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Total Disc Replacement Surgery
Relevant information about Total Disc Replacement Surgery.
Total disc replacement (TDR) is a surgery performed in order to alleviate symptoms of back pain, which are the consequence of damaged disc and joints of the spine that become overloaded due to the collapse and narrowing of the disc. This also causes a reduction on the size of the openings where the nerves exit the spine (neural foramen) and may cause the sensation of pinching in the nerves. Another symptom can be pain in the leg. These symptoms disappear with the Total Disc Replacement Surgery that eliminates the disc which is the source of the pain, inserting an artificial disc. This artificial disc enables the restoration of motion in the spine, the return of the height of the disc, and elimination of the over-load of the joints. The materials used are not different from the ones used in hip or knee replacement, specially designed not to produce sensitivity or pain once they are placed in the body. The Total Disc Replacement Surgery is an excellent alternative to spinal fusion, mainly because the TDR is superior in the matter of improvement in the patient’s quality of life and pain relief.
If the patient is in an early stage of disc degeneration, a total disc replacement is not recommended: a nucleus replacement is a good option for these patients because the annulus’s condition is stable. Nonetheless, if the degeneration is more advanced, therefore more severe, a total disc replacement is the right option and surgery.
Artificial discs are made of metal, plastic, or both, and have two plates permitting motion. The charité artificial disc, the most clinically tested disc replacement in the world, consists of three parts: 2 metal endplates made of cobalt chromium alloy, whose outer surfaces have pores that allow bonding to the bone in a firm way, whereas the inner surfaces, concave dishes, permit the mobility with the third part of the charité artificial disc, the central plastic core. The latter is made of polyethylene and its surfaces encase in the concave dishes of the endplates. Up to 2 discs can be replaced; higher than that number is not recommended by doctors and professionals.
The patients that are contraindicated to undergo this kind of surgery are those who suffer of scoliosis, osteoporosis, and those who need decompressive laminectomies for spinal stenotic symptoms because the back is not stable enough. Those who suffer scoliosis are not good candidates because TDR might not correct in a positive way the deformity of the spine; and those with osteoporosis are not good candidates either, because this type of surgery requires a strong foundation and this condition thins the spine bones.
There are different implants that are right for each patient: they vary according to the stature and height of the person and the level of the disc that will be replaced. General anesthesia is used in the Total Disc Replacement Surgery, which takes approximately two hours if only one disc is being replaced, and between three to four hours if the replacement consists of two discs. The procedure is done though the lower part of the abdomen and the form of the incision (which will be of 5 to 6 centimeters) can be horizontal or vertical: this depends on the level of the disc that is going to be replaced. After taking x-ray to confirm the position of the disc, an incision is made, separating the anterior abdominal muscles and carefully moving the peritoneal sack as well as the blood vessels near the spine, in order to comfortably access the area of the disc. The removal of the disc’s central section is made and the vertebrae are carefully spread apart in order to remove the disc; then, the endplates are inserted in the space where the disc was, and they accommodate thanks to the pressure of the spine and the metal spikes allowing the insertion of the core between the plates.
Risks are very unusual. However, they will depend on the patient’s state of health, his/her medical history and age. Bleeding of the blood vessels (which can lead to vein thrombosis), blood clot (hematoma under the skin), development of new pain, damage to the nerves (in men it can lead to retrograde ejaculation, sexual dysfunction), injury of the nerve root (muscles can weaken, it can cause numbness of the legs and sciatic pain) damage of the urologic structures and infection are among the risks that involve the surgery. Complications after the surgery can be the failure or dislodgement of the mechanical component that was inserted, related to wear of the disc replacement. Nevertheless, it is not likely that the disc breaks or comes apart. If the patients experience a strong fall, or if the vertebral bone has an overload, there is a small chance that the endplate could sink into the vertebra and another surgery may be needed.
After the operation, the patient might experience discomfort and a small amount of pain. This can be treated with physical therapy and therapeutic injections. Total disc replacement has a great advantage that consists of a fast return to activities. Since this kind of surgery has the aim to restore motion, the doctors encourage patients that have undergone this procedure to go back to their routine gradually. In spite of being a new technology, this surgery has a lot of advantages.
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