Low back pain is a major cause of disability & concern worldwide. It has been estimated that about 70 – 80 percent of the people will invariably experience low back pain at some point of time in life. Lumbar Disk Replacement Surgery is a newer surgical procedure designed to relieve low back pain. Quite similar to many other joint replacement procedures, disc replacement basically substitutes a mechanical device for inter-vertebral disc in spine. This artificial device is meant to restore motion to spine by replacing the degenerated disc.
Artificial disc replacement technology has been available in Europe for over a decade now. This procedure initially gained approval of FDA in United States in the year 2004. Over these years, many other disc replacement designs have developed & are presently being tested for large scale application. Future of lumbar disc replacement technology will most likely include significant advancements in tools for diagnosis of source of pain in spine, improved design of implants & fresh approaches to regeneration of discs for normal function.
Lumbar fusion surgery still remains the standard treatment for treatment of low back pain which has not benefited by nonsurgical approaches to treatment. However, results of lumbar fusion surgery vary even though many people find relief from low back pain with the help of this procedure. Like for example, spinal stenosis patients undergoing lumbar fusion procedure may have a totally different outcome from patients who are having lumbar fusion to help back pain which is caused by disc degeneration disease. Additionally, quite a few patients whose lumbar fusion surgeries perfectly heal yet end up with no improvement in back pain. There could be many reasons contributing for failure to improve following lumbar fusion surgery, but spine surgeons agree to the fact that fusion invariably prevents normal motion within spine. Lumbar Spine Surgery has therefore emerged as an ideal alternative treatment option for people suffering from low back pain.
Surgeons will be required to take a few tests for determining ideal candidates for disc replacement surgery. Some of these tests may include x-rays, computed tomography (CT or CAT), discography & magnetic resonance imaging (MRI) which will help surgeons determine source of pain.
Good candidates for artificial lumbar disc replacement surgery have –
Process of surgical lumbar disc implantation is typically performed through an incision in abdomen which is similar to anterior lumbar interbody fusion. Organs & blood vessels located within the region are required to be moved so as to approach the surgical site. This approach also allows surgeons to access spine without moving any nerves. Most often vascular surgeons also assist orthopedic surgeons in opening & exposing disc space. Normal time taken for lumbar disc replacement surgery ranges between 2 – 3 hours.
Although this technology is still in investigative stage, artificial disc replacement device may comprise nucleus of the disc while leaving the outer ring in place. However, in most cases total artificial lumbar disc replacements substitute annulus & nucleus with a mechanical device simulating spinal function, though there are a number of other lumbar disc designs. Even though each one is unique in a way, they all maintain a similar goal which is to efficiently reproduce size & function of normal inter-vertebral discs. Some of these artificial discs are made of metal, while other others combine metal & plastic which is quite similar to devices employed in joint replacements of hip & knee. Materials normally used in artificial lumbar discs include polyethylene medical grade plastic, medical grade cobalt chromium or titanium alloy.
Most patients are generally encouraged to stand & walk on the first day after lumbar disc replacement surgery. Since no bone healing is required following artificial disc implantation, patients are typically encouraged to move through mid-section. Early motion in trunk region will eventually translate into quicker recovery & rehabilitation. Typical hospital stay following lumbar disc replacement surgery is between 2 – 4 days generally depending upon control of pain & returning to function. Routine walking & stretching while avoiding hyperextension activities comprise basic exercises which are required during the first several weeks following surgery. Most patients experience improvement of disability & low back pain within weeks to months after lumbar disc replacement surgery. However, a wide range of results from numerous studies reveal that lumbar disc replacement surgery improves but does not completely eliminate pain. Nevertheless, it is critical that both the patient & the orthopedic surgeon develop realistic expectations of pain relief prior to undertaking lumbar disc replacement surgery.
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