Lumbar discs are the cushions between vertebrae in the lumbar part of the spine (or lower back). Degenerative disc disease, or DDD, affects many people over age 60 and surgery is sometimes necessary to correct the problem. In most cases, lumbar DDD is characterized by pain in the lower back and radiating pain from the damaged discs. Because the disc acts as a shock absorber between the vertebrae, when they are damaged, moving the spine can become both painful and difficult.
The lumbar spine is made up of several bones or vertebrae stacked one on top of another in the lower back. In between the vertebrae are cushions called discs that act as shock absorbers. When they wear out or are damaged, often associated with age, it can become painful and hard to move the lower back. Loss of mobility with lumbar disc degeneration is common.
Lumbar disc replacement surgery is a newer procedure approved by the FDA in 2004 to treat lumbar DDD. It is an alternative to fusion surgery during which the vertebrae are fused together after the diseased disc has been removed. In lumbar disc replacement surgery, the diseased disc is removed but replaced with an artificial disk made of metal and/or plastic to allow for better movement post-surgery.
In most cases, lumbar disc replacement surgery is reserved for patients who experience chronic and severe lower back pain that does not subside with non-surgical interventions such as rest, physical therapy, pain medication and steroid injections. To determine if a patient is a good candidate for lumbar disc replacement surgery, doctors will often perform tests including MRI, discography, CT scans and x-ray. They will also look at symptoms. In most cases those who will benefit from lumbar disc replacement surgery have back pain caused by one or multiple vertebrae in the lumbar spine, are not overweight, do not have deformity of the spine (scoliosis), have not had prior major surgery on the lumbar spine and do not have significant facet joint disease or bony compression on the spinal nerves.
During surgery, to reach the affected vertebrae, a surgeon will make an incision in the abdomen. Organs and blood vessels are moved to the side so the doctor can reach the appropriate area. To open the disc space, a vascular surgeon will usually join the orthopedic surgeon in the operating room to lower the chances of complication. In most cases, a mechanical device is inserted into the space the disc was removed from to replace both the center and outer ring of the disc. In some cases, only the center of the disc is replaced. Regardless of the device your surgeon chooses to work with, the goal is the same: to replace a diseased disc with a piece of equipment that is the same size of the intervertebral disk and can perform the same functions. The surgery typically takes two to three hours to perform. If you have multiple affected discs, it will take longer.
After the replacement is put in, the patient will be sewn up and wheeled into recovery. Plan to spend one to three days at the hospital after surgery. Doctors will get you up on your feet as soon as possible after surgery to promote fast healing and reduce the risk of low mobility issues including deep vein thrombosis (blood clots in the deep veins) and bed sores. For several weeks after surgery patients should avoid overextending their back, but they can walk and stretch.
Those who undergo disc replacement surgery do so to improve pain in the lower back caused by a diseased or damaged disc in the lumbar spine. Fusion surgery is still more popular but studies suggest, at least in some cases, that artificial replacement can return patients to better mobility following surgery as well as reduce pain. Most, however, do not enjoy total pain relief after surgery. Always talk with a doctor about realistic expectations.
Those who undergo lumbar disc replacement surgery usually enjoy a reduction in lower back pain. Because the vertebrae are not fused together, patients often enjoy better mobility post-surgery than they would with a fusion surgery. While there is always a possibility that symptoms will not improve after lumbar spine surgery, research shows the risk of that happening is typically lower in lumbar disc replacement surgery than it is in fusion surgery.
There are risks associated with every surgery, and lumbar disc replacement surgery is no different. Because better access is needed during this surgery than in fusion surgery, the risks can be greater. Reported risks include: infection in or around the artificial disc, dislocation or dislodging of the disc, implant fracture, loosening or wearing down of the implant, stenosis (narrowing of the spine), problems associated with an implant that was not positioned optimally, stiffness of the spine and blood clots caused by reduced activity. There are also risks associated with general anesthesia, which is typically used during this kind of surgery. Other risks may exist based on your overall health and any underlying disease.
Lumbar disc degeneration surgery commonly relieves some, but not all, of the pain associated with lumbar degenerative disc disease. In most cases it also allows for better mobility than alternative surgeries used to treat lumbar DDD.
Before surgical intervention, most patients will try a mix of physical therapy and pain medication to alleviate symptoms associated with degenerative disk disease. In some cases, steroid injections will be given in the spine. In addition to lumbar disc replacement surgery, other surgical methods are available. The most common procedure used to treat lumbar DDD surgically is fusion surgery.
Disc replacement surgery commonly runs around $31,000. The hospital stay, who performs the surgery (typically both vascular and orthopedic surgeons are needed) and where it is done all affect cost. Don’t forget to factor in additional costs related to recovery, such as physical therapy. In most cases, insurance will cover all or some of the procedure so always check with your provider for an accurate estimate of out-of-pocket costs.
“Lumbar Disk Replacement.” Lumbar Disk Replacement | Johns Hopkins Medicine Health Library. Accessed May 02, 2018. https://www.hopkinsmedicine.org/healthlibrary/test_procedures/neurological/lumbar_disk_replacement_135,1.
“Our Knowledge of Orthopaedics. Your Best Health.” Artificial Disk Replacement in the Lumbar Spine – OrthoInfo – AAOS. Accessed May 02, 2018. https://orthoinfo.aaos.org/en/treatment/artificial-disk-replacement-in-the-lumbar-spine/.
“Lumbar Degenerative Disc Disease Video.” Spine-health. Accessed May 02, 2018. https://www.spine-health.com/video/lumbar-degenerative-disc-disease-video.
Salzmann, Stephan N., Nicolas Plais, Jennifer Shue, and Federico P. Girardi. Current Reviews in Musculoskeletal Medicine. June 2017. Accessed May 02, 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435628/.
“Disc Replacement Cost.” Disc Replacement Surgery Cost. Accessed May 02, 2018. http://www.artificialdiscreplacement.com/disc-replacement-cost.html.