Lumbar Spinal Arthroplasty Procedure Overview

Low-back pain is one of the main health problems all over the world, especially in Western countries. The major causes of which are thought to be facet arthropathy.

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The scientists informed that as a result of disk dehydration, annular tears, and loss of disk height, degenerative disk disease (DDD) could result in abnormal motion of the involved segment and biomechanical instability, becoming the main factor leading to pain.

Table of content

  1. Description of lumbar spinal arthroplasty
  2. Arthroplasty vs. spinal fusion
  3. Conclusion

A lumbar disk replacement is a type of back or spine surgery involving replacing a worn or degenerated disk in the lower part of a spine with an artificial disk made of metal or a combination of metal and plastic.

Physiologically, the disk acts as a mainshock absorber between the vertebrae. It plays a major role in maintaining spinal alignment and facilitating ROM. The problems with the disc lead to an increase of stress across the facet joint, impingement on neural structures, and strain on paraspinal muscles from loss of alignment.

Chronic facet stress usually leads to hypertrophy, osteophyte formation, pathologic motion, and distortion of innervating elements, as well as pain. After a patient finally understands that the conservative methods of treatment such as physical therapy, massage, and oral medication regimens are not effective, patients begin to consider surgical intervention.

Lumbar arthrodesis is defined as the criterion standard surgical treatment for DDD and facet arthropathy. The procedure can be conducted with the help of surgical corridors such as posterior, posterolateral, lateral retroperitoneal, and anterior retroperitoneal). Also, it can involve fusion across any of the three lumbar columns via interbody services, clamp, plating systems, and posterolateral autograft.

Lumbar arthrodesis achieved pain relief with the help of motion elimination at the fused segment, regardless of which column is serving as the pain generator. However, the healthcare professionals inform that the results after lumbar spinal arthroplasty can vary. While one type of patient experiences a significant decrease in pain, the other cannot achieve pain relief. Also, some such patients get further complications at all levels. Lumbar spinal arthroplasty treatment options were developed as an alternative to standard fusion procedures as means of relieving pain while restoring and maintaining segmental load transfer, sagittal balance, and spinal segment motion.

Lumbar spinal arthroplasty is recommended when:

  • The back pain comes from 1-2 disks in a lower spine;
  • There is no significant joint disease or compression on the nerves of a spine;
  • A patient is not excessively overweight;
  • A patient has not had spinal surgery before;
  • A patient does not have scoliosis or any other type of spinal deformity.

1. Description of lumbar spinal arthroplasty

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First of all, healthcare professionals put a patient into a deep sleep, keeping from feeling pain during the surgery. Secondly, a team of surgeons (professional vascular surgeon, neurosurgeon, and orthopedic) will do the procedure together. In order to gain access to the vertebrae, a surgeon makes an incision in one of the three locations such as neck or back (directly over the spine) or abdomen, or even throat. All the organs and blood vessels will be moved to the side so that there will be access to the spine.

A surgeon removes the damaged disk and puts the new artificial disk in the correct place. All patients are taken to a recovery area for close monitoring until they’re awake from the anesthesia. Also, a patient has a catheter in the bladder in order to ease the process of urination. After patients are fully awake and alert, they will be taken to a hospital room.

After a surgical invasion, a patient has to stay in a hospital for a few days. Because a lumbar disk replacement does not require bones to heal, the recovery period may be faster than with other back surgeries. As a part of the recovery process, a patient will be encouraged to walk and stretch. The recovery process can be from a few weeks to a few months. Both fusion and LDR are widely studied as a special type of standard care for lumbar DDD patients.

Lumbar fusion is the result of an obvious discrepancy between the technical achievement of the surgical goals. Minimally invasive surgical approaches for spinal disk arthroplasty or reconstruction in degenerative diseases have been popularized within the last 10 years. Arthroplasty in spinal surgery is a new and exciting application of less invasive surgical approaches.

2. Arthroplasty vs. spinal fusion

Spinal fusion surgery is a surgical procedure to fuse the spinal bones together with a bone graft. Once a patient’s spine has healed, two or more vertebral bones will be fused together like a single bone. Artificial disk replacement is a surgical procedure to replace the injured vertebral disc, artificial joint, or others.

The major difference between the procedure of disc replacement and spinal fusion is the mobility of the spine after the surgery. Artificial disc replacement performs the advantages over spinal fusion. It is important for people who want to live active and not just pain-free lives. We’d like to strike once again that the recovery requires much less time after disc replacement as no bone was touched.

Arthroplasty, when compared to spinal fusion, provides excellent pain relief for most patients with chronic back pain. An outcome after the artificial disc replacement and spinal fusion depends on the unique clinical situation as well as on the special skills and experience of a surgeon.

3. Conclusion

Total disk replacement is an innovative procedure that has gained traction in spine surgery. Degenerative disk disease describes the gradual failure of the disk in order to perform its main function, resulting in a worsened range of motions and back pain. The disease can be attributed to aging, mechanical overloading as well as other specific genetic factors.

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The elimination of motion through a fusion procedure has been the major treatment for degenerative spine disease since the beginning of the early 20th century. There is a significant increase in lumbar spinal disk arthroplasty in the years following FDA approval, with the largest rise. Additionally, improvements in pain management, fusion techniques, and less-invasive methods also contribute to restrictions in arthroplasty.

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