Lumbar Disc Replacement
|A new Restoration of Motion, Return to Sports, Return to Life.
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Lumbar Artificial Disc Replacement / Arthroplasty
Devices are being developed for the lumbar spine to restore the function of all or part of the degenerative disc. By replacing a collapsed, faulty, painful degenerative disc with a mobile artificial disc replacement motion is restored and theoretically the risk for adjacent, or nearby disc degeneration can be decreased.
The renewed interest in Lumbar artificial disc replacement, or arthroplasty, has been in part stimulated by the desire for an effective alternative to lumbar fusion. The first artificial disc replacements performed were methyl-acrylic injections and Lucite ring models, which were first inserted in the mid-1950s. Over the past fifty eight years, advances in technology have provided for several generations of disc arthroplasties (Vitallium spheres in the late 1950s, silicone injections and prostheses in the 1970s). Orthopaedic surgeons have been performing hip, knee, shoulder, wrist, elbow and ankle replacements for several years. Dr. Pablo Pazmino has combined new developments in technology, with arthroplasty concepts and lessons gleaned from his Orthopaedic Arthoplasty experiences, to apply these to the spine.
Dr. Pablo Pazmino's Orthopaedic knowledge includes concepts such as modularity, revision surgery, kinematics, geometry, mechanics, bone-implant interfaces, impingement, wear properties, fixation techniques, porous-coated implants, ceramics, plasma-sprayed implants, and high-density polymer mobile bearing surfaces.
The image below demonstrates the concept of porosity and the importance of porous coating. Here is a close up view of the porous ongrowth surface which allows bone from the vertebral bodies to actually grow onto and bond with the endplates of the artificial disc.
The Prodisc-L arthroplasty consists of two metal (cobalt-chrome alloy) endplates that are anchored to the top and bottom surfaces of the spinal bones (vertebrae) through both keel fixation (The fins featured on the metal surfaces) and porous ongrowth (The pores on the metal). In between the endplates there is a plastic (ultra-high molecular weight polyethylene, or UHMWPE) inlay that fits between the two endplates. The plastic inlay and endplates help restore the natural distance between the two vertebrae (disc height). The top (superior) endplate can slide over the domed part of the inlay, which can allow movement at the level where it is implanted.
For each patient, Dr. Pablo Pazmino custom fits each arthroplasty to approximate the overall geometry of the disc's intended height, width, depth, and axial plane dimensions in order to create appropriate stability, and fit within the intended level, and preserve normal motion and load on the facet joints.
Once inserted the mechanics of the disc prosthesis must allow for normal load transmission through the disc without failure, abnormal motion, load transfer, or shifting to other structures such as the facets or nearby discs.
The rationales of lumbar disc replacements are to:
- Eliminate the need for a fusion
- Eliminate the need for bone grafts and donor-site morbidity
- Minimize the stresses which occur on the adjacent level/the discs above and below the degenerated disc
- Preserve motion of the spine
- Restore shock-absorption capabilities of the disc itself
- Restore disc-space height and indirectly restore foraminal size (where the nerve exits the spine)
- Maintain stability of the spine
- Help protect neural elements/nerves
- Relieve back pain associated with degenerative disc disease
- Provide an alternative option for patients with lumbar degenerative disc disease who have pain and have tried a full course of non operative management
Two lumbar total disc prostheses have been approved for use by the US Food and Drug Administration:
- SB CHARITÉ® Intervertebral Prosthesis
- PRODISC®-L Total Disc Replacement
Several Lumbar Disc Arthroplasties are currently being developed and we are in the process of evaluating a third generation Lumbar arthroplasty.Some contraindications to total disc replacement include:
- Severe Radiculopathy
- Spinal stenosis
- Facet joint arthritis
- Significant psychiatric problems
- Spinal tumor
The Food and Drug Administration (FDA) has approved the Prodisc-L for the lumbar spine in treating pain associated with degenerative disc disease. The lumbar devices were approved for use in the lumbar spine for patients who have had no relief from low back pain after several months of non-surgical treatment. Dr. Pablo Pazmino currently uses the Prodisc-L prosthesis, and is currently investigating other third generation Lumbar Arthroplasties as part of ongoing clinical trials.
When Should You Seek Medical Care?
If severe pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize you to avoid the risk of further injury and possible paralysis. Emergent medical care should be sought immediately.
Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs.
Radiating pain, or numbness in your arms or legs which causes weakness in the arms or legs without significant neck pain should also be evaluated.
If there has not been an injury, you should seek a Spinal Evaluation with Dr. Pablo Pazmino when pain is:
- Continuous and persistent
- Accompanied by pain that radiates down the arms or legs
- Accompanied by headaches
- Accompanied by numbness, or tingling
- Accompanied by weakness!
Many patients seek care for Lumbar Artificial Disc Replacement pain by Dr. Pablo Pazmino because as an Orthopaedic surgeon he is specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although Dr. Pablo Pazmino confines his practices to Spinal pathology he also treats a wide variety of diseases, injuries, and other conditions, including Lumbar Fractures.