Before you commit to any type of surgery, it’s advisable to do your homework first. Patients who educate themselves about their conditions and treatment options are more likely to have successful surgeries because they understand why they’re doing it and how a specific procedure can help—which means they have a better chance of choosing the right course of treatment. And with all the resources available today, you don’t have to be a doctor to get a good understanding of most medical conditions. Our Knowledge Center has a good deal of information about anterior lumbar disc replacement (and other types of back surgeries) that will be helpful in explaining the common causes of pain and treatments; I also recommend searching for information from a variety of other sources, too.
If you’re like a lot of patients who are considering lumbar disc replacement surgery, so far you may only know one thing: You don’t want a fusion. But if you’re uncertain about your options from there, this article is a good place to start. It provides some basic information about lumbar disc replacement, and gives you a list of questions to discuss with your doctor that will help you decide if this particular procedure is the right course of action for you.
Anterior Lumbar Disc Replacement: What is it?
Each of the series of stacked vertebrae in your spine has two components: a disc and two facet joints. Both components work together to enable movement—the discs space and connect the vertebral bodies and the facets are small, cartilage-lined joints that act like hinges, controlling motion.
It’s not uncommon that, over time, both the discs and the facet joints wear down. Degenerating discs are unable to offer normal mechanical support, and as a result they cause pain. Similarly, degenerating facet joints may experience wear and tear of the cartilage, preventing the joints from moving smoothly.
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Anterior lumbar disc replacement surgery is when a worn-out or degenerated disc is replaced with a new, artificial one. “Anterior” refers to the approach the surgeon uses to reach the spine, which in this case is from the front, through the stomach. In this procedure, only the disc itself is replaced, not the facet joints. Unlike fusion, which removes and fuses a disc and its facet joints completely, it is possible that replacing only a disc does may not alter the natural movement of your spine. If your pain is being caused solely by a degenerating disc and your facet joints are in good health, this procedure can be a good choice for pain relief. However, replacing only the disc can be problematic if stenosis and/or changes to the facet joints is present.
The scenario of isolated anterior disc disease is relatively rare.
Most people with back and leg pain have other, additional issues besides a degenerating disc, which could prevent this surgery from being successful:
- Discs and facet joints both typically experience a degree of wear and tear over time, making it unlikely that a new disc alone would solve the problem. If left alone, arthritic facet joints will still cause pain even with a new disc in place.
- In addition to the back pain caused by a worn-out disc, many people have leg pain from a pinched nerve. Again, a new disc would solve only part of the problem. The anterior approach used by surgeons does not allow for pinched nerves to be addressed, and you’ll still have pain as a result.
- Some patients have instability-related pain caused by spondylolysis or spondylolisthesis. (Spondylolysis is the presence of a bone defect within the vertebral unit; it eventually leads to spondylolisthesis, when a disc begins slipping forward and causes dysfunction of the vertebral unit.) These conditions make the spine unstable—a condition that cannot be solved simply by replacing a disc.
Will lumbar disc replacement work for you? 4 Questions To Ask Your Doctor
Based on the information you now know about the procedure and the possible sources of your pain, here are four questions to ask your doctor that will help you determine whether or not anterior lumbar disc replacement is the right solution for you:
1. Are my facet joints in reasonably healthy condition?
As you know, facet joints can wear out just as easily as a disc. If your facets are degrading, they may either be the source of your back pain or contributing to the pain. Because your facet joints will still be in place even after an anterior lumbar disc replacement, you’ll likely still experience pain. Your facets should be no more than “mildly degenerative” in order to move ahead with this surgery; your doctor can determine the degree of degradation with a CAT scan. If they are more than mildly degenerated, look for another option.
2. Is there any evidence of narrowing in the foramen?
The foramen is the bony hollow passageway where spinal nerve roots pass or exit. Narrowing of this passageway is likely to encroach on those nerves, causing pain. As you learned above, lumbar disc replacement uses an anterior, or frontal approach, an angle from which it’s not possible to safely relieve this type of condition. So if you’re already suffering from a pinched nerve or there appear to be signs of narrowing in the foramen, you’re likely not a good candidate for lumbar disc replacement.
3. Is my pain the result of spondylolysis/spondylolisthesis?
If you’ve been diagnosed with spondylolysis or spondylolisthesis, you have a disc that has lost its ability to stabilize the spine, causing your spine to slip forward. The problem in this case is spinal stability, which requires a different solution than simply replacing the disc. Sometimes spondylolisthesis is accompanied by some degree of spinal stenosis, another condition that cannot be be treated with an anterior approach. Spondylolisthesis is a common reason for back and leg pain; if you have anything more than just a subtle instability as a result of this condition, artificial disc replacement may not solve the problem.
4. Is my back pain the result of an infection, tumor, or fracture?
A small percentage of people have back pain as the result of an infection, tumor, or fracture. If you do fit into this category, a disc replacement—nor any other type of motion device—is probably not the solution. In these cases it’s less about solving pain and more about giving your spine the stability it needs to avoid neurological complications or worse; very often that means fusion.
If not a lumbar disc replacement, then what?
Anterior lumbar disc replacements can work well for people with very specific conditions. But if the answers to the questions above lead you and your doctor to determine that it’s not right for you, then what should you look to next?
Today, there is another option beyond fusion—BalancedBack Total Joint Replacement. BalancedBack is an innovative form of artificial disc replacement with two important differences: 1) It replaces the function of the facet joints as well as the disc, and 2) It is performed using a posterior (from the back) approach, allowing surgeons to address a broad range of issues that commonly contribute to back and leg pain. As a result, BalancedBack works well for patients with:
- Degenerative disc disease
- Moderate to severe facet joint arthritis
- Severe spinal stenosis
- Grade 1 spondylolisthesis
- Recurring herniated discs
If you’d like to do more research about the BalancedBack procedure, I encourage you to visit our website, where we have numerous resources available to explain what it is and how it works. For many people, BalancedBack is a more complete solution for their pain; it may be the case for you, too.