Disk replacement - lumbar spine
Lumbar spine disk replacement is surgery of the lower back (lumbar) area. It is done to treat spinal stenosis or disc problems and allow normal movement of the backbone.
Spinal stenosis is present when:
Lumbar disk arthroplasty; Thoracic disk arthroplasty; Artificial disk replacement; Total disk replacement; TDR; Disc arthroplasty; Disc replacement; Artificial disc
During total disk replacement (TDR), the inner portion of a damaged spinal disk is replaced with an artificial disk to restore normal movement of the backbone.
Most often, surgery is done for only one disk, but at times, two levels next to each other may be replaced.
The surgery is done under general anesthesia. You will be asleep and not feel any pain.
The surgery takes about 2 hours to complete.
Why the Procedure Is Performed
Cushion-like disks help the spine stay mobile. Nerves in the lower spine area get compressed due to:
Surgery for spinal stenosis, may be considered if you have severe symptoms that interfere with your daily life and do not improve with other therapy. Symptoms most often include:
Talk to your health care provider about whether surgery is right for you. Not everyone with lower back pain needs surgery. Most people are first treated with medicines, physical therapy, and exercise for relief of back pain.
During traditional spinal surgery for spinal stenosis, the surgeon will need to fuse some of the bones in your spine to make your spine more stable. As a result, other parts of your spine below and above the fusion may be more likely to have disk problems in the future.
With disc replacement surgery, no fusion is needed. As a result, the spine above and below the site of surgery still has preserved movement. This movement may help prevent further disk problems.
You may be a candidate for disk replacement surgery if the following are true:
Risks of anesthesia and surgery in general are:
Risks for TDR are:
Before the Procedure
Your provider will order an imaging test such as an MRI, CT scan, or x-ray to check if you need surgery.
Your provider will want to know if you:
Tell your health care provider what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.
During the days before the surgery:
On the day of the surgery:
After the Procedure
You will stay in the hospital 2 to 3 days after surgery. Your provider will encourage you to stand and start walking as soon as the anesthesia wears off. You may have to wear a corset brace for support and faster healing. In the beginning, you'll be given clear liquids. You'll later progress to a liquid and semi-solid diet.
Your provider will ask you not to:
Follow instructions on how to take care of your back at home.
You can likely return to normal activities 3 months after the surgery.
The risk of complications are low after lumbar disk replacement. The surgery usually improves movement of the backbone better than other (spine surgeries). It is a safe procedure and pain relief occurs soon after surgery. The risk of spinal muscle (paravertebral muscle) injury is less than with other types of spine surgeries.
Duffy MF, Zigler JE. Lumbar total disk arthroplasty. In: Baron EM, Vaccaro AR, eds. Operative Techniques: Spine Surgery. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 42.
Gardocki RJ, Park AL. Degenerative disorders of the thoracic and lumbar spine. In: Azar FM, Beaty JH, Canale ST, eds. Campbell's Operative Orthopaedics. 13th ed. Philadelphia, PA: Elsevier; 2017:chap 39.
Johnson R, Guyer RD. Lumbar disc degeneration: Anterior lumbar interbody fusion, degeneration, and disc replacement. In: Garfin SR, Eismont FJ, Bell GR, Fischgrund JS, Bono CM, eds. Rothman-Simeone and Herkowitz's The Spine. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 49.
Vialle E, Santos de Moraes OJ. Lumbar arthroplasty. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 322.
Review Date: 8/15/2018
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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