Spine surgery

Lumbar disc replacement (lumbar total disc replacement)

This article provides general information about lumbar disc replacement surgery, also called total disc replacement (TDR) and is not a substitute for advice from Dr Reddy. It does not account for your individual health, diagnosis or treatment plan.

 

Lumbar disc replacement (lumbar total disc replacement or TDR), is a surgical procedure that involves replacing a damaged intervertebral (spinal) disc in the lumbar spine (lower back) with an artificial one. The surgery happens in two parts:

  • The damaged disc is taken out – this is called a lumbar discectomy. The spinal canal and nerve foramen are decompressed.
  • The space is filled with an artificial lumbar disc that mimics a natural disc to preserve movement in the affected area of the lower spine.

Why might someone need lumbar disc replacement?

A person may need a lumbar TDR if a damaged disc in the lumbar (lower) spine causes severe or ongoing pain low back pain that does not respond to nonsurgical treatment.

Not everyone with a damaged lumbar spinal disc is suited to a lumbar TDR. Dr Reddy will assess things like your age, health and condition to advise the most appropriate treatment for you.

What causes lumbar disc damage?

Lumbar disc damage is mostly caused by degenerative disc disease but it can also happen through injury.

Degenerative disc disease happens when the spinal discs wear down over time. The discs shrink and lose moisture, leading to damage. As a result, this can damage the surrounding area and means the discs can’t properly support the spine, leading to structural changes and pain.

How is a lumbar disc replacement done?

The surgery begins by using general anaesthetic to put you to sleep. The surgeon then makes a small incision (surgical cut) in your abdomen (tummy) and carefully parts the muscles and abdominal content to reach the affected part of your spine.

The surgeon will then remove the damaged disc and any loose disc material or other structures, such as osteophytes (bone spurs), that are putting pressure on the spinal nerves and spinal cord. Once the disc has been removed, they will insert an artificial disc and secure it. Last, they will close the incision with sutures before a dressing is placed over the top.

What are the benefits of a lumbar disc replacement?

A lumbar TDR is effective at relieving a person from low back pain and symptom of nerve compression, with up to 80% of people reporting improvement after surgery.

TDR helps to preserve motion of the spine and potentially reduces the rate of wear and tear of the discs above and below it, compared to a traditional spinal fusion (replacing a damaged disc with a bone graft and fusing the adjacent vertebrae together with metal plates and screws).

However, this procedure is also unable to treat other sources of pain in the spine and fewer people are suited to this surgery.

What are the risks of a lumbar disc replacement?

While any surgery carries some risk, a lumbar TDR is a relatively safe procedure. However, since it is fairly new, it is difficult to know how an artificial disc affects the spine over a long period.

Some potential risks of this procedure include but are not limited to:

  • bleeding, infection, blood clots, and reaction to anaesthesia, as with any type of surgery
  • injury to the large vessels within the abdomen (tummy)
  • persistence of symptoms despite surgery
  • new back or leg pain after surgery
  • bowel obstruction
  • bowel injury
  • retrograde ejaculation (semen enters the bladder instead of coming out of the penis during ejaculation) in males
  • autonomic nerve dysfunction (nerves controlling things like sensation, heart rate, temperature and digestion do not work properly)
  • adjacent segment degeneration (disc replacement puts extra stress on the vertebrae and discs above and below, so these levels may have an increased rate of degeneration and may cause pain over time)
  • Implant misalignment
  • damage to the spinal nerve roots or spinal cord, resulting in worsened pain, weakness, numbness
  • faulty or lack of movement from implant

Your surgeon will discuss these risks with you in more detail and address any further questions you may have.

How should I decide to have a lumbar disc replacement?

To decide whether to have a lumbar TDR, it is important to discuss your medical condition and the procedure with your doctor, and carefully consider the benefits, risks and limitations. There may be risks with not having surgery to stop the pressure on your spinal nerves.

If you decide to have surgery, you will need to sign a consent form. Please read this carefully before signing it. If you have any questions, ask Dr Reddy.

How do I prepare for surgery?

It is important to tell Dr Reddy about all the prescription, over-the-counter and herbal medicines, and supplements, that you take. Medicines and supplements may affect blood clotting and healing after surgery, so you may need to stop taking them beforehand.

You may need to fast (not eat or drink) for several hours before your procedure. You may also have to stay in the hospital for a few days so it’s a good idea to bring anything you need with you.

Smokers should stop smoking since this can delay recovery and increase the risk of wound infection.

Speak with Dr Reddy to learn exactly what to do before your procedure.

What happens after surgery?

After surgery, you will be taken to the recovery ward where your health will be monitored until you are fully awake. From there, you’ll go to another ward where you will continue to be looked after.

It is normal to feel some pain around the incision after the operation, but pain medication can help to control this.

Most people can begin moving around the day after their procedure. This is recommended to help prevent blood clots in your legs. You may leave hospital about 2 to 4 days after surgery, depending on your health.

You may not be allowed to drive for a time after surgery, and once you get home you may need help with things like showering and chores.

 

Please only refer to this information in consultation with Dr Reddy. If you have any questions, ask Dr Reddy.


Sources 
  • Büttner-Janz K, Guyer RD, Ohnmeiss DD. Indications for lumbar total disc replacement: selecting the right patient with the right indication for the right total disc. International journal of spine surgery 2014;8:12.
  • Salzmann SN, Plais N, Shue J, Girardi FP. Lumbar disc replacement surgery—successes and obstacles to widespread adoption. Current reviews in musculoskeletal medicine 2017;10(2):153-9.
  • Yajun W, Yue Z, Xiuxin H, Cui C. A meta-analysis of artificial total disc replacement versus fusion for lumbar degenerative disc disease. European Spine Journal 2010;19(8):1250-61.
  • Lammli J, Whitaker MC, Moskowitz A, Duong J, Dong F, Felts L, et al. Stand-alone anterior lumbar interbody fusion for degenerative disc disease of the lumbar spine: results with a 2-year follow-up. Spine 2014;39(15):E894-E901.