Can I have a new disc, please?

You would think that this was a reasonable question, given the way technology has gone, wouldn’t you? Well the answer, of course, is yes. Lumbar artificial disc replacement is a standard operation. Since Mr Sutcliffe performed the first of these in London in 1996, there have been thousands of patients, who have had new discs inserted into the low back to control their back pain, around the UK, in Europe generally and Scandinavia. Other areas of the world also became centres for disc replacement, such as Australia and Japan and the USA became licensed for this procedure around ten years later, increasing the numbers.

Because lumbar disc replacement is a major operation, generally it is reserved for very specific cases, where other methods of treatment have been tried and have failed to give adequate relief. These include physical therapies, physiotherapy, osteopathy, chiropractic and general fitness work, injections, pain management programs and even other operations.

To access the lumbar disc, the surgery is done through the front, through the abdomen, rather like operating on the bowel. Just as with these operations, the techniques have been refined, so that smaller incisions are now made and the recovery generally is quicker than it used to be. If the disc is known to be the pain source and all other methods of controlling the pain have failed, the patient would be considered for this.

The surgery is performed through a small incision on the abdomen, between the muscles, and around the abdominal organs (contained in a bag called the peritoneum). The disc is removed, the height of the disc space is restored and the new disc is inserted. The wound is sutured with absorbable stitches and the patient goes back to the ward. Most are up and about within a few hours and out of hospital in 24-72 hours, but overall it takes several weeks to fully recover.

The patient is usually followed up by the surgical team for several months and x-rays may be taken, as you see here, to show the position of the new disc and the alignment of the spine. X-rays taken with the patient standing up and bending forwards (flexion) and backwards (extension) are useful to show how well the new disc is moving. Looking at the images here, the metallic components are almost parallel in the extension film (on the left), but tilted together at the front in the flexion film (on the right), showing movement. A normal disc would have 6° of movement in these positions, which this artificial disc replicates.

As with any major surgery, there are risks attached to this procedure, which can be very severe if they occur, such as major bleeding, or damage to the nerves behind the disc, which, at its worst, can lead to weakness or paralysis and loss of control of the bladder and bowel. These are uncommon and most patients are pleased with their new disc. It is very important to get fit again afterwards, to strengthen the muscles to both protect the disc and to allow it to move normally.

This type of surgery is not for every patient with a bad back. In highly selected cases, where all else is healthy and one disc is known to be the source of the pain, it can be of great benefit.

Get in touch with John Sutcliffe here.