Lumbar Disc Replacement (LDR)
This is an operation which involves removing a worn or danmaged disc from the lumbar spine and replacing it with an artificial one – this is made of either medical-grade metal or a combination of metal and plastic. This is done as an alternative to the more widely known lumbar fusion. It can be particularly beneficial in certain patients, and is not suitable for everyone. Mr Cass will carefully explain the reasons why it may be suitable for you.
The normal intervertebral disc has several purposes:
- It acts as a spacer between the vertebral bones allowing full range of motion and preventing any compression of the nerves.
- It acts as a shock absorber, enabling the spine to compress and rebound.
- It acts as a motion unit through its elasticity, allowing flexion, extension and rotation at the same time.
Disc replacement surgery aims to mimic as many of these qualities as possible, particularly the preservation of movement between adjacent vertebrae.
Mr Cass pioneered the technique in South East England some 15 years ago & continues to be the only surgeon in Sussex, Kent & Surrey performing the procedure.
This surgery is performed under general anaesthetic, with an incision through your tummy wall. This is usually between the top of your pubic (or bikini) line & the belly button. The abdominal muscles are gently spread apart without being cut and the organs and blood vessels are moved to the side to allow access to the spine without interfering with the back muscles or nerves. A vascular surgeon is present to assist with the moving & protecting of the blood vessels.
The worn or damaged disc is then removed and the artificial disc is then inserted into the empty disc space guided by X-rays.
Total surgery time is typically between 2 and 3 hours, depending on the number of levels involved.
Lumbar disc replacement is quite specialist major surgery, done under general anaesthetic and will require on average a two to four night stay in hospital. The rehabilitation time may be quicker than other spine surgeries as this doesn’t require the bone to heal or the back muscles to repair.
You are encouraged to mobilise the day after surgery and a physiotherapist in hospital will instruct you on getting up & doing early exercises. You will need to avoid any jarring, heavy lifting and strenuous exercise for a while. Once your wound has healed and you have had a post-op check up with Mr Cass, you would typically commence formal physiotherapy 2-3 weeks after your surgery. Complete recovery can be anything from several weeks to a few months.
The surgery does have risks, including some risks which are specific to anterior (through the tummy) surgery. These are explained further in specific risks of anterior surgery. Mr Cass will also discuss these with you.