Anterior Lumbar Total Disc Arthropasty
An anterior lumbar total disc arthroplasty avoids nonphysiologic fusion of two bones, decreases recovery time, and allows patients to return to work and normal activities of daily living (ADLs) within 4-12 weeks. An anterior lumbar total disc arthroplasty begins with a lower abdominal incision to expose the front of the spine. The disc material between two vertebrae is removed and an appropriate size, mobile, total disc arthroplasty is placed and the incision is closed.
Who Is A Candidate For Total Disc Arthroplasty?
Surgery is a last-resort treatment that a doctor recommends when nonsurgical therapies fail to achieve significant or lasting relief from uncomfortable symptoms. While surgery may be a necessary step in regaining a better quality of life, surgeons prefer that patients are well-prepared for surgery.
Ideal surgical candidates do not smoke and are in good general health. Patients who smoke are advised to quit as soon as possible to allow their body to regain optimal circulation before surgery. Quitting smoking reduces surgical risks and improves the body’s capacity to heal after the procedure.
Patients who could benefit from total disc arthroplasty should be at a healthy weight. Studies have shown that overweight patients who undergo lumbar surgery have a higher risk of postoperative complications. Furthermore, excess weight places more stress on the low back. Reaching a healthy weight before surgery can improve the long-term outcome from a spinal procedure.
To achieve the best results from lumbar surgery, doctors evaluate patients for the presence of spinal deformities that may compromise the integrity of the artificial disc. They also examine the patient for signs of underlying joint disease such as osteoarthritis and spinal nerve compression.
Can You Combine Total Disc Arthroplasty With Other Procedures?
Studies indicate that, in some cases, surgeons may combine total disc arthroplasty with interbody fusion to correct symptomatic degenerative disc disease.
How Do I Prepare For Total Disc Arthroplasty?
When you consult with a spine specialist, expect to discuss multiple factors that may affect your health and mobility. Inform your doctor of all medications and supplements you take regularly, including over-the-counter medications like aspirin. Substances that thin the blood increase the risk of intraoperative and postoperative bleeding and bruising. The doctor may suggest avoiding certain medications that are not absolutely necessary.
Patients who smoke are advised to quit as far before surgery as possible. Additionally, it is beneficial to minimize or avoid alcohol for several days before surgery. As we move closer to the day of the procedure, patients receive detailed preoperative instructions that are tailored to their case. Our staff is available to answer questions that may arise in the planning stage of treatment.
The Total Disc Arthroplasty Procedure
Total disc arthroplasty is an outpatient procedure that involves replacing a natural, damaged disc with an artificial disc. The procedure is performed under general anesthesia. To access the spine anteriorly, the doctor makes a small incision in the lower abdominal area. They remove the damaged disc with special instruments and set an artificial disc in its place. The new disc has three parts, two metallic plates and a plastic core situated between them. The metallic places have prongs that can be attached to the vertebrae to gain full stabilization.
Over time, the bone tissue naturally grows around the prongs, increasing their integrity. After the incisions are closed, the patient is moved to a monitored recovery area where they will remain until they regain sufficient alertness to be released.
What Is Recovery Like?
The recovery period after total disc arthroplasty is relatively short in comparison to fusion procedures. That said, patients should prepare a few things before surgery. Ideally, patients will have access to healthy, easy-to-prepare meals beginning the day of their procedure. It is also necessary to pick up prescriptions before the day of surgery so they are readily available when needed.
Postoperative pain after the total disc arthroplasty is typically milder than patients expect. However, a low-dose opioid may be prescribed to help manage comfort. This medication or another prescription pain reliever may be needed only for a few days. Many patients quickly find it possible to manage comfort using an over-the-counter medication like acetaminophen.
It is advisable for patients and their temporary caregivers to review our postoperative care instructions before the day of surgery. This allows time for questions in advance of the procedure. Postoperative instructions discuss when the patient may shower, drive, return to work, and resume normal activities. While patients are encouraged to walk casually to help prevent blood clots, they will spend several days doing little more than that. Postoperative follow-up visits are scheduled ahead of surgery to observe wound healing and integration of the new disc. At these visits, x-rays may be taken to evaluate internal healing.
What Should I Expect From My Results?
Total disc arthroplasty is a minimally invasive spine procedure that is very conservative. Patients require minimal downtime to recover. Some degree of pain and weakness is expected during the recovery period. Many patients return to work after a few weeks of rest and gentle movement. Once the artificial disc has integrated with the adjacent vertebrae, it should perform just like a normal, healthy disc. Patients can expect comfortable mobility in the lower back as a result.
How Long Does The Procedure Usually Take?
The total disc arthroplasty procedure usually takes 1 to 2 hours. Patients may be at the surgery center for 4 to 5 hours to allow for presurgical preparation and anesthesia recovery.