Lumbar Arthroplasty Surgery: Details You Need to Learn Before The Procedure

A range of spinal conditions can lead to chronic lower back pain. When this pain doesn’t respond to non-surgical treatment options, your doctor may recommend lumbar arthroplasty.

Lumbar arthroplasty is a surgical procedure that can resolve symptoms of spinal conditions including spinal stenosis, spondylolisthesis, and facet joint arthrosis.

Below, you’ll find a detailed overview of spinal arthroplasty surgery to help you feel confident and informed heading into the procedure. 

What is Lumbar Arthroplasty?

Lumbar arthroplasty is a surgical procedure that involves removing and replacing a damaged spinal disc in the lumbar spine. It’s commonly considered a substitute for spinal fusion, which involves fusing two vertebrae into a single bone. 

In lumbar arthroplasty, the damaged spinal disc is replaced with a spinal implant, prosthetic, or artificial disc. There are many different implant options for this procedure, each of which can impact the success of the surgery and your spinal motion.

Later in this article, we’ll discuss spinal implants for lumbar arthroplasty, such as the TOPS spinal implant, in greater depth. 

Lumbar Arthroplasty vs. Spinal Fusion

Both spinal fusion and lumbar arthroplasty can be used to resolve pain from spinal disc damage. However, arthroplasty can preserve motion in the spine, while spinal fusion limits it. 

In spinal fusion, the surgeon removes the damaged spinal disc tissue, much like in lumbar arthroplasty. However, instead of using a spinal implant, the surgeon places bone graft material in between the affected vertebrae. 

In the months following spinal fusion, the vertebrae will fuse and form one bone. This prevents lower back pain, but it also keeps the patient from bending and twisting the fused portion of the spine. 

By using an implant instead of fusion, spinal arthroplasty allows the patient to retain spinal flexibility with lower back pain relief. Plus, the recovery process for lumbar arthroplasty with an implant is much shorter than that of spinal fusion.  

Lumbar Arthroplasty For Degenerative Disc Disease

One of the main applications of lumbar arthroplasty is lumbar degenerative disc disease. With almost 400 million people in the world each year diagnosed with degenerative disc disease, this spinal condition is a prevalent issue among older adults.  

What is Degenerative Disc Disease?

Degenerative disc disease occurs as a result of wear and tear on the spinal discs, typically due to aging. Spinal discs protect the vertebrae against damage by absorbing shock and reducing pressure on the spine. Unfortunately, the aging process can weaken and dry out these discs, often leading to pain and other symptoms. 

The spinal discs consist of fibrous tissue, cartilage, and water. The fibrous tissue makes up each disc’s tough outer layer, called the annulus fibrosus. The interior of each spinal disc is a soft, viscous core called the nucleus.

When spinal discs are undermined by the natural aging process, it can increase your risk of developing spinal conditions, such as osteoarthritis, spinal stenosis, and spondylolisthesis. 

If a degenerated disc in the lumbar spine causes severe and/or chronic back pain, lumbar arthroplasty may be performed to remove the diseased disc. However, lumbar arthroplasty is typically only performed if non-invasive treatments have failed.

Non-Invasive Treatments For Lumbar Disc Disease

Physicians usually recommend non-invasive treatments to relieve symptoms of lumbar disc disease before considering spinal arthroplasty. Examples of non-surgical solutions for disc disease include:

• Heat and cold therapy

At-home heat and cold therapy can help relieve pain, muscle tension, and inflammation from lumbar disc disease.

Placing an ice pack over the lower back for 10 to 20 minutes can ease inflammation, swelling, and pain. Using a heating pad or taking a warm bath can release tension in the lower back and prevent spasms for pain relief. 

• Physical therapy 

Physical therapy is one of the most effective non-surgical treatments for disc disease. It often involves strengthening the muscles that support the spine, improving the body’s range of motion, and promoting physical activity to relieve pain. 

• Pain medications

Over-the-counter pain medications can offer relief from spinal disc disease pain. Generally, OTC pain medications are effective for mild pain and inflammation.

Severe pain typically needs to be treated with prescription pain medications. Additionally, prescription pain medications can generally only be used for a limited period of time, so they’re not a sustainable solution for spinal disc pain. 

• Epidural steroid injections

Epidural steroid injections can be used to relieve pain and inflammation from a damaged spinal disc. Specifically, steroid injections lower the immune activity in the damaged area of the spine, which reduces inflammatory cell production. 

Usually, epidural steroid injections are the most effective when they’re used in combination with other therapies, such as physical therapy. However, physicians usually only recommend that patients get two to three steroid injections per year. Excessive injections can diminish the condition of the vertebrae and adjacent muscles.

What To Know About Lumbar Arthroplasty Before The Procedure

Before undergoing lumbar arthroplasty to relieve lower back pain, it’s important to understand the surgery preparation, procedure steps, and recovery process. 

Preparing For Lumbar Arthroplasty

To prepare for lumbar arthroplasty, your doctor may ask that you:

• Quit smoking

Smoking reduces blood flow and adversely affects the function of the heart and lungs. This can lead to breathing issues during surgery and inhibit your healing process. 

• Stop taking certain medications and/or supplements

Before undergoing lumbar arthroplasty, talk to your doctor about the medications and supplements that you’re currently taking. You may need to stop taking some or all of them before the surgery. 

• Stop eating and drinking in the hours before the procedure

To ensure that the anesthesia is more predictable, patients are generally asked to stop eating and drinking around 8 hours before the procedure. 

The Steps of Lumbar Arthroplasty Surgery

Spinal arthroplasty generally involves the following steps:

1. You’ll receive general anesthesia to keep you asleep throughout the procedure. 
2. The surgeon will make an incision, often in the abdomen, and move aside organs and tissues to gain access to the spine. 
3. The surgeon will remove the damaged disc. 
4. An artificial disc/spinal implant will be positioned and secured around the affected vertebrae. 
5. The surgeon will reposition the organs and tissues, then close the incision to complete the procedure. 

The exact steps of lumbar surgery can depend on a range of factors, including which spinal implant is used. The TOPS System is an innovative spinal implant that has proven to yield positive patient outcomes after lumbar arthroplasty surgery.  

Recovering From Lumbar Arthroplasty

Lumbar arthroplasty doesn’t involve bone healing. So, it has a shorter and less painful recovery period than other spinal procedures, such as spinal fusion. 

With that said, you may still be given pain medications and will need to avoid intense physical activities for several weeks. Your doctor will likely recommend physical therapy to improve spinal flexibility and stability after lumbar arthroplasty. 

Shorten The Recovery Period With TOPS

TOPS is a spinal arthroplasty system that can preserve patients’ range of motion and reduce the recovery period after lumbar arthroplasty surgery. Patients can often return to their favorite activities, including sports, within 4 to 6 weeks of spinal arthroplasty with the TOPS implant.  

To learn more about the TOPS spinal arthroplasty system, reach out to Premia Spine today. 

How to Treat Lumbar Facet Joint Pain

The lumbar facet joints are crucial structures within the lower spine. Thanks to these small joints, the spine can move comfortably and securely. 

Unfortunately, the strain of age and injuries can trigger lumbar facet joint pain. Often referred to as lumbar facet joint syndrome, this type of spinal pain can limit your range of motion and daily activities. 

In this article, we’ll discuss the treatment options for lumbar facet joint pain, including facet joint replacement. 

What Are Facet Joints?

Each of the vertebrae in the spine has two facet joints. One facet joint is located on either side of the vertebra. These joints link the vertebrae together to make the spine a cohesive structure.

There are a few key functions of the facet joints, including:

• Stability

The facet joints help stabilize the spine, especially while it’s in motion. 

• Motion 

By linking the vertebrae together, facet joints allow the spine to move. Thanks (in part) to the facet joints, the spine can securely twist and bend in different directions.  

• Protection

Facet joints protect the structures within the spine, including the spinal cord and discs. 

Understanding Lumbar Facet Joint Pain 

The lumbar spine is the most common area of the spine for facet joint pain. In fact, lumbar facet joint pain is estimated to make up 15% of all back pain cases.

After the lumbar spine, the most prevalent area of the spine for facet joint pain is the cervical spine, followed by the thoracic spine. 

Lumbar facet joint pain can lead to chronic lower back pain and reduced range of motion. This may limit your ability to carry out day-to-day activities. 

What Causes Lumbar Facet Joint Pain?

Age-Related Degeneration

Lumbar facet joint pain is most often caused by spinal degeneration. As we age, the structures of the spine gradually deteriorate. This age-related wear and tear can impact the facet joints in several ways. 

For one, the facet joints themselves can wear down from the repeated impact. However, the degeneration of other spinal structures, like the spinal discs, can also affect the facet joints. 

With age, the spinal discs lose strength and hydration. This can make the discs flatten out. As a result, the facet joints may become misaligned, leading to back pain. 

Trauma

Although it’s more common in the cervical and thoracic spine, lumbar facet joint pain can be triggered by trauma. The trauma of a sudden impact, (from a car accident, sports injury, etc.) can affect the lumbar facet joints and cause lower back pain. 

How is Lumbar Facet Joint Pain Treated?

Multiple treatment options can help relieve lower back pain and stiffness from lumbar facet joint disorders. Generally, doctors recommend a non-surgical treatment plan to start. 

Non-Surgical Treatments

Non-surgical treatment options for lumbar facet joint pain include:

• Heat and cold therapy

Heat and cold therapy are at-home treatments that can offer relief from symptoms of lumbar facet joint pain. 

• Heat therapy helps relax tight lower back muscles and promote blood flow to the lumbar spine. 
• Cold therapy can help relieve painful flares of facet joint pain by making the blood vessels contract. This numbs the pain, and when the cold pack is removed, blood containing oxygen and healing nutrients will rush to the affected area. 

• Activity modifications

Avoiding activities that exacerbate facet joint pain is recommended for recovery. These activities may include long periods of sitting and repeatedly bending the spine. 

• Low-impact exercise

While certain types of physical activity can worsen facet joint pain, it’s important to stay active (in moderation). Remaining sedentary can diminish the tissues in the lower back, leading to worsened pain.

Short walks, water aerobics, and using an elliptical machine are examples of low-impact exercises that can support your facet joint pain recovery. 

• Medications

Your doctor may recommend over-the-counter and/or prescription pain medications to treat lumbar facet joint pain. NSAIDs, acetaminophen, antidepressants, and muscle relaxants are all examples of medications that can provide lower back pain relief. 

• Physical therapy

A physical therapist can help you overcome lumbar facet joint pain with stretching, strengthening exercises, and manual therapy. These methods can help relieve muscle tension, support spinal stability, and improve the alignment of the spine. 

• Injections

Epidural steroid injections may be used to decrease inflammation in a diseased facet joint. While this is often an effective method for pain relief, doctors typically limit the number of injections that you can get per year. Excessive steroid injections can lead to tissue damage. 

Lumbar Facet Joint Replacement Surgery

If lumbar facet joint pain doesn’t respond to several months of non-invasive treatments, surgery may be recommended. 

Surgery for lumbar facet joint pain typically involves replacing the damaged facet joint with a spinal implant. This process, commonly known as lumbar facet joint replacement surgery, can relieve pain and stiffness in the lower back. 

Lumbar facet joint replacement has proven to be a long-term solution for spinal conditions, including lumbar spinal stenosis and degenerative spondylolisthesis.  

The Steps of Lumbar Facet Joint Replacement Surgery

In lumbar facet joint replacement surgery, the surgeon will first access the spine. Then, the damaged facet joint is removed. 

Next, a spinal implant, such as the TOPS System, is implanted at the site of the diseased joint. This is usually at L4-L5, L3-L4, or L2-L3.  The implant stabilizes the spine while allowing the patient to retain full spinal flexibility. 

After lumbar facet joint replacement surgery with the TOPS spinal implant, patients can usually return to their regular activities within just 4 to 6 weeks. 

Facet Joint Replacement vs. Spinal Fusion

Facet joint replacement surgery is an alternative to facet fusion surgery. Fusion involves fusing the vertebrae in the painful region of the spine together, forming a single bone.

While spinal fusion relieves facet joint pain, it does so by preventing motion in the spine. So, patients can’t bend, twist, and move as they used to after fusion. 

Facet joint replacement stabilizes the spine and relieves facet joint pain without preventing spinal motion. This allows patients to quickly return to their favorite activities soon after the procedure.  

To learn more about the TOPS spinal implant for lumbar facet joint replacement, contact Premia Spine today. 

Does Medication Reduce Back Pain?

Most back pain improves with a few weeks of self-care, including over-the-counter pain relievers, ice, heat and taking care not to lift heavy items or work out too vigorously.  It also helps to get some mild exercise and movement into your day, rather than lying down and staying still for too long – which can make back pain worse. But if these self-care methods don’t relieve your back pain after a few weeks, you should consult with a back pain specialist to improve your symptoms with medications.

The most common first steps in pain-reducing medications is your doctor’s recommendations of acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve). Both of these types of medications are effective at relieving back pain, often within a very short period of time after taking them. Always take these medications as directed by your doctor, because overuse can cause serious side effects.

If over-the-counter medications don’t relieve your back pain issues, including secondary pain such as sore hips from compensating for your stiff or painful back, your doctor may also prescribe a muscle relaxant. While muscle relaxants will often lessen back pain, they can cause side effects like sleepiness and dizziness, so you should take them only when you’re done driving for the day, and when you can relax and let the medication ease your pain. Do not take muscle relaxants when you’re at work or if you have to make important decisions, cook, or conduct any other tasks that require focus. Save them for when you’re truly free of all items on your to-do list, and be sure someone is available to care for your kids and pets. Some people are more sensitive than others to the effects of muscle relaxants, and you may be among those who cannot function safely while on a particular type of back pain medication.

Your doctor may also prescribe to you narcotics, such as codeine or hydrocodone, which should be used only for a short period of time and with close supervision by your doctor. Take these medications only as prescribed.

Interestingly, some back pain patients experience relief for chronic back pain from low doses of certain types of antidepressants — particularly tricyclic antidepressants, such as amitriptyline.  You may not feel depressed, or show other signs of depression, but this is among the arsenal of pain-relieving medications that your doctor may consider for you.

Lastly, cortisone injections for back pain are also an option. These anti-inflammatory injections are delivered to the space around your spinal cord (like an epidural is administered during childbirth.) Your doctor might inject cortisone into the facet joints of your vertebrae, decreasing inflammation in those areas that may be the cause of back pain and allowing your spine to regain fuller range of motion and stability. A cortisone injection helps decrease inflammation around the nerve roots, and you might experience back pain relief for up to a few months after your injection.

Ask your doctor about which medications may be ideal to relieve your back pain, and ask for information on possible side effects, as well as – importantly – how long you should take each type of medication suggested or prescribed to relieve your back pain.

Common Questions About Back Pain: What are the Different Types of Back Surgery

There are several different types of back surgery proving successful at resolving patients’ back pain issues, each involving the highest level of surgical technology available today, as well as the skill of a board-certified spinal surgeon. If your spinal specialist advises back surgery, you’ll embark upon a learning process about the different available back surgery procedures – guided by your physician. You always want to get your information directly from your spinal surgeon, since back surgery information online can be outdated or incorrect, and Googling back surgery topics can sometimes cause unnecessary anxiety.   The best course of action for researching back surgery procedures is to prepare a list of questions for your surgeon, and request all of the back surgery literature possible that your doctor can provide you with so that you can fully understand what will be done during your surgical procedure.

Overall, back surgery can accomplish several different pain-relieving goals, including removing portions of the bone to widen the narrowed area in your vertebrae, which can cause back pain. Your spinal surgeon may remove the gel-like middle section of a ruptured disc to relieve pressure on pinched nerves in the back. And sometimes, the damage to a disc is so severe, your doctor has to remove the entire disc and then fuse together the remaining discs.

Below is a list of some of the different types of back surgery that may be the customized choice for your back damage or condition:

• Discectomy. In this type of back surgery, your spinal surgeon will remove the herniated portion of a disc to relieve irritation and inflammation of a nerve.
• Laminectomy. This back surgery procedure involves removing the bone overlying the spinal canal, which then enlarges the spinal canal to relieve nerve pressure caused by spinal stenosis.
• Fusion. Spinal fusion permanently connects two or more bones in your spine. When the vertebrae are fused, you get added stability to your spinal movements, or relief of pain from a spinal fracture. Occasionally, spinal surgeons will opt for spinal fusion to eliminate painful motion between vertebrae that can result from a degenerated disc or injured disc.
• Vertebroplasty. During this type of back surgery, your surgeon will inject bone cement into compressed vertebrae to stabilize fractures or compressed vertebrae, which can relieve pain. A balloon-like method may be used to expand the vertebrae area, allowing your surgeon to inject the bone cement into the treatment area for optimal results.
• Artificial discs. Your spinal surgeon may find that your discs are in an advanced stage of degeneration, and that implanted artificial discs are necessary for the creation of a spine that functions better and without compression to the nerves. Artificial disc technology is advancing every day through rigorous studies and testing, and your surgeon can introduce you to the materials and information about having new discs implanted for your spinal pain relief.
• TOPS (Total Posterior Spine) System.  A mechanical implant device that stabilizes the spine without eliminating the independent motion of the individual vertebrae, as spinal fusion does.

Since back surgery is a complex procedure, work with your spinal surgeon to explore all your options.  Every situation is different and you need to feel secure that you have fully researched which type of back surgery would be best for you, and if back surgery is necessary at all. And of course, your doctor will guide you through all the information you need regarding recovering from back surgery and what you can expect for your post-surgery lifestyle.

reference: www.mayoclinic.com

Common Questions About Back Pain: Do You Need Back Surgery?

If you’re experiencing ongoing or severe back pain, you’re likely wondering if you’ll need back surgery to finally rid yourself of that constant back ache or debilitating back pain. The answer will come once your spinal surgeon assesses your back pain or back injury symptoms, and takes a full medical history, to review your general health level and medical issues.  But before you panic, keep in mind that back surgery is generally needed only in a small percentage of back paincases. Most back pain can be resolved by a range of non-surgical options that can keep you off the operating table and have you feeling better soon.  Some of these are as the application of ice or heat, anti-inflammatory medications, physical therapy, and massage.  Changing your diet with the goal of losing weight can also help take pressure off the nerves in your back and once the initial discomfort is lessened, exercise can also provide non-surgical relief.

However, when conservative treatments don’t help, back surgery may be your physician’s advice.  This is often the case when your doctor is seeking to get you relief from back pain that’s limiting your lifestyle, interrupting your sleep and preventing you from being active and at your best.

Here are the symptoms and conditions that might mean back surgery would be an optimal solution for you:

• If you have a back injury or condition that causes compression to your spinal nerves, causing debilitating back pain or numbness along the back of your leg.
• If you have a bulging disc or ruptured (herniated) discs, which means the the rubbery ‘cushions’ separating the bones in your spine aren’t at their best and are causing discs to move without the cushioning they need.
• If you have fractured vertebrae or other damage to your spinal column from a back injury. A fractured disc will cause pain, and also leaves your spine unstable, often causing additional back pain.
• If you have fractured vertebrae or other spine issues such as osteoporosis.
• If your prescribed conservative remedies including medication and physical therapy for back pain aren’t bringing you relief, and you’re still suffering from back pain and other systems after a longer-than-usual amount of time.

You may also be diagnosed with a condition that causes back pain and additional progressive nerve compression:

• Scoliosis, a curvature of the spine that can compress nerves in the back
• Spinal stenosis, a narrowing of the spinal canal typically caused by arthritis
• Spondylolisthesis, the forward slippage of a segment of the spine
• Degenerative disc disease, the development of pain in a disc as a result of its normal wear and tear over time
• Radiculopathy, the irritation and inflammation of a nerve caused by a herniated disc
• Kyphosis, a humpback deformity
• And other degenerative disc conditions

Your spinal surgeon’s primary goal is to eliminate your back pain and to return your quality of life.  When a progressive condition is diagnosed through testing and examination, back surgery may certainly move to the forefront of your surgeon’s mind.  It is their job to consider your best and personalized options for ridding you of back pain before your current condition deteriorates further.

http://www.mayoclinic.com/health/back-surgery/HQ00305

Types of Back Pain

Back pain is one of the most complex and confounding conditions in medicine. There are several types of back pain, typically classified by their cause, and these pains may have their origins in back muscles, ligaments, in the spine, or even as a result of health problems in other parts of the body.

Muscle strains are the source of many cases of back pain, usually caused by overuse, such as engaging in strenuous activities to which your body is not accustomed. Symptoms of muscle strains include muscle weakness, inflammation, cramping and muscle spasms. These strains can result in severe lower back pain, but the pain remains localized, and does not radiate down to the legs.

Ligaments, which bind bones together, can also cause pain when sprained. Symptoms of ligament sprains are similar to muscle strains, but take longer to heal – between six to eight weeks and several months. If not allowed to heal properly, ligament sprains can give rise to chronic back pain.

Pain due to spinal problems is a common form of back pain. It often results from pressure exerted on spinal nerves – a condition commonly called a pinched nerve – due to degeneration, injury, or illness affecting the spinal column. A pinched nerve causes localized pain similar to a muscle strain, but may also involve other parts of the body. Pinched nerves in the lower, or lumbar region of the spine, can cause burning lower back and leg pain, and also affect the bladder, appendix, large intestine, sex organs, knees and prostate. Simple rest, medications, and physical therapy are among the beneficial non-invasive approaches to alleviate back pain in these cases. Even serious spinal conditions such as spinal stenosis and associated degenerative disc diseases that have condemned generations to sometimes crippling pain and restricted mobility, can today be effectively treated with advanced microsurgical procedures such as laminectomies and other forms of spinal decompression surgery. Spinal fusion back surgery has usually been performed immediately following spinal decompression, in order to stabilize the affected portion of the spine. Though decompression spinal surgery can dramatically alleviate pain and other symptoms of compressed or pinched nerves, the spinal fusion eliminates the independent motion of the fused vertebrae. Today even this limitation has been surmounted. The TOPS™ System from Premia Spine provides a clinically proven superior alternative to spinal fusion that preserves the full, independent motion of each vertebra.

If you’re experiencing back pain, remember that though the condition can have a variety of causes, a qualified physician can offer many effective treatment options.

Causes of Back Pain in Men

Back pain affects people of all ages and both genders. But the gender most affected by back pain is men. Men are especially prone to traumatic back pain due to engagement in physical activities at work and play, such as heavy lifting, prolonged sitting, and inconsistent exercise (i.e., the weekend warrior). These activities carry a greater risk of injury to the spine and to the ligaments that support the spine. Accidents, sports injuries, and actions as simple as improperly lifting a heavy object or twisting the back awkwardly when reaching for something can all be responsible for trauma injuries. Even spinal injuries that occur in childhood can manifest in later years, providing a painful reminder of long-ago trauma. The physical stresses and strains on the spine to which men are subjected can also accelerate and exacerbate the onset of spinal conditions such as degenerative disc disease.

If you’re concerned about a back condition that’s causing you pain, remember that the great majority of cases of back pain in men involve muscle trauma or other strains or minor injuries that resolve on their own with rest and proper care. If back pain persists, a qualified medical specialist can identify the problem, and a variety of effective treatment options are likely available. Even serious spinal conditions such as degenerative disc diseases and spinal stenosis can be effectively treated. Spinal decompression surgery, for example, can relieve pressure on spinal nerves, dramatically reducing pain and associated symptoms. And today, patients no longer need to surrender the full range of spinal motion to benefit from decompression spinal surgery. Whereas spinal fusion back surgery was routinely performed in conjunction with decompression spine surgery, now the TOPS™ System alternative enables spinal decompression patients to maintain their full range of spinal motion. Instead of fusing adjacent vertebrae at the point of the decompression surgery, the TOPS System implant allows each vertebra to maintain independent flexion and lateral motion.

Men may be more prone to back pain than other groups, but today a variety of effective treatment options can provide relief for even its most serious forms.