Low Cost Lumbar Disc Replacement Surgery

Lumbar Disc Replacement Surgery in India

Lumbar disc replacement surgery comes as a relief for all those patients suffering from severe discogenic back pain for several years. Discogenic back pain refers to pain in the low back and legs arising from compression of neural structures by degenerated disc fragments. The surgery aims at replacing the diseased disc with a prosthesis (artificial disc) that mimics the movement of the natural disc.

The lumbar spine refers to the lower segment of the human spine in the low back region. This segment consists of 5 short bones called vertebrae arranged over one another, separated by soft cushion like structures called as intervertebral discs. The low back is subjected to maximum load during all the movements of the human body as maximum movement occurs here. As a result it is vulnerable to degenerative changes in the disc as well as in the vertebrae. When the disc degenerates it loses its water content, shrinks in height and disintegrates into fragments and bulges. This may compress the nearby spinal nerves passing in its vicinity. Also reduced disc height results in reduced intervertebral distance, which puts pressure on the facet joints causing their hypertrophy (thickening).

Lumbar Disc Replacement Surgery

Compression of the spinal nerves due to thickened ligaments, bony spurs on the lower surface of vertebral bodies or due to prolapsed disc leads to pain in the back and radiating pain numbness and tingling in the legs. In longstanding cases there may also be weakness in the legs.

The procedure aims at replacing the diseased disc with a metal or plastic prosthesis which maintains normal spine movement. It also aims at restoring normal intervertebral distance and enlargement of narrowed intervertebral foramen thus relieving the compression of nerves.

Who may require Lumbar Disc Replacement Surgery

All those individual suffering from discogenic back pain as diagnosed by a combination of clinical symptoms of back pain, and radiating leg pain and diagnostic tests supported by radiological evidence of degenerative disc disease are ideally suited for this procedure. These patients must also have undertaken conservative treatment (bed rest, traction, physical therapy, medication) for a considerable period of time with no satisfactory results.

Details of the Surgery

Disc replacement surgery is done to stop the symptoms of degenerative disc disease. Discs wear out or degenerate as a natural part of aging and from stress and strain on the spine. Eventually, the problem disc collapses, which causes the vertebra above to sink toward the one below. This loss of disc height affects nearby structures - especially the facet joints.

When the disc collapses it no longer supports its share of the load in the spine. The facet joints of the spine begin to support more of the force that is transmitted between each vertebra. This increases the wear and tear on the articular cartilage that covers the surface of the joints. The articular cartilage is the smooth, slippery surface that covers the surface of the bone in any joint in the body. Articular cartilage is tough, but it does not tolerate abnormal pressure well for long. When damaged, articular cartilage does not have the ability to heal. This wear and tear is what is commonly referred to as arthritis.

Shrinking disc height also reduces the size of the neural foramina, the openings between each vertebral pair where the nerve roots leave the spinal column. The arthritis also results in the development of bone spurs that may protrude into these openings further narrowing the space that the nerves have to exit the spinal canal. The nerve roots can end up getting squeezed where they pass through the neural foramina.

Replacing the damaged disc with an artificial disc, or implant, called a prosthesis can restore the normal distance between the two vertebrae. The artificial disc sits between the two vertebrae and distracts or jacks up the upper vertebra. Enlarging the disc space relieves pressure on the facet joints. It also opens up the space around the spinal nerve roots where they pass through the neural foramina.

Another benefit of the artificial disc replacement is that it mimics a healthy disc. Natural motion is preserved in the spine where the new disc is implanted. And it helps maintain stability in the spinal joints above and below it.

Who can benefit from this procedure?

For many years, the standard of care for chronic pain from a degenerated disc has been spinal fusion surgery. Bone graft donated by a bone bank or taken from your pelvic bone is used to fuse two or more vertebral bones together. The spine is stabilized but you will lose motion at that level. The increased stress on the next lumbar vertebra can cause problems later.

The artificial disc replacement is used to reduce or eliminate the pain while still allowing motion. One advantage of the artificial disc is that it may also prevent premature breakdown of adjacent levels of the lumbar spine.

You may be a good candidate for a lumbar artificial disc replacement if you have chronic pain and disability from lumbar disc degeneration despite nonoperative treatment for at least six months. The artificial disc replacement provides an alternative to spinal fusion. The device helps restore the normal space between two vertebrae. You will still have movement at the level where the ADR is implanted.

Cervical Disc Replacement Surgery in India | Best Spine Surgery Hospital India

Cervical Disc Replacement Surgery in India

This promising new procedure is a boon for all those suffering from severe and intractable neck pain. It has revolutionized the approach used for treating patients with severe longstanding cervical spondylitis, whiplash injuries, cervical disc prolapse, offering them a better quality of life. Also known as artificial disc replacement, this technique is fast becoming popular amidst surgeons and patients alike because of its excellent results. It is considered superior to cervical spine fusion surgeries as it maintains normal neck motion post operatively and ensures early return of patient to normal activities. In this procedure a stainless steel disc with a ball in trough design is inserted between the affected cervical vertebrae. This helps to simulate natural neck movements. The patient stays in the hospital for 1-2 days and resumes work in 45 days.

Working Anatomy of Cervical Spine

The cervical spine consists of 7 cervical vertebrae named C1, C2, C3, C4, C5, C6, C7 with shock absorbing intervertebral disc in between them. These discs allow for the smooth rotating and bending movements of the cervical spine. With age these discs lose their water content and get compressed between the vertebrae which may lead to herniation of disc contents. Along with this there is wear and tear of the vertebrae causing formation bony outgrowths known as (osteophytes). The prolapsed disc can compress the spinal cord within the spinal canal (myelopathy) or the exiting nerve roots at the intervertebral foramina (lateral openings between each vertebral pair) causing radiculopathy (radiating pain in the arm).

Objective of the Procedure

The cervical segments C4- C5, C5-C6, C6-C7 are more vulnerable to disc prolapse and spondylitis due greater mobility at these joints. Disc prolapse results in reduction of intervertebral distance which causes pressure on the exiting nerve roots at intervertebral foramina. Disc replacement surgery aims at reducing the symptoms of degenerative joint disease. Replacing the damaged disc with an artificial implant or prosthesis, restores the normal distance between the two vertebrae and relieves the pressure on the nerve roots.

Why is Cervical Disc Replacement Surgery required?

A large number of people nowadays face neck, shoulder and/ or pain in the arms mainly because of the abnormalities in the neck. These complaints can be signs of disc herniations or disc degeneration, and/or arthritis of the neck.

The cervical spine is composed of vertebral bodies and intervertebral discs. These discs wear out with time causing pain and other symptoms and are referred to as degenerative disc disease, a subgroup of which includes cervical disc herniations. This means the disc becomes compressed, frayed, and/or herniates into the adjacent spinal canal where it can press on nerves or the spinal cord.

Most patients with these types of symptoms do not need surgery and improve with conservative like anti-inflammatory medications, physical therapy, or cold/heat therapy. However, if a person continues to have significant neck pain and/or radicular arm pain, he or she may be a candidate for cervical spine surgery. An anterior discectomy and fusion is the most common operation for treating patients with symptoms related to a degenerative or herniated disc in the neck.

Cervical Disc Replacement Surgery- The Procedure

The procedure for cervical disc replacement surgery consists of removing the problem disc entirely and replacing it with a piece of bone taken either from the patient's hip and a metal plate with screws and/or a cervical collar may also be used to help hold the bone in place and to allow this segment of the neck to fuse together. The purpose of an anterior cervical discectomy and fusion surgery is twofold:

• To remove the offending agent—either the herniated disc or the osteophytes that are compressing the nerves and/or spinal cord.
• To eliminate motion by inducing a fusion at the disc space where the disc has been removed, aided by the use of bone grafts and possibly plates/screws, etc. and thereby creating stability and/or eliminating pain associated with the motion.

This type of surgery typically improves the pain in over 90% of people with one-level disease. However, there may be complications in using bone grafts in pursuit of a fusion. Harvest of one's own bone may be associated with both acute and potentially long-term pain from the donor site. Any type of bone graft may fail to heal, resulting in a so-called 'non-union', which may require another fusion operation.

Also, by fusing a segment of the spine, the levels of the spine above and below the fused area are now forced to absorb more load since there is no longer any intervening motion shock absorption. These adjacent levels will then wear out and become symptomatic in more than 25% of these patients within ten years, meaning possibly more surgery. This is called adjacent-segment degeneration.

The development of artificial cervical discs is intended to accomplish the same objectives as the traditional decompression and fusion surgery in terms of providing pain relief and stability, but with fewer drawbacks. For example, the cervical artificial disc does not include the potential complications involved with using bone graft (e.g. 'non-unions') and theoretically should lessen the risk of developing adjacent-segment disc degeneration or disease.

Post operative Recovery and Rehabilitation Period

The patient stays in the hospital for 1-2 days and resumes work in 45 days post operatively. Avoid bending neck backwards. A brace or soft collar may be recommended after the operation to support the neck muscles. Physical therapy may be prescribed 1-2 weeks after surgery which has to be done on outpatient basis. The therapy will initially start with pain relieving modalities such as ice, electrical stimulation to reduce pain followed by gentle active exercises. Gradually gentle stretching, strengthening and endurance exercises to the neck muscles are introduced. The therapist gives instructions on how to maintain the neck postures during various tasks of daily living. This is followed by a home exercise program.