Are you a candidate for lumbar disc replacement surgery? 
There’s no easy answer to that question, according to Dr. Jessica Shellock, a spine surgeon on the medical staff at Texas Health Center for Diagnostics and Surgery (THCDS) in Plano, Texas and a co-director at the Center for Disc Replacement. It’s a decision patients need to make in consultation with their surgeons.
But there are some key factors your surgeon will consider.
The first consideration is the symptoms you’re experiencing.
Generally, spine surgery isn’t recommended unless the patient has severe, prolonged pain, and then only after other measures, such as physical therapy and medication, have failed to provide relief.
“The ideal candidate is someone who presents with debilitating back pain, often with leg pain, but not always,” said Dr. Shellock.
In the lumbar spine (lower back), disc replacement surgery may be performed at one or two levels. (Surgery for two levels involves replacing the discs in between two adjacent vertebrae.)
“Not all insurance carriers are approving two levels, so there's some individual considerations there,” said Dr. Shellock.
A previous history of extensive abdominal surgery is another factor.
“With the lumbar spine, we do come in from the front, so if you’ve had extensive abdominal surgery previously, scarring might prevent us from safely getting to the front of your spine,” Dr. Shellock said.
Patients with excess weight may also not be good candidates for lower back disc replacement until or unless they’ve lost weight.
“That’s based on safety concerns related to getting to the spine from the front, because we have to work around the big vessels, the intra-abdominal organs, so we want to make sure that we can safely access the spine,” Dr. Shellock said.
Bone density is another key consideration. Patients with osteoporosis may not qualify for disc replacement surgery. Before surgery, patients undergo a bone density study or a DEXA scan.
“We have to make sure that your bone density is normal because when we're inserting a lumbar artificial disc — which are metal and plastic devices — between the bones, we’re relying on those bones to function under the loads of our everyday life,” she said. “If your bone quality is not good, then that implant could sink into the bone or fracture.”
Patients with spinal instability, due to degenerative changes or a fracture, may also not qualify as candidates for disc replacement surgery. Patients with severe scoliosis or a spinal deformity are also typically excluded from consideration for the procedure.1
How Lumbar Disc Replacement Surgery is Performed
In lower back disc replacement surgery, the surgeon makes an incision in the abdomen. The abdominal muscles are gently spread apart and the intestines and large blood vessels are moved to the side so that the surgeon can see the front of the lumbar spine. The affected disc is then removed and the artificial disc is inserted in its place.
Lumbar disc replacement surgery often involves two surgeons – an access surgeon, and a spine surgeon. The access surgeon has training in the vascular (blood vessel) system, and handles the first steps of the procedure, moving the organs in the abdomen to give the spine surgeon access to the spine.
The spine surgeon then performs the discectomy – removing the damaged disc, opening up a space to make room for an artificial disc, and then determining the best ‘footprint’ for the inserted disc.
“We determine the height and the width of the available space so that we can make the most use of the space and put the best size implant in for each patient,” said Dr. Shellock. “Some of these devices also require that we make a bone cut to guide the implant into place.”2
After surgery, the patient is then transferred to the recovery unit. The surgery usually takes about an hour for a single level or about two hours for two levels.
Is disc replacement surgery safe?
As with any type of surgery, lower back disc replacement does involve some risk. Patients should talk with their surgeons to understand artificial disc replacement risks that may apply to them.
“Most of the lumbar disc replacement surgery risks relate to the step where we move the intra-abdominal and the intra-pelvic organs,” said Dr. Shellock. “The access or general surgeon who works with us is there to help minimize those risks.”3
Recovery from Lumbar Disc Replacement
The key advantage of lumbar disc replacement is easier and faster recovery, compared to traditional surgical procedures in the lumbar spine.
Most patients can go home from the hospital one or two days after surgery. Before discharge, therapists work with patients and instruct them on proper techniques for getting in and out of bed and walking independently.
Most patients return to work in 2-4 weeks after surgery. Patients can gradually begin to bend, twist and lift after 4-6 weeks, as the pain subsides and the back muscles get stronger.
Finally, Dr. Shellock adds that artificial disc replacement is transforming the lives of thousands of people by setting them free from debilitating back and neck pain.
“For many patients suffering from chronic, severe lower back pain, lumbar disc replacement is going to be the best option for retaining mobility and resuming their lives with minimal pain or discomfort,” said Dr. Shellock.
This is general information for educational purposes only. You should discuss your symptoms with your provider.
[1] Shellock video: Who is a candidate for lumbar disc replacement surgery?
https://www.youtube.com/watch?v=_HcptSks-Tg
[2] Shellock video: What happens during lumbar disc replacement surgery?
https://www.youtube.com/watch?v=tt2Wmk00tBE
[3] Shellock video: What are the risks related to lumbar disc replacement?
https://youtu.be/N7rGx1s_P2g?si=S-XZ9vvC5Y4yyeUx