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I wanted to get a disc replacement for a bad disc at L45, but the surgeon said that I was too old, too fat, and too retired. Well, he didn't put it quite that way, but that was the take home message I got. So, who can get one of these new discs?
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Artificial disc replacement (ADR) is a device or implant used to replace a diseased or damaged intervertebral disc. After removing what’s left of the worn out disc, the ADR is inserted in the space between two lumbar vertebrae.
The goal is to replace the diseased or damaged disc while keeping your normal spinal motion. Artificial disc surgery is relatively new in the United States but has been used in Europe for many years. In the U.S., the first artificial disc surgery in the United States was done in October 2001.
As with any new device, surgeons don't just use it with anyone and everyone to see how it works. They must follow strict guidelines provided by the implant manufacturer and the results of published studies. You may be a good candidate for a lumbar artificial disc replacement if you have chronic pain and disability from lumbar disc degeneration despite nonoperative treatment for at least six months.
Finding the ideal patient for total disc replacement (TDR) surgery helps ensure successful results. Identifying subgroups of patients who should not have TDR surgery is also important. As the authors of one study sum it up so nicely, Patient selection is the primary key to achieving a favorable outcome.
The main use of TDRs is Reports of short- and medium-term results are now available. The data from these studies has helped shape selection criteria for this procedure. As you discovered, age restrictions (younger than 65 for most surgeons, younger than 60 for more experienced surgeons) apply. Body mass index (BMI) indicating being overweight or obese is another defining factor.
Anyone with degenerative changes of the facet (spinal) joints is also excluded. Without good joint health and alignment, normal motion is not available and an artificial disc won't change that. And bone loss from osteoporosis is also a risk factor for poor results. The disc device sinks down into the bone and/or there is a risk of bone fracture around the implant.
Being retired or off work is another risk factor. Some new findings show that the longer a person is off work for sick leave or disability, the worse their final outcomes. Although being retired hasn't been examined, it may be considered a risk on the basis of the research that showed off-work status was linked with worse outcomes.
So, even though you weren't selected for this procedure, your surgeon had your best interests in mind. Patients who don't qualify for this procedure are more likely to have problems and complications that are best avoided.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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