Lumbar disc replacement is a good option in patients with degenerative disc disease with low back pain. There are more advantages to this technique when compared to arthrodesis, such as the maintenance of the movement of the joint.
Degenerative disc disease
Degenerative disc disease can lead to two types of clinical symptoms: first, it can cause a hernia and cause sciatica in the patient, for which a discectomy is chosen. In patients with degenerative discopathy with low back pain, which can become disabling and chronic, the usual surgery is arthrodesis, which eliminates joint movement, and pain, with improvements in 70-75 per cent of patients.
The implantation of an artificial disc is the alternative to this arthrodesis surgery: by means of a discectomy the degenerated disc is removed and the artificial disc is implanted.
The first advantage we can mention is that the movement of the joint is maintained instead of eliminating it, which has clinical implications – with a better postoperative course – and fewer lesions and degeneration in adjacent disks in the medium term, unlike what happens to arthrodesis patients due to the increase in intradiscal pressure demonstrated that takes place in adjacent disks.
The technique also presents inherent advantages to its approach by anterior route, which avoids large incisions, with wide dissections of the muscles and the consequent blood loss. In addition, this paravertebral musculature is very important due to the pain experienced by patients both in the postoperative period and in the medium and long term.
Access to the spine is made between L4 and L5, slightly separating the bifurcation of the vena cava as well as the bifurcation of the aortic artery, while between L5 and S1 it is usually not necessary to mobilize the vessels. Once the exposure is achieved, the degenerated disc is removed and an artificial disc implant is placed so that the patient can be discharged on the second or third day after the intervention.
The anterior approach of the disc has some technical complexity and a vascular surgeon is usually necessary. But spine specialists trained in doing the approach have the same or even fewer complications than the vascular surgeon. In the end, the approach is not so complex, although it requires some learning. And, just as cervical disc prostheses are placed, lumbar disc prostheses should be placed. The approach should not be a limitation.
Artificial discs are valid implants thanks to the technology and experience of the last 15 years, and above all, with better clinical results that are obtained now. As noted, the third generation of artificial discs are much better than the previous ones, with designs very similar to the natural disc and with the same flexion and extension curve.