Although it is estimated that 60 to 75 percent of patients will experience back pain at some point in time in their lives, most will not require surgery to improve their condition. Surgery is generally considered when the condition of back pain does not get better with traditional treatments. For patients who have enervated non-surgical alternatives & are still in pain, spinal disc replacement surgery remains the most common alternative for treating back pain. Over the past few years, numerous spinal disc replacement designs have been created & are currently being tested. The success rate of spinal disc replacement surgery is greater & statistics shows that it is around 80 percent.
The inter-vertebral disc is responsible for providing cushioning & support between vertebrae. This disc might suffer damage from an injury or from a medical disorder such as scoliosis. When an inter-vertebral disc in spinal column gets damaged, spinal disc replacement surgery can be performed to relieve intense back pain by restricting movement of two consecutive damaged vertebrae as advised by the doctor. An artificial implant device that works to substitute inter-vertebral disc replaces the ruptured disc & alleviates pain as well as restores movement.
Although brutal injuries can deteriorate spinal discs, complications with discs are often brought on by the natural aging process or by the following routine activities.
- Heavy object lifting
- Extremely hard stretching during any sport
- Merely slipping & sliding on icy sidewalks
Such events may cause fibrous outer covering of the disc to distort or break to the extent that it creates a strain on spinal nerves, especially if spinal disc material extrudes. Disc sometimes tears, swells or degenerates without any proven cause. Low back pain associated with degenerative spinal disc disease most commonly occurs from one or both of following two sources.
- Inflammation – As proteins in the spinal disc space aggravate the neighboring nerves – both nerves within the spinal disc space & the larger nerves that go to the legs.
- Abnormal Micro-Motion Instability – When outer rings of the spinal disc, called annulus fibrosis, cannot efficiently soak up stress on the spine & are worn down resulting in movement along vertebral segments.
With spinal disc degeneration, patients may notice the following pain patterns.
- Extreme pain while sitting for a long time, lifting, twisting or bending
- Less pain while walking
- Minimal pain if patients change positions frequently
- Less pain while patients lie down
It is extremely important for patients to treat neck & back pain properly. One should seek medical attention if pain persists & immediately contact a doctor if they have any of the emergency signs & symptoms enumerated below.
- Leg pain, weakness, numbness or tingling
- Pain is getting worse
- Disabling pain
- Loss of bladder control
Patients should not ignore these signs & contact a doctor as early as possible.
Specific tests are required to determine if a patient is a good candidate for spinal disc replacement. Orthopedic specialists may ask patients to undergo imaging tests such as an x-ray, computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan to help determine severity & location of vertebral damage. Following are the conditions that decide if a patient is eligible for spinal disc replacement surgery.
- Lower back pain determined to be caused by intervertebral discs
- No compression on nerves or facet joint disease detected
- Patient is not excessively obese
- No previous major spine surgery
- No medical disorders/deformities of spine
Spine surgeons may be able to rule out a spinal cord problem by carefully inspecting & testing for sensory function & movement & also by asking certain questions about the accident. But if patients complain of severe neck pain or have obvious indications of neurological weakness or injury, following diagnostic tests may be required.
- Computerized Tomography (CT) Scan – CT scan may give a clear picture of abnormalities seen on an X-ray. CT scan involves computers to generate a series of cross-sectional pictures that can define disc, bone & other issues.
- X-Ray Tests – Doctors usually order this test on patients who are suspected to have a spinal cord problem after trauma. X-rays are helpful in revealing vertebral or spinal column troubles, fractures, tumors or degenerative changes in the spinal column.
- Magnetic Resonance Imaging (MRI) – MRI involves a strong magnetic field & radio waves to create precise images. This test is immensely helpful for looking at the spinal cord & identifying blood clots, herniated discs or any other factors that may be compressing the spinal cord.
In addition to these tests, surgeons may conduct a neurological examination to determine the level & completeness of spinal injury. This usually involves testing patient’s muscle strength & the ability to sense touch, light & pinpricks.
Traumatic spinal cord injuries are difficult to bear & patients who are injured may take an appointment with neurosurgeons to analyze their condition.
- A large number of specialists will do patient’s counseling on stabilizing their condition, including surgeons who are trained in nervous system disorders & doctors who specialize in spinal cord problems & other nervous system problems.
- Surgeons will evaluate diagnosis reports & determine the severity of spinal cord injury.
- Surgeons may ask patients to avoid smoking & alcohol consumption as it may make recovery tougher.
- Patients must tell surgeons regarding medications they take including any vitamin supplements & herbs.
Patients should be prepared to give out information about circumstances of the event which resulted in spinal injury, including any that may seem irrelevant. Patients may also ask any friend or family member join when they are speaking with surgeons, if possible. Patients may ask the following questions to spine surgeons in order to understand the procedure for spinal disc replacement surgery.
- What is spinal disc replacement surgery?
- What alternative treatments are available for me?
- Why are you suggesting this surgery? What are its benefits?
- Can you explain short-term as well as long-term advantages of spinal disc replacement surgery?
- What kind of side effects can I expect from this surgery?
- Could this surgery help in completely alleviating my back & neck pain?
- What kind of rehabilitation program might help me?
- Do you have any printed material or brochure that can help me in understanding this procedure?
- Are there any specific websites that you may want to recommend me?
- When can I return back to my daily routine post-surgery?
- Are there any medications which I will require to treat back pain in future?
Patients should not hesitate to ask any other doubts or queries which they have.
Inter-vertebral discs are responsible for providing cushioning & movement to two consecutive vertebrae. Wear & tear due to old age or damage to disc due to severe injury in the spinal region gives rise to chronic lower back pain & restricts movement of the spine. In cases, where other non-surgical methods for relieving symptoms of disc degeneration are not successful then orthopedic specialist might advise patients to undergo spinal disc replacement in order to replace the damaged disc with an artificial implant. Spinal disc replacement surgery involves the following steps.
- Anesthesia – This is a major type of surgical procedure & is performed by putting the patient under general anesthesia.
- Incision – Orthopedic surgeons start surgery with an incision in the abdomen to access the patient’s vertebrae. This is known as ‘anterior approach’ & the surgeon will have to shift aside all underlying blood vessels, organs, tissues, etc to gain clear access to the spinal column from the front. This approach helps surgeons avoid moving nerves in the lower back & thus prevents the risk of nerve damage. After having gained access to the spinal column from the front the surgeon will then use a medical clamp to increase space between two consecutive vertebrae & remove the damaged disc.
- Disc Replacement & Closing Incisions – Replacement artificial disc is made to resemble a natural intervertebral disc in shape & size & is composed of metal as well as a mix of metal & plastic. There are a number of disc designs available but they all work to restore cushioning to vertebrae as well as for allowing movement in the spine. Spine surgeon will then replace the damaged disc & incisions will be closed after rearranging all shifted tissues, blood vessels, organs, etc back to the original position. As this does not require any type of bone healing most patients are advised to start walking under the doctor’s supervision on the day after surgery.
In a majority of cases, patients need to stay in the hospital for at least 2 to 3 days following spinal disc replacement surgery. The length of hospital stay largely depends upon how well-controlled is the patient’s pain & ability to return to normal function. Patients are motivated & encouraged to stand & walk by the first day after surgery. As bone healing is not needed following spinal disc replacement, patients are told to move through the mid-section. Early movement in the trunk region may help to quicken rehabilitation & healing process. Patients may perform basic exercises, including regular stretching & walking, during initial weeks after surgery. During this phase, it is extremely essential to avoid any activities that may cause patients to hyperextend their back.
Spinal disc replacement surgeries are more complex orthopedic surgical procedures. As is seen in major surgical procedures these treatments also face certain risks as outlined below.
- Blood clot
- Internal bleeding (hemorrhage)
- Pain at surgical site
Along with these, spinal disc replacement surgery also faces certain uncommonly seen complications as follows.
- Shifting of implant
- Misaligned fusion
- Vertebral fracture when fixing implant
- Implant collapse into bone (subsidence)
- Implant damage after several years
When patients experience complications post-surgery, they should go for a follow-up session & openly discuss these problems with surgeons.
The major benefit of spinal disc replacement surgery is that it permanently relieves patients of the constant lower back pain. Spinal disc replacement surgery for the spine is a better alternative to spinal fusion as this procedure restores & retains movements between vertebrae. There is less than 1 percent chance of breakage to artificial disc implant as seen in various studies & live cases. Spinal disc surgery is one of the more extensive orthopedic implant procedures & is most successful when performed by an experienced & well-trained orthopedic surgeon.
Patients who have undergone spinal disc replacement surgery can expect improvement of back pain & disability in few weeks to months following surgery. Various health reports show that spinal disc replacement enhances the patient’s condition, but does not fully diminish pain. It is essential for patients to talk with spine surgeons about realistic expectations of spinal disc replacement surgery for pain relief. Doctors will also design a post-surgery recovery plan to boost patient’s recovery.
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