Sarah Lewis, PharmD
What is disc replacement?
Disc replacement removes a damaged spinal disc and replaces it with an artificial disc. Spinal discs are made of cartilage-like material. They act as cushions between two vertebrae. Your surgeon may recommend this surgery if you have back pain due to one or two damaged spinal discs. Disc replacement can improve your back pain and disability. However, it is important to have realistic expectations for disc replacement. Some pain and disability will likely remain.
Spinal discs allow your spine to move and twist. The gold standard for treating spinal pain with surgery is spinal fusion. Spinal fusion removes the spinal disc and fuses two vertebrae together. This can eliminate pain, but it also eliminates spine movement and flexibility. Disc replacement is an alternative to spinal fusion that maintains spine flexibility.
Looking for a Doctor?
Disc replacement is major surgery that has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment options before having a disc replacement.
Why is disc replacement performed?
Your doctor may recommend disc replacement to treat spinal pain that has not responded to other treatments for six months or longer. Disc replacement is not a common surgery and is not the first choice to treat spinal problems. Ask your doctor about all of your treatment options and consider getting a second opinion.
Your doctor may recommend disc replacement if you meet the following criteria:
Back pain is related to only one to two spinal discs.
Back pain is not related to facet joint problems or nerve compression.
Spine is skeletally mature and no longer growing.
You are not excessively overweight.
You do not have scoliosis or any other spinal deformity.
You have not had previous spine surgery.
Who performs disc replacement?
Orthopedic surgeons perform disc replacement. Orthopedic surgeons are specially trained to treat problems of the bones and joints. They perform surgery and prescribe other treatments.
A vascular surgeon may assist in the surgery. Vascular surgeons treat problems with blood vessels outside the heart and brain.
How is disc replacement performed?
Your disc replacement will be performed in a hospital. It is major surgery that involves an incision in the abdomen. A vascular surgeon will move abdominal organs and vessels out of the way. This will allow access to your spine. Your orthopedic surgeon then removes the damaged disc and replaces it with an artificial disc made of metal or metal and plastic.
Type of anesthesia
Your surgeon will use general anesthesia for your disc replacement surgery. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain.
What to expect the day of your disc replacement
The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of disc replacement?
As with all surgeries, disc replacement involves risks and complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of disc replacement
Complications of disc replacement include:
Dislocation of the new disc
Loosening or breakage of the new disc possibly requiring additional surgery
Narrowing of the spine, called spinal stenosis
Nerve or blood vessel damage
Ongoing pain and disability
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy, occupational therapy, and other rehabilitation treatments.
Informing your doctor if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my disc replacement?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for disc replacement by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Arranging for a ride home after hospital discharge. It is also a good idea to have someone stay with you for the first 24 hours.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, CT (computed tomography), MRI (magnetic resonance imaging), EKG (electrocardiogram), blood tests, and other tests as needed.
Following dietary guidelines as directed
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need disc replacement? Are there any other options for treating my condition?
If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
When will I start physical therapy? Where do I go for it?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my disc replacement?
Knowing what to expect can help make your road to recovery after disc replacement as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable. You will stay in the hospital for two to four days, depending on how quickly you regain spine function.
You will have physical therapy and rehabilitation to improve spine flexibility and help you recover. You will need to avoid hyperextending your spine and movements that jar your spine for many weeks. Your surgeon or therapist will tell you when it is safe to return to your normal activities.
Recovery after surgery is a gradual process. Recovery time varies depending on your general health, age, and other factors. Full recovery takes several weeks to several months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up and physical therapy appointments after disc replacement. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Numbness or tingling in an extremity
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might disc replacement affect my everyday life?
Disc replacement can reduce back pain and improve disability so you can lead a more active, normal life. It is important to have realistic expectations for disc replacement. Some pain and disability can remain following disc replacement.
Disc replacement is a relatively new form of back surgery. The surgery will have better results as technology and techniques continue to advance.
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