Dr. Larry W. McDaniel Ed.D., Carmyn Streitz, Allen Jackson, MS., Laura Gaudet PHD discuss artificial disc replacement surgery, pre-operative preparation, the surgical procedure, and post-operative recovery.
Back pain is a common health problem that affects a majority of people at some point in their lives. Most back pain is not serious and may be the result of poor posture, improper body mechanics, or overexertion. About 50% of people older than 40 years of age have Degenerative Disc Disease (DDD), which is a condition similar to osteoarthritis. Many people do not have pain, but for others, chronic pain can become a life-altering condition that affects their daily living and quality of life. Arthrodesis (i.e. spinal fusion) has been the treatment of choice for people with DDD, but this paper will discuss artificial disc replacement instead of spinal fusion.
The spine is a biomechanical phenomenon that allows flexion, extension, and a wide range of motion for the body. The spine naturally curves at the cervical, thoracic, and lumbar regions. There are four normal curvatures to the adult spine from superior to inferior. Most injuries occur at the lower lumbar level because the majority of the axial weight of the torso is distributed toward the pelvis. The vertebral body becomes larger toward the sacrum where more weight is carried.
Degenerative disc disease occurs when an IVD becomes worn out because of ageing or as a result of damage or trauma. With DDD, the disc does not correctly cushion the vertebrae and distribute body weight. Discs can wear out, tear, bulge outward, or rupture through the annulus causing pressure on the nerve results in nerve impingement, inflammation, and pain. Nerve impingement can cause numbness and muscle weakness of extremities, sciatica, and even bowel or bladder problems. If this is left untreated, permanent nerve damage may occur. As discs wear down, bone spurs and osteophytes form on the vertebrae in a condition similar to osteoarthritis.
Patients are given a conservative course of treatment to ease pain and inflammation of their backs: Brief rest until pain has decreased, moist heat to the affected area, muscle relaxant medications to treat pain-related muscle spasms, non-steroidal anti-inflammatory drugs or steroid medications to relieve inflammation and pain, opioid analgesia for immediate relief, physical therapy and exercise to ease pain, improve mobility and flexion, and strengthen abdominal and back muscles to support the spine, and weight loss to decrease pain resulting from increased load bearing.
It takes approximately three to six months and can take as long as 18 months after bone graft and implants are surgically placed in the spinal segment to fuse. Physicians may recommend that the patient wear a brace or corset to support the back and encourage good posture. Physical therapy and exercise programs help the patient regain movement. Many patients experience relief of symptoms as pressure is taken off the irritated nerve roots. Some patients experience adverse effects, such as vascular or dural tears, chronic pain or stiffness, or failed back syndrome. Some of these ailments may require that the patient need additional surgery.
The metal endplates of the implant must be able to grab onto solid bone for the prosthesis to be effective, and the surgical approach is through the abdomen. Some contradictions to the surgery could be allergies to metal, autoimmune disorders, facet joint disease, history of chronic steroid use, infection, morbid obesity, osteoporosis, pregnancy, previous back surgery, spondylolisthesis greater than 3 mm, scoliosis, or a spinal tumour. Some postoperative complications that may occur involve both abdominal and spine surgery includes anaesthetic side effects, bladder problems, bleeding, device failure, dural tears, ileus, incision problems, infection, pain, paralysis, spinal fluid leakage, or death.
Usually, artificial disc replacement patients are discharged from the hospital about 4 days after surgery if there are not any complications. Some physical limitations the patient has are no rotation of the lumbar region for three weeks after surgery, no curving of the lumbar region or intense stomach exercise for six weeks, no participation in sports for three months, no activities that stretch the sciatic nerve, and the need to ensure correct posture to avoid putting pressure on the prosthesis.
The success of an artificial disc replacement procedure depends on proper patient selection, diagnosis, and specialized surgeon experience with device placement. FDA data shows that patients who have undergone artificial disc replacement experience results that are comparable to patients who have undergone spinal fusion. Artificial disc replacement is a safe and effective treatment for mechanical back pain caused by DDD. Only a select population of patients will be eligible for total disc replacement. It is predicted that within two years, approximately 20% of all patients with lower level DDD will have artificial disc replacement surgery.
Back pain is a common health problem for a number of people. One of the leading causes of back pain is Degenerative Disc Disease (DDD). For years spinal fusion was the number one procedure for solving back pain because of DDD. Now doctors are using an artificial disc to replace the diseased disc. The artificial disc offers an alternative to spinal fusion for the treatment of degenerative disc disease at these levels and is designed to preserve spinal motion and recreate the natural function of the disc. It is a safe and effective surgery for back pain caused by DDD.
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About the Authors
Larry W. McDaniel Ed.D. is an Associate Professor of Exercise Science at Dakota State University Madison, SD. USA. Dr. McDaniel was a First Team All-American football player (USA Football), a Hall of Fame Athlete, and Hall of Fame Wrestling Coach.
Allen Jackson, M. Ed. is an Assistant Professor of Physical Education and Health at Chadron State College in Chadron, Nebraska (USA) who is well known for his presentations and publications at international conferences focusing on Leadership, Curriculum, and Health.
Laura Gaudet, Ph.D. is a Professor and Chair of the Department of Counselling, Psychology and Social Work at Chadron State College, Chadron NE.
Carmyn Streitz, Dakota State University is an outstanding student of Exercise Science.
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