discreplacement2

As I related in the video post, the disc replacement is a relatively new compared to most of what’s out there. It is a pretty elaborate procedure, and the recovery time will vary largely based upon the overall health, weight, age, and fitness of the patient prior to the surgery.

Below is an image of the prosthetic device itself.

One type of replacement disc prosthesis.

Thanks for visiting, in the next installment of this surgery series, I will review the foraminotomy and a brief wrap up. Look for more posts from Israel this week.

Best,

Andy

Surgery is the most aggressive treatment option available for relief from back pain, and should be considered only after all more conservative options have been weighed. Many patients in my own practice have come to me as a last resort before deciding whether or not to have surgery.

If you google information about the outcomes of spinal surgery, you may find that the statistics are a little discouraging. The overall statistics for patients in my own practice who have had surgery for their back pain is not too different from most of the numbers you see out there- I have observed that about 30% of patients get some relief from the surgery, 30% have virtually no improvement, and about 30% report that they actually felt worse following surgery. Now, while these numbers sound kind of dismal, they improve significantly when patients are well screened, and when you are dealing with a particularly talented surgeon (and no, I ain’t namin names!)

In the next posts, I will review a few of the more common surgical procedures for treating back and neck pain as well as radicular pain such as sciatica. We will review the foraminotomy, spinal fusion, disc repair, and disc replacement.

Now, in this introduction, let me give you some basics that apply to all types of spinal surgery;

-If you have exhausted all conservative approaches to your pain, and you are considering surgery- as with any surgery, when possible get a second opinion.

-In your area, try to find people who have had surgery, and gather information about their experiences- not only about their own outcome, but about their experiences with the surgeon, their hospital, recovery, therapy, etc…

-As with any surgery, there are inherent risks such as hemorrhage, infection, etc… I am wary of any physician which describes anything as ‘risk free’ or ‘minor surgery.’ In the world of spinal surgery, there is no such thing as minor surgery- only degrees of ‘major.’

-Be prepared to do any post operative therapy your surgeon recommends- for many procedures, the follow up is just as important as the procedure itself when it comes to a favourable outcome.

-Try and recruit friends and family members to provide a network of support both pre and postoperatively. There can be significant anxiety as well as pain & discomfort associated with any of these procedures. Having emotional support before and after surgery can help hasten recovery.

These are just a few considerations when gearing up for surgery. Over the next few installments, I hope to provide you a basic understanding of what these procedures entail. If you have had surgery for back or neck pain, please share your experiences.

Best,

Andy

“I have had back pain for more than 20 years. When I was in high school, I twisted my back playing field hockey, and it never really felt right again. In my 20s, the pain worsened, and an MRI showed that I had a herniated disc. A cousin of mine had disc replacement surgery, and has been doing really well with it. It seems like a pretty extensive procedure. Do you think it could help me?”

Sarah,

First of all, thank you for your question.

I know that having back pain be a part of your daily life can be really tough, and there are so many options out there to provide relief, it’s hard to make sense of it all.

First, let’s talk about the disc before we go over replacing it. The intravertebral disc is a small hamburger shaped capsule which lies in between two vertebra. It consists of two primary structures; the soft center called the nucleus, and the thick fibrous ring which surrounds it, called the annulus. When we are younger, the fluid in the nucleus it thinner and more flexible. As we get older, it thickens and becomes more like silly putty. The disc serves two primary functions: 1) It helps to absorb shock between the vertebra, and 2) It articulates two adjacent vertebra, so they can move freely. There are lots of ways a disc can become damaged, most commonly a disc bulge or herniation- were the annular part of the disc becomes compromised, and the outer portion of the disc becomes mis-shapen, and then encroaches into areas and onto structures which can cause pain.

Disc replacement surgery is a relatively new option for people with severe disc damage. Basically, the soft disc in between two vertebrae is removed, and replaced with a mechanical device which simulates the movement and function the disc had before it was damaged. The procedure is often used in place of a fusion, where two vertebra are fused together. There is a relatively long recovery period from this surgery, including the first few weeks of healing and physical therapy, followed by strengthening. The initial recovery period varies in length based upon the age and overall physical condition of the patient. And based upon the patients in my practice who have undergone the surgery, it can take a full year for a patient to feel ‘normal.’

There are varying statistics on the efficacy of disc replacement surgery. In my own practice, and in discussion with several other physicians, there seems to be about a 50% chance that disc replacement will make a patients pain go away.

As to whether it is appropriate for you- that would largely depend upon your specific disc injury, and a host of other factors which I cannot address without examining you and your imaging studies. I suggest you get on line, and look for surgeons in your area who are performing the procedure, and arrange a consultation. How did your cousin’s procedure go? Do you live near your cousin? Perhaps you could meet with their doctor.

I hope this information is a little helpful, and thank you so much for your question.

-Andy