Friday, April 12, 2024

L5 S1 Disc Replacement Surgery

When To Talk To A Spine Surgeon About Treatment

Patient Journey L5-S1 Artificial Disc Replacement | Dr. Khawar Siddique DOCS Health Los Angeles

Surgical operations of any kind can be intimidating to patients. This can cause them to delay meeting with a doctor until the pain levels get too high to handle. Delaying treatment is never a good idea. If you have persistent back pain, talk to a doctor. You can meet with a general practitioner who can recommend a spine surgeon near you. If you live in Beverly Hills or Miami, set up an appointment with Dr. Lanman.

What Is L5 S1 Fusion Surgery

Spinal fusion is a major surgery where one or more spinal bones are fused together using screws, bolts, and or plates. The hardware may be placed in the front or the back of the spine. The disc between the spinal bones is often times removed and replaced with bone or a spacer. L5 S1 Fusion refers to the level of the surgery.

There are 5 spinal bones in the low back which are numbered from top to bottom L1, L2, L3, L4, and L5. Sandwiched between each of the spinal bones is a disc. The disc is named for the two spinal bones it is sandwiched between. For example, the lowest disc in the low back is the L5/S1 disc. The L5/S1 disc is sandwiched between the L5 and S1 spinal bones. Therefore, L5 S1 fusion surgery involves the surgical removal of the L5/S1 disc and fusing the L5 and S1 spinal bones together. Different surgical techniques and approaches exist. PLIF, posterior lumbar interbody fusion is a case in point that has been reviewed in detail in a prior blog.

Are There Any Risks With Lumbar Disc Replacement

As with any surgery, there are certain risks with lumbar disc replacement. General risks include bleeding, infections, blood clots, and negative reactions to anesthesia. Specific lumbar disc replacement risks include implant malposition , spine rigidity, infection very near the artificial lumbar disc, or one of the bones above or below the device fractures. Fortunately, lumbar disc replacement risks are uncommon, especially when the procedure is performed by a highly skilled spine surgeon. The best lumbar disc replacement surgeons use meticulous sterile technique, expertly place the artificial lumbar disc, and perhaps most importantly, correctly choose who is a candidate for best lumbar disc replacement surgery.

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What Are The Signs Of L5

Lumbar fusion is a well-known surgery. In the United States, lumbar fusion has grown in popularity from 77,682 surgeries to 210,407. Lumbar fusion can treat many degenerative conditions and pains in the low back. L5 S1 fusion is used for the following conditions: Low back disc problems , Spinal Bone Fracture, Recurrent Disc Herniation, Curvature , Narrowing of Canal , Failed Spine Surgery.

Is Spinal Fusion Major Surgery Possible?

Absolutely! This surgery involves cutting through important muscles and ligaments to reach the targeted disc. The disc is then removed. The area is then packed with bone, and sometimes a spacer. Stabilizing the spine is done by placing screws into the spinal bones. Additional hardware such as rods and plates are used to support the screws.

What is the Success Rate for Spinal Fusion Surgery Surgery?

As it relates spinal fusion surgery success is not easy to determine. Why? Because of the many variables involved, such as the preoperative MRI, surgical approach and x ray finding, results from pressing on the disc, patients ages, medical history, and the parameters that were studied.

Spinal Fusion Can Screws Come Loose?

Yes! Yes. There are many complications that can arise from L5-S1 fusion. Failed fusion is where the bones dont properly fuse.

Non-Union
Broken Screws in Lumbar Fusion
Hardware is loosening up
Additional Complications after L5 S1 Fusion Lumbar Fusion
Diseases of the adjacent segment
Spinal Muscle Injury

Who is a candidate for the job?

What Happens During A Lumbar Disk Replacement

Clinical Case: Before and After. Woman, 65 years old, L4  L5 disc ...

You will have an IV line put into a vein in your hand or arm through which an anesthetic is given. The medicine will put you into a deep sleep and keep you from feeling pain during the surgery. You will be lying on your back for this surgery.

A team of surgeons will do the procedure together. The surgeon will make an incision in your abdomen. Your organs and blood vessels will be moved to the side to allow access to your spine.

The surgeon will remove the damaged disk and put the new artificial disk in place. Your organs and blood vessels are put back in place and the incision will be closed.

You will be taken to a recovery area for close monitoring until you are awake from the anesthesia. You will still have an IV line and may also have a catheter in your bladder to make urination easier. When you are fully awake and alert, you will be taken to your hospital room.

Talk with your healthcare provider about what you can expect your lumbar disk replacement procedure to be like.

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Lumbar Artificial Disc Replacement: The Pros & Cons

Lumbar artificial disc replacement can be remarkably effective in reducing pain in people with degenerative disc disease. Nerves and nerve roots are no longer pinched because the diseased intervertebral disc has been removed. Bone spurs are smoothed so they can no longer rub against sensitive structures. The normal distance between the spinal bones is restored. These interventions combine to relieve chronic low back pain.

Perhaps the greatest additional benefit of lumbar artificial disc replacement surgery is that it can restore or preserve motion in the spine. Both spinal fusion and artificial disc replacementthe two surgical treatment options for degenerative disc diseasecan relieve low back pain however, only lumbar artificial disc replacement preserves the lumbar spines ability bend, flex, and rotate. Instead of fusing the two spinal bones together in spinal fusion surgery, the new artificial disc functions in many ways like a natural, healthy disc. After lumbar artificial disc replacement, patients can usually return to many of the activities they once enjoyed. After spinal fusion, spinal range of motion is more limited, and the patients ability to move the spine normally is also limited.

Whats The Difference Between Disc Replacement And Spinal Fusion

Spinal fusion surgery is a surgical procedure to fuse the spinal bones together with a bone graft. There are many variations on this theme, but once the spine has healed, two or more vertebral bones will be fused together like a single bone.

Artificial disc replacement surgery, on the other hand, is a surgical procedure to replace the problem vertebral disc or discs with a prosthesis or artificial joint.

The main difference between disc replacement and spinal fusion is the mobility of the spine after the surgery. After fusion surgery, the treated area is less flexible and mobile because the vertebral bones of the spine no longer move independently. After disc replacement surgery, the prosthesis mimics the natural joint, so the spine is able to bend, flex, and rotate as it did when the disc was healthy.

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Goals Of Lumbar Disc Replacement

Lumbar arthroplasty is aimed at restoring the shock-absorbing function of the damaged or degenerated intervertebral disc with simultaneous decompression of the spinal cord and nerve roots. Similar to the well-established hip and knee joint replacement procedures, the evolution of artificial disc prostheses may also result in a dramatic improvement of patients quality of life and achieve high levels of patient satisfaction.

The goals of a lumbar disc replacement include:

Reduction of back pain Prevention of disc and facet joint degeneration Improved posture, lower back and leg function Improved work and recreational capacity Improved quality of life The chance of obtaining a significant benefit from surgery depends upon a wide variety of factors which will be discussed at your appointment with Dr Aliashkevich.

The meta-analysis study of Deng-Yan Bai et al. . 2019 Jul 98: Total disc replacement versus fusion for lumbar degenerative diseases a meta-analysis of randomized controlled trials) stated:Compared to lumbar fusion, total Lumbar disc replacement significantly improved ODI, VAS, SF-36, patient satisfaction, overall success, reoperation rate, ODI successful, reduced operation time, shortened duration of hospitalization, decreased postsurgical complications.

Materials and Designs

Injection Treatments For L5

Watch Live Spine Surgery – Laser Disc Repair LUMBAR L4-5 L5-S1 Minimally Invasive

Injections may be considered for pain relief after nonsurgical methods are tried for several weeks and before surgery is considered.

Common injection treatments for L5-S1 include:

  • Lumbar epidural steroid injections. Steroids injected directly into the spinal epidural space can help decrease inflammation and reduce the sensitivity of nerve fibers to pain, generating fewer pain signals. These injections are more effective in treating the inflammatory causes of pain, such as pain from herniated disc fragments, and are typically less effective for compressive causes of pain.

Surgeons may perform more than one procedure at a time. For example, a laminoforaminotomy is when a laminectomy procedure is done along with a foraminotomy. While minimally invasive techniques are used for these surgeries, open surgeries may be performed in some cases.

Some patients who do not have progressive neurological changes may not respond to nonsurgical care. They may also not be good candidates for surgery due to other medical problems or drug addiction, to name a few.

A small risk of serious complications, such as infection, nerve injury, excessive bleeding, or severe allergic reactions are possible with spine surgeries. Before deciding to have surgery, it is important to discuss the risks and alternatives to surgery with a surgeon. It is also important to understand the possible complications if surgery is not performed.

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Goals Of Each Surgery

Before considering surgery, treatment for DDD should focus on non-invasive or minimally invasive options. Surgery for DDD is typically considered when conservative methods like physical therapy and anti-inflammatory medication don’t provide relief.

Spinal fusion has been the standard surgical treatment for DDD when surgery is needed. The goal for spinal fusion is to correct deformities of the spine by fusing two or more vertebrae together to increase stability and decrease motion that may be causing pain.

In a spinal fusion procedure, a damaged disc can be removed and replaced with a bone graft to stimulate bone growth. Over time, the space of the absent disc gradually fills with bone, fusing the vertebrae.

On the other hand, lumbar disc replacement is similar to other types of joint replacement, such as those involving the knee or hip. The surgery involves removing a damaged disc and replacing it with an artificial disc that mimics a healthy one, which can preserve the spine’s mobility.

Outcomes Of Lumbar Disc Replacement

Postoperative pain is usually moderate and subsides markedly within 7-14 days. Recovery times can vary in different patients, depending on their age and individual medical conditions. The longer the problems existed before surgery, the longer it may take to notice a benefit. In some cases, the final recovery can take a few months.

Most patients recover well from lumbar arthroplasty and can expect the improvement of lower back and leg pain in a few weeks or months. It is realistic to expect significant pain reduction after successful surgery, but its complete elimination is rare. Restoration of muscle strength may require several weeks of rehabilitation and physical exercises. Muscle wasting may take up to 6-12 months to improve. The muscle may never recover its normal bulk if the nerve compression had been too severe. Preoperative sensory loss, tingling or pins and needles may take 3-9 months to recover fully. In rare situations, neurological deficits may persist for over a year after surgery or become permanent.

Possible outcomes if no treatment is undertaken

If the lumbar disc replacement degeneration is not treated appropriately, the possible outcomes may include: Chronic back and leg pain Problems with mobility

Advantages of Lumbar Arthroplasty

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About Degenerative Disc Disease

As a structure, the spinal column is made of stacked vertebral bones separated by spinal discs. Each disc is composed of tough, but pliable collagen fibers that help maintain the position and integrity of the spine while allowing movement between the vertebrae. This complex structure provides us the stability needed to stand upright, as well as the flexibility to bend and twist in multiple directions.

With DDD, the spinal discs that rest between the bones of the spine wear away. This can be due to various reasons, such as old age, daily activities and sports, or injuries. To an extent, this type of deterioration is normal most people by age 60 will experience it to some degree.

People can have disc degeneration that doesn’t cause any problems, but sometimes, it can lead to pain.

Prodisc Lumbar Disc Replacement

Excuse me...fuse me too!! My story of L5

Zigler et al. reported the 5-year results of the prospective, randomized, multicenter FDA IDE study of the ProDisc-L. In this study, 236 patients were randomized either to single-level TDR or circumferential fusion. Although patients in both groups maintained significant improvement in their ODI scoes at the 5-year follow-up compared to their preoperative values, TDR patients were more satisfied than fusion patients. The percentage of patients indicating they would have surgery again was 82.5% in TDR patients and 68% in fusion patients. Furthermore, the reoperation rate at the index level was higher in the fusion group compared to the ProDisc-L group .

Zigler et al. also reported on 5-year adjacent-level degenerative changes. Adjacent-level degeneration was defined by radiologic signs including disc height loss, endplate sclerosis, osteophytes, and spondylolisthesis. Comparing adjacent levels preoperatively and at 5 years after the index surgery, circumferential fusion patients were more than three times likely to experience changes in adjacent-level degeneration than the TDR patients .

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Lumbar Artificial Disc Replacement In Los Angeles

Lumbar Artificial Disc Replacement is a technology designed to replace a symptomatic lumbar degenerated disc with a metal and plastic ball and socket prosthesis. A symptomatic disc is defined as causing low back or leg pain with or without a functional or neurologic deficit. Examples of structurally degenerated discs are herniated nucleus pulposes , mild instability on motion, loss of disc height or hydration of the disc , and vacuum phenomenon .

The L-ADR is inserted through a front side approach. It is implanted at the diseased level after the disc has been completely removed . The discectomy and removal of bone spurs will decompress the nerves. The implanted L-ADR will maintain the joint space height and potentially preserve motion at the surgically corrected level. This motion preservation may theoretically prevent or slow the progression of adjacent disc levels from degenerating.

Here we have an example of a patient who suffered from mainly back pain, with some leg pain, for several years. She failed conservative management in the form of physical therapy, spinal injections, oral medications, and activity modification. She underwent an artificial disc replacement at L4-5 and L5-S1. At two and a half year follow-up, her pain decreased from 8/10 pre-op to 0, and she was training for a half marathon.

How To Know If I Need Lumbar Disc Replacement

A lumbar disc replacement is an excellent treatment choice for people who have certain kinds of lower back problems and who have not found relief from supportive treatments, physical therapy or other medical care. You may be a candidate for lumbar artificial disc replacement if you have any of the following symptoms of conditions:

  • Chronic low back pain that sometimes flares in intensity
  • Low back pain that increases with bending or lifting
  • Muscle cramps and/or spasms in the lower back
  • Pain that radiates into the hip, buttock, or down the back of the leg
  • Low back pain that may be relieved by changing positions frequently

The best way to know if you need lumbar disc replacement is to speak with an expert in spine surgery who routinely performs lumbar artificial disc replacement procedures.

Importantly, many spine surgeons focus almost exclusively on spinal fusion, another surgical treatment for chronic low back pain. However, since lumbar artificial disc replacement can preserve spinal movement and lumbar fusion does not, it is best to speak with a surgeon who performs both lumbar disc replacement and lumbar spinal fusion to fully discuss your options. Learn more in our disc replacement vs. spinal fusion comparison guide.

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Rehabilitation Following Artificial Spinal Disc Replacement

Generally after spinal disc replacement, activity has no serious limitations. Usually, on the day of surgery, unaided walking is possible and encouraged. The hospital stay following a disc prosthesis operation is 2-5 days.

After the proper healing of the surgical wound, the patient will be discharged. A special corset must be worn for six weeks. After that time, the patient is normally able to return to a full professional and recreational life.

Lumbar Disc Replacement Surgery Recovery

Endoscopic Spine Surgery for L5 S1 Disc Prolapse — PIVD

Most people require at least one night in the hospital after lumbar disc replacement surgery. Fortunately, you will be able to perform some tasks like walking the day after lumbar disc replacement surgery. Heavy lifting, on the other hand, will not be allowed for a few weeks. People who work in jobs that do not require physical exertion may be able to return to work within 2 3 weeks.

Your surgeons office should provide detailed instructions to follow during recovery from lumbar disc replacement surgery. These will include how to handle bathing and hygiene, dressing changes, activity restrictions, medications, and the timing of follow-up appointments.

Dr. Lanman is a world-renowned specialist in the advancement of spine health, spinal surgery and restoring mobility with his focus on 4D Health.

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Contraindications For Lumbar Disc Replacement Surgery

The procedure should not be performed in patients younger than 16 years , in the presence of significant osteoporosis , impaired motion due to segmental fusion , an active infection or advanced malignancy. It is contraindicated if abnormal motion or instability is present at the affected level. The goal of lumbar disc replacement arthroplasty is to preserve but not to recreate motion, and severe degeneration of the facet joints with loss of mobility on flexion/extension x-rays or significantly reduced disc height would make fusion more appropriate. Kyphotic or scoliotic spine deformity cannot be reliably corrected by Lumbar disc replacement. Patients with a high pelvic incidence are prone to have back pain due to facet arthropathy and may not respond well to a disc replacement. It may also be contraindicated by certain vascular anomalies or conditions that would make the necessary surgical approach unsafe. Possible allergy to the device material should also be taking into consideration during preoperative planning.

Advanced Spinal Technology

Recovery after lumbar arthroplasty

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