Lumbar Arthroplasty: Total Disc Replacement (Tdr)

1646 words - 7 pages

Degenerative disc disease (DDD) refers to a spinal condition caused by the breakdown of the intervertebral discs. As one ages, the spine begins to show signs of wear and tear as the discs dessicate and shrink. It is one of the most common causes of low back pain and is challenging to treat. The most common surgical intervention for DDD is spinal fusion (arthodesis) but total disc replacements are making strives to become the chief surgical treatment for DDD. Total disc replacement technology has been making an effort to preserve motion in degenerative spinal segments sine the 1980’s. According to many, this technology will reduce the future need for arthrodesis and its related ...view middle of the document...

The chief surgeon stands between the patient’s legs while his two assistants standing each on the sides of the lumbar spine. A retroiperitoneal approach is most commonly used due to a lower risk to the superior hypograstric plexus; if there is a contraindication, obesity or past open abdominal surgery, a transperitoneal approach may be used.
Once the spine is reached, the initial protocol is to remove the anterior longitudinal ligament (ALL). Once the ALL is removed and the annulus is visible, an anterior annulectomy is performed with a scalpel at the junction of the annulus and vertebral end plates. After the anterior annulus is detached, the entire nucleus pulposus is removed. Once removed, both vertebral plates are thoroughly shaven and cleaned to prepare the bodies for the anchorage. A distraction device is used to mobilize the vertebral bodies and create enough space for the arthroplasty. A stem or macro-texture anchorage is performed without going past the subchondral bone and once the anchors are set, a polyethylene inlay is placed in between. When centering the polyethylene inlay, the surgeon must make sure the implant fits firm as it allows for more normal mechanical function. The average LTDR height is between 11-13 mm, but may be larger or smaller depending on the size of the patient. The average time for the procedure is between 1-3 hours.
Before performing this procedure, a thorough examination and past medical history is vital to see if the patient is able to have the lumbar total disc replacement. Any condition compromising the structural integrity of the vertebral end plates and/or bodies is necessary to check. Some of these conditions are: osteoporosis, intraspinal neoplasm, acute fracture and osteomalacia. Since the procedure is done with an anterior approach, any past anterior surgical procedures for example, major abdominal surgery or irradiation, must be taken accounted for. Another major contraindication is any condition that may affect the stability of the prosthesis. Scoliosis, spondylolsis, spondylolisthesis and a past fracture with residual deformity are just a few of these conditions that can affect spinal stability pre and post surgery. Other conditions that are addressed are disc herniation with predominant radicular symptoms, signs of cauda equina compression, Grade III or IV facet arthrosis and central or lateral recess stenosis. Other miscellaneous contraindications are severe obesity, pregnancy, active drug or alcohol abuse, history of spinal infection at the surgical level, and active infection anywhere in the body but specifically the spine.

This procedure involves many long term or even life threatening complications. When performing the procedure, the surgeon must be careful with any visceral or vascular injury. Readily access to a vascular surgeon is made prior to the surgical treatment in the case of an emergency. The chief surgeon must also be cautious with retrograde ejaculation...

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