain medications and antibiotics may be administered, and physical therapists may begin early mobilisation and gentle exercises.
• Pain Management: Pain and discomfort are common after lumbar disc replacement surgery. Doctors will prescribe pain medications to manage the postoperative pain. These medications may be gradually reduced as the recovery progresses.
• Activity Restrictions: During the initial recovery period, patients are advised to avoid bending, lifting heavy objects, or engaging in strenuous activities that can put stress on the spine. The surgical team will provide specific guidelines regarding activity restrictions and limitations.
• Physical Therapy: A physical therapist will guide the patient through exercises to improve strength, flexibility, and range of motion. This helps in the rehabilitation of the spine and surrounding muscles. The therapy sessions may continue for several weeks or months, depending on the progress.
• Gradual Resumption of Activities: As the recovery progresses and with the approval of the surgical team, patients can gradually increase their activity levels. This may include returning to work, driving, and participating in low-impact exercises or recreational activities. However, high-impact activities or heavy lifting should still be avoided during the initial months.

The results can vary, but many individuals experienced significant improvement in their symptoms, including reduced pain and increased mobility. The artificial implant is designed to mimic the natural movement and function of the disc.

What is the Cost of Lumbar Disc Replacement Surgery?

The lumbar disc replacement surgery cost can depend on the type of implant used, the surgeon's experience and skill level, the location of the procedure, and the patient's insurance coverage.

Q1. What is the success rate of lumbar disc replacement?

The success rate varies and depends on factors such as the patient's age, health condition, type of replacement, and postoperative care. Generally, the success rate is estimated to be between 70-90%.

Q2. How long does a lumbar disc replacement last?

The longevity varies from patient to patient, but on average, it can last between 10-20 years.

Q3. Is disc replacement better than fusion?

Disc replacement is better than fusion for some patients, as it allows for more mobility and preservation of the natural spinal motion. However, it is important to note that fusion may be a better option for others, depending on the condition.

Q4. Is Disc Replacement FDA-approved?

Yes, FDA has approved the use of artificial lumbar discs for the treatment of chronic low back pain.

Q5. How serious is disc replacement surgery?

Disc replacement surgery is considered a serious procedure and involves a significant amount of risks and potential complications, including infection, nerve damage, and implant failure.

Q6. Can lumbar discs regenerate?

No, lumbar discs do not regenerate once they have degenerated.

Q7. What are artificial lumbar discs made of?

Artificial lumbar discs are made of various materials, including metal and plastic.

Reviewed by Dr Ashish Gupta, Senior Director, Neurosurgery, Spine Surgery on 29-May-2023.

• Lumbar spine surgery post-operative care and instruction
• New Help For All Spinal Problems: Live Better!