Total Disc Replacement Advice Sheet
You have been scheduled for an operation on your low back known as a total disc replacement (TDR).
This is an operation designed to improve your low back pain. Total disc replacement has been performed in continental Europe for more than seventeen years although in the U.K. there are very few centres that perform this operation.
You will probably have been offered a choice of operation between TDR and spinal fusion and this leaflet outlines what you can expect from the TDR procedure.
The reasons for artificial disc replacement
The main reason for patients to have a total disc replacement is for significant and incapacitating low back pain which has been present for a long period (minimum 6 months), and which has failed to respond to non-surgical treatments.
Low back pain is a disabling condition but, whilst very troublesome, is not life threatening, holds no risks of paralysis, and many people learn to tolerate episodes of back pain throughout their life without need for surgical treatment.
You have chosen surgery as you feel that your symptoms are sufficiently severe to justify the magnitude of surgery that is being offered. You will have undergone various investigations to try and prove where your back pain comes from, and in your case, it is thought your back pain relates to one of the discs between the bones of the spine.
What happens during total disc surgery
The spine is approached through the abdomen. The disc between the two spinal bones is removed, and an artificial disc inserted.
The rewards of disc surgery
No operation is guaranteed to improve your symptoms. This operation is being offered to you with the aim of significantly improving your pain but no guarantees of success can be given.
We think it is reasonable to expect that at least two thirds of patients who undergo this sort of procedure are satisfied with the results although not necessarily pain free. If you are left with residual mild backache, this may be something that you have to accept.
The risks of surgery for low back pain
All operations carry with them a degree of risk. These include the risks of:
Operations such as TDR do offer some specific risks and while these should not be overstated, they can be quite serious if they occur.
Recovery from disc replacement
You will be in Hospital for a few days. You will be walking within 48 hours of your operation and when you go home will be independently walking around, able to get in and out of a shower, up and down stairs and in and out of bed.
You will be encouraged by the Physiotherapist to do specific exercises. You will be reviewed in the Out patient clinic at approximately six weeks after surgery. At that time, you may be referred for a more formal course of physiotherapy.
Time taken to return to work varies upon the type of work that you do. If you work from home doing office type work, you can expect to be working within two weeks. Light manual workers would usually return to work at approximately six weeks after surgery, and people doing more physical jobs may take some three months to return to work.
You will be allowed to return to swimming activities at approximately 6 weeks and activities such as tennis between 6 – 12 weeks. We would not recommend a return to contact sports such as football or more stressful sports such as squash for perhaps six months from the time of surgery. You can drive 6 weeks after surgery. You can have sex 6 weeks after surgery.
Summary of artificial disc replacement
Total disc replacement is a major undertaking for any patient. It is reserved for patient’s who have severe and incapacitating low back pain. No operation is guaranteed to relieve low back pain.
You should not enter into this procedure unless your pain is very significant and markedly interfering with your quality of life. You should have pursued and exhausted other forms of conservative treatment including manipulation, strengthening exercises, cardiovascular fitness programs and so forth.
The decision whether or not to undergo spinal fusion is complex and involves many factors. This decision must be made carefully and should be discussed thoroughly with your surgeon.