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The operation normally takes about two hours for a single level disc replacement and about three and a half hours if two discs are being replaced.
Where is the incision made?
The operation is done from the front, through the lower part of the abdomen, the patient being placed on his or her back. The incision may be horizontal or vertical and its position will depend on the level of the disc being replaced. For the L5/S1 disc it is usually a little above the top of the pubic hair line but a few centimetres above this for the L4/5 disc. The incision can be as little as 5 or 6 cms (2 inches) in a slim patient.
What happens during the procedure?
After making the incision the anterior abdominal muscles (the ‘six-pack’ muscles) are separated and the peritoneal sack, containing the abdominal organs, carefully moved to one side. A marker is placed on the disc and an x-ray obtained to confirm the level where the disc replacement is to be inserted. The large blood vessels in front of the spine are then carefully moved to give the necessary access to the disc.
The central section of the disc is then removed and the vertebrae spread apart to allow access to the very back of the disc which must be carefully cleared away to ensure good movement of the artificial disc.
The appropriate size and lordosis of the disc replacement is then determined using x-ray control, which is also used to ensure very accurate placement. This is an important technical step which we know affects the long term functioning of the disc replacement.
The endplates are inserted into the disc space, being pressed home and held in position by the protruding teeth and the inherent pressure of the spine. Placement is meticulously checked, millimetre by millimetre, as the disc replacement is inserted. Once in place the core is inserted and a final check of the prosthesis is made.
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X Ray of Disc ReplacementTo minimise the risk of a deep vein thrombosis (DVT), which is the formation of a blood clot in one of the deep veins in the leg, you will be provided with special elasticated stockings. When you are resting in bed you will be fitted with A-V impulse boots and we will ask you (and remind you ) not to cross your legs and to do special foot exercises.
All these measures help to reduce the chance of a thrombosis forming, as will walking which is another reason we encourage you to get up and start mobilising quite early.
The position of the disc replacement will be checked very carefully under x-ray control during the operation but a check x-ray will be obtained, usually the day after your operation.
Once you are comfortable and happy with your ability to get around you are about ready to go home. This is usually by about the third or fourth day after your operation. By this stage you will be safe to sit, walk and travel in a car for moderate periods.
Will I need a brace?
No, there is no need for a brace after disc replacement.
What will my convalescence involve after leaving hospital?
The Surgical Wound The clips are removed once the wound has healed, usually at nine days after your operation. This is not uncomfortable and is very simple. You can either come into the hospital or we can arrange for your district nurse to remove the clips for you at home.
Activity and MovementActivity and Movement You will need to continue with your programme of active home exercises and supervised physiotherapy after your discharge from hospital. This will usually involve attending the physiotherapy department about twice a week, either at the Nuffield Hospital Hampshire or locally to your home. Initially your physiotherapist may use treatments to help settle soreness and muscle spasm and bruising from the operation. Regular walks are also helpful. You will be taught what to do to protect your back and how to position yourself when you sit or lie down. Quite soon you will move onto more active treatments to build up your strength and improve your flexibility. It can be quite daunting when you first start gentle bending. Working steadily on both strengthening and movement exercises will soon instil confidence and gain flexibility. Endurance exercises such as treadmill walking and static cycling further help muscle strengthening. Our physiotherapy department has developed a detailed protocol for treatment after disc replacement and are always happy to discuss this with your own physiotherapist.
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