In patients with symptoms of a degenerated disc, that is to say, lumbar or cervical pain, and when conservative treatments have not been effective, two types of procedures can be carried out: fusion surgery, in which vertebrae are fused by means of screws and/or plates causing the vertebrae to remain fixed; or another option is disc replacement surgery (ADR), in which the damaged disc is replaced by an artificial disc prosthesis.
Many surgeons consider fusion surgery as the surgery of choice. But at Instituto Clavel, as spine specialists, we believe that ADR surgery is an option that has many advantages compared to fusion surgery and the improvements over recent years in prosthesis material, have made it, when possible, our procedure of choice, and the one we most frequently perform. Total or partial disc replacement makes it possible to eliminate the causes of pain: the degenerated nucleus, the degenerated and fissured ring, the sinuvertebral nerve endings, and the degenerated facets.
Advantages of ADR surgery versus fusion surgery:
- In ADR surgery, vertebrae are not permanently immobilized, so joint movement is preserved.
- Disc replacement surgery, by not immobilizing vertebrae, minimizes the risk of degeneration of the adjacent disc, a consequence of fusion surgery, which requires further surgery in the future.
- ADR surgery is minimally invasive, since an anterior approach to the spine is used, that is, the muscles of the back are not cut open nor are the nerves manipulated, which significantly reduces the risk of nerve damage or chronic pain.
- Osteotomies, which can cause significant blood loss, are not performed.
- By fully recovering spine mobility, the patient’s quality of life increases remarkably, allowing him to return to sports activities and considerably reducing pain.
Before undergoing surgery, a patient should ask for a consultation at Instituto Clavel so that the surgeon knows his medical history and can advise him on the best option for his case.
Thus, patient and doctor together determine whether surgery is necessary. If it is, the patient will be admitted on the day of the procedure with a minimum 6-hour fast.
Surgery time is usually one hour when the procedure involves one lumbar or cervical spine, and each extra level represents about thirty minutes longer. Once surgery has been completed, the patient is transferred to the resuscitation area where he will stay for about two hours, prior to transfer to his room. Patients usually spend two to five nights in hospital depending on the type of surgery.
Recovery from ADR surgery is progressive and, as is normal, the patient may suffer some discomfort. After seven or ten days, the patient has a post-surgical follow-up visit, to carry out wound healing and suture removal when appropriate.
During the first week it is advisable for the patient to walk, but not do anything involving any strain, and after this to continue walking which is the best exercise for recovery. In general, the patient should not lift things or adopt poor postures during the first three months after surgery and be especially careful during the first month. The patient can start swimming a month after surgery; and running and cycling 3 months after surgery.
After about 5 weeks, the patient can return to work if it does not involve any strain. If the patient’s work involves strain, they must wait 9 weeks before returning to work. Alternatively, it is advisable that the patient undergo supervised rehabilitation sessions at a specialized physiotherapy center.
Possible risks or side effects of ADR surgery:
Regarding the risks of surgery, it should be considered that although damage to the nervous structures is much rarer than when the traditional posterior approach is used, because during much of the procedure the surgeon is working far away from these, it is not something impossible. It is relatively common to suffer moderate discomfort in the buttocks and thighs during the first two weeks as the patient becomes more mobile, and this is easily controlled with pharmacological treatment.
Dissection of the large vessels in front of the spine is the most delicate procedure during surgery, therefore, bleeding and the need for transfusion are risks to be taken into account. It is, however, a controlled risk since in cases of involuntary injury to these structures they are immediately and adequately repaired in situ, and, therefore, there is no impact on the patient. Even in cases of fairly complex lesions, we have the help of dedicated vascular surgeons whenever we perform this type of surgery.
It must be taken into account that since the approach route is abdominal, bowel movement or peristalsis is slowed down during the first days, so the reintroduction of normal food after surgery is carried out progressively, from liquids to normal solid foods during the first 48 hours. Constipation during 3 or 4 days is perfectly normal and can be treated with mild laxatives if necessary.
Like any surgery, it is not exempt from the risk of infections, but the fact that these are fast procedures, with conservative openings, and with an easy-to-handle surgical wound makes them rare.
At Barcelona Spine Center we have the most advanced tools and technology and new generation systems to help us carry out these types of procedures.