Today, more and more doctors examine the possibility of treating intervertebral disc damaged by surgery. There is still no clear answer to the question: what to choose – a surgery to stabilize the vertebrae or an implant? Each of these options has pros and cons.
Types of surgery
Patients with severe intervertebral disc injuries, severe chronic pain, and leg pain can now have two possible types of surgery:
- Stabilization (spinal fusion) – a certain part of the spine becomes rigid.
- Prosthesis – a complete replacement of the damaged disc with an artificial one.
It should be noted that the tendency towards classical methods to stabilize the spine, rather than replacing the damaged disk with an artificial one in recent years. Each case is considered on an individual basis and orthopedic specialists, with a complete diagnosis of the patient, decide what type of surgery is especially suitable for that patient.
Sometimes the choice is very difficult, depending on a number of factors. For example, if the patient is under the age of 50, active, agile, with good bone density, they are likely to be provided a vertebral replacement. For patients over 50 who are overweight or have a poor bone structure, this method is not simply not recommended; more – is categorically contraindicated.
Unfortunately, a general rule for all patients simply does not exist. But there is something that unites these two methods: both implants and surgery to stabilize the vertebrae must necessarily meet a number of special requirements.
The head of the ADR Barcelona Spine Center, Dr. Pablo Clavel argues that in Germany, a sufficient number of patients have undergone spinal surgery.
But even if the diagnosis is clear, if there are pronounced changes in the discs and instability of the spine before the surgery is made, a more in-depth diagnosis, and convened a consultation with doctors, such as radiologists, neurologists, and anesthesiologists is required.
Therefore, such serious orthopedic or neurosurgical interventions – a replacement of cervical vertebrae or the implant of the lumbar spine – are recommended only in cases where all conservative treatment methods have been tried without positive results.
Until recently, spinal fusion surgery was considered the only possible option for stabilizing the spine. What is such an operation?
A damaged disc is removed, after which the affected vertebrae are secured using a special rod-screw system. In addition, an implant is inserted between the two front vertebrae. This is done so that the vertebrae do not rub against each other in the future. The materials used are screws and titanium rods.
The vertebrae, connected with each other, significantly limit the mobility of the spine. Due to the restriction of mobility, a domino effect occurs, degenerative changes of the adjacent spine develop spondylolisthesis.
In this case, all subsequent surgeries will often become the only possible treatment option.
The operation of replacement of the implant vertebrae (disc prosthesis) is performed only on the lumbar spine. The newest disc implants renew the natural distance between the vertebrae.
The best titanium implants are equipped with a mobile plastic core and a special layer that ensure the implantation in the bone within 3 months.
The operation is performed from the front, not from the back. The natural functions of the vertebrae are not violated, in this sense, the mobility in the segments is restored after the disc replacement.
How does the procedure work? The operation is performed under general anesthesia. Access to the vertebrae is through the rectus abdominalis muscle. The surgeon changes all organs and tissues, thus clearing the pathway to the spine.
Equipped with special tools, the doctor removes the disc, after which the implant is installed under the control of an X-ray machine and a microscope. Then the wound is closed layer-by-layer.
As soon as the anesthesia stops, the patient is allowed to stand up and, if necessary, be prescribed pain medication. The patient can be discharged earlier than 2-5 days after the procedure. Everything depends on the patient and their rehabilitation process.
Within a month, the load on the spine gradually increases. In a period of 5-6 weeks after the surgery, it is advisable not to ride a motorcycle and bicycle. At the end of the 1.5 months, any physical activity is allowed, even sports.
Any surgery can have unintended consequences. By accepting an operation, each patient should be informed about possible complications. The main types of possible complications after implantation:
- soft tissue infection in the area of a postoperative wound;
- thrombosis in vessels;
- severe pain;
- implant change;
- fracture of the prosthesis.
Some patients also complain of having a painful leg after replacing the vertebrae with the implant.
In any case, before deciding on surgery you should undergo a thorough examination and discuss with your doctor all the possible risks, complications and consequences of the procedure. But before that, make sure you’ve tried all the conservative treatments.
Health to you!