Spinal surgery is for those whose severe back pain has not responded to more conservative treatment methods after at least 3 to 6 months. The back pain must have an identifiable source, such as a pinched nerve or a painful motion segment. The source should come largely from 1-2 discs in the spine, and good candidate are generally not excessively overweight.
Patients who have severe back pain without an identifiable cause would not be helped by spinal surgery. Patients who have yet to try more conservative treatment methods such as physical therapy, chiropractics, epidural injections and medication should try more conservative treatment before deciding upon lumbar decompression surgery. Patients who have significant joint disease or compression on the nerves, as well as patients who have a spinal deformity would not be candidates for lumbar disc replacement.
Like other surgeries, lumbar disc replacement requires a complete physical examination with your primary care provider and/or orthopedic surgeon prior to surgery. You should inform your orthopedic surgeon of any medications or supplements you take, and comply with general surgery procedures such as preoperative blood testing and possible cessation of smoking or use of pain relievers and anti-inflammatory drugs one week prior to surgery. You may need to stop taking blood thinner medication if you are on a regular dose of drugs such as Warfarin (or other blood thinners). You will likely be asked to stop eating or drinking the night before surgery.
The first few days after your procedure will be spent in the hospital, and you will likely have a urinary catheter inserted. You will be discharged home with a back brace or cast, and should follow your doctor’s instructions with regards to general activity level and level of assistance required. Ensure your incisions are kept clean and dry, and follow your surgeon’s instructions in regards to bathing, changing the dressing, and follow-up visits. Take pain medication as needed.
Recovery can take anywhere between a few weeks to a few months, and should be accompanied by a regimen of physical therapy. Driving should be avoided initially and not resumed until you are not taking pain medication that may compromise your ability to drive safely.
As with any surgery, there are risks of complications related to blood clots, infection, injury to nerves or blood vessels, or adverse reactions to anesthesia. As lumbar disc replacement is a highly invasive surgery requiring greater access to the spine than standard spinal fusion, its overall risk profile is much higher. Complications specific to lumbar disc replacement include dislocation or dislodging of the artificial disc, implant failure/fracture, implant loosening/wear, narrowing of the spine because of the breakdown of spinal bones, and stiffness of the spine.