Lumbar Disc Replacement
Who needs this operation?
Most joints in the body have been affected by a variety of disease processes and have been treated by fusion in the early days of surgery and more recently by replacing the joint with an artificial one. Whilst the spinal discs are not joints in the technical sense, they do allow a degree of movement which when all discs are taken together confers a considerable degree of flexibility on the spine as a whole.
When a disc is damaged it may lead to pain or abnormal movement, both of which may need correction. Most people get through life with the discs they were born with; in some, however, the discs degenerate, through ageing processes, trauma or repeated stress to the extent that they become increasingly painful. This is typically a central back pain which may spread to the legs in a vague manner, or even into the abdomen.
Standard treatment for this type of pain includes rest during an acute exacerbation, with anti-inflammatory medication, followed by physiotherapy. Injections, such as epidurals may help. In most instances the pain will resolve adequately, but when it does not the patient may feel that the symptoms are bad enough to warrant surgery.
Pre operative advice
48 hours before surgery, take some gentle laxatives (colace, senna) to ensure you have your bowels opened on the day of surgery.
On the day of your surgery it is important to remain Nothing by Mouth (NPO). Do not eat past midnight the night before your surgery. However you may drink small amount of water to take any medications up to two hours before admission.
It is not necessary to bring your medications with you, as these are supplied from the pharmacy at the hospital (you can use your medications when you return home). However, if you take a number of medications, please bring a list of names and doses so they can be appropriately supplied by the pharmacy department.
Please BRING YOUR SCANS WITH YOU to the hospital.
Please avoid smoking on the day of your surgery.
Please shower or bathe as normal in the morning, and remove any make up or nail polish.
How Is It Done?
The operation is performed under a general anaesthetic with the patient lying on their back. An incision is made in the left lower quadrant of the abdomen and the muscles are split to
allow access. It is unusual for the muscle to be cut at this stage, so recovery of function can be expected.
The spine is approached through the retro-peritoneal space, the peritoneum being the sac containing the bowel, and by moving the blood vessels carefully away towards the right side. The spine can now be seen and the damaged disc can be removed. The disc replacement is inserted after distraction of the disc space (spreading it to restore its normal height) and the wound is then closed. X-rays are used during the operation to make sure the artificial disc is in the right position.
Post operative care
You will wake up recovery, where you will spend a short time recovering from the anesthetic and then you will be transferred back to the floor.
You will remain to be Nothing By Mouth (NPO) until you begin having bowel sounds again. The bowels maybe slow to begin working again, and it is important not to eat or drink too quickly post operatively to avoid sickness and further complications. You will have maintenance fluids intravenously to keep you hydrated.
On day 1 post operatively, you will be seen by the physical therapy team on the floor. They will start teaching you how to safely get out of bed, and will help you to start walking again. You may feel lightheaded or dizzy the first few times you get up – this is normal, and will wear off. The therapist may also fit you with a brace to support your spine. You will have to wear this for at least 2 weeks.
Your wounds will be managed by the nursing staff; they will be dressed as needed. They will also provide you with the appropriate information for discharge.
When you go home
For the first 6-8 weeks, it is important that you take things easy. Do not start lifting or exercising during this period. You may walk about as pain allows, while wearing the brace, but not too vigorously. Several short walks, rather than one long walk.
You will not be permitted to drive for 4-6 weeks. However you may be a passenger during this time, as long as you take regular rest periods to adjust your position and wear your brace.
Flying is not a problem, but airports are. Avoid carrying luggage, especially off the carrousel. Try to avoid sitting for too long – get up and exercise when it is safe to do so. Please also check with your airline before flying.
With regards to working, please discuss this with your surgeon, as this varies depending on the work you do. Patients may return to work in a sedentary occupation when they feel comfortable. Those in manual jobs may need to be off work for longer, until the fusion is solid, as demonstrated by the x-rays.
The nursing staff on the floor will have given you some information on wound care prior to discharge. If you have any concerns regarding you wound, please do not hesitate to contact us. In general, all dressings can be changed after 72 hours, with a new dressing applied every day thereafter if the incision is draining. However, if no drainage is present, the dressing may be discontinued. Moreover, you may shower and wet the incision after 72 hours, but bathing or soaking the incision is not recommended for 2 weeks.
Pain killers can be constipating so we encourage you to eat food that will help to keep your bowels working well. Drink plenty of water. You can take colace, senna and/or fiber to help with constipation.
From 2 weeks post op, assuming the x-ray appearances are satisfactory, you will start physical therapy. These exercises are very gentle initially and increase over 6 weeks, so that by 12 weeks post-op you will be in the gym, swimming or cycling regularly.
Patients are seen at 2 and 6 weeks post-operatively and then at 3, 6 and 12 months with x-rays taken at each visit to determine the stage of healing. If metal screws are used these may be removed 1 – 2 years later, but this is usually not required.
Brace with Lumbar support
After your surgery you will need to wear a brace to support your muscles and spine (Similar to wearing a cast on your arm after surgery). It should be worn when you are out of the house, walking, shopping, when you are sitting in the car, bus, or train. You don’t need to wear it in bed or when you are sitting at home.
You may need to wear this for several weeks. You will be fitted with the appropriate size by the therapist on the floor or at your pre-op visit, and then be taught how to put it on correctly.
- The brace should be worn over the top of a vest, or light t-shirt to prevent skin abrasions.
- Do not wear any greasy or oily lotions, or talcum powder, and fully dry the skin before applying the brace.
- Clean your brace regularly with a damp cloth and soapy water. Wipe and dry thoroughly before re-applying.