Disk replacement - lumbar spine

定义

腰椎椎间盘置换术是下背部(腰椎)区域的手术. 这样做是为了治疗椎管狭窄或椎间盘问题，并允许脊柱正常活动.

Spinal stenosis is present when:

• The space for the spinal column is narrowed.
• 神经根离开脊柱的开口变得狭窄, placing pressure on the nerve.

选择的名字

Lumbar disk arthroplasty; Thoracic disk arthroplasty; Artificial disk replacement; Total disk replacement; TDR; Disc arthroplasty; Disc replacement; Artificial disc

描述

During total disk replacement (TDR), 受损的椎间盘内部部分用人工椎间盘代替，以恢复脊柱的正常运动.

最常, surgery is done for only one disk, 但有时, two levels next to each other may be replaced.

The surgery is done under general anesthesia. You will be asleep and not feel any pain.

在手术过程中:

• You will lie on your back on the operating table.
• 你的手臂在肘部被填塞，并折叠在胸前.
• Your surgeon makes an incision (cut) on your abdomen. 通过腹部进行手术可以使外科十大赌博平台排行榜在不干扰脊神经的情况下进入脊柱.
• 肠道器官和血管被移到一侧以进入脊柱.
• 你的外科十大赌博平台排行榜会移除椎间盘受损的部分，并将新的人工椎间盘置入原位.
• All the organs are put back into place.
• The incision is closed with stitches.

The surgery takes about 2 hours to complete.

Why the Procedure Is Performed

Cushion-like disks help the spine stay mobile. Nerves in the lower spine area get compressed due to:

• Narrowing of the disk due to old injuries
• Bulging of the disk (protrusion)
• 发生在脊椎的关节炎会压迫神经

手术 脊髓狭窄 如果你有严重的症状，干扰了你的日常生活，并且其他治疗没有改善，可以考虑吗. Symptoms most often include:

• Pain that may be felt in your thigh, calf or lower back. The pain is often deep and steady.
• 在做某些活动或以某种方式移动身体时感到疼痛.
• Numbness, tingling, and muscle weakness.
• Difficulty with balance and walking.
• Loss of bladder or bowel control.

和你的医疗保健提供者谈谈手术是否适合你. Most people with lower back pain do not need surgery. 大多数人首先通过药物、物理疗法和运动来缓解背痛.

During traditional spinal surgery for 脊髓狭窄, 外科十大赌博平台排行榜将需要融合你脊柱中的一些骨头，使你的脊柱更稳定. 结果是, 脊柱融合点下方和上方的其他部位将来可能更容易出现椎间盘问题.

With disk replacement surgery, no fusion is needed. 因此，手术部位上下的脊柱仍能保持活动. This movement may help prevent further disk problems.

如果符合以下情况，您可能需要进行椎间盘置换手术:

• You are not very overweight.
• 只有一个或两个层次的你的脊柱有这个问题，其他地区没有.
• 你的脊柱关节没有很多关节炎.
• You have not had spine surgery in the past.
• 你的脊柱神经没有严重的压力.
  

风险

风险 of anesthesia and surgery in general are:

• Allergic reaction to medicines
• 呼吸困难
• Bleeding, blood clots, and infection

TDR的风险是:

• Increase in back pain
• Difficulty with movement
• 肠道损伤
• Blood clots in legs
• 脊髓周围肌肉和肌腱的异常骨形成
• Sexual dysfunction (more common in men)
• Damage to the ureter and bladder
• Infection at the surgical site
• Breakage of the artificial disk
• Artificial disk may move out of place
• Loosening of the implant
• 麻痹

Before the Procedure

Your provider will order an imaging test such as an MRI, CT扫描, or x-ray to check if you need surgery.

Your provider will want to know if you:

• 怀孕
• Are taking any medicines, supplements, or herbs
• 是否有糖尿病、高血压或其他疾病
• 我吸烟吗?

Tell your provider what medicines you are taking. 这包括你在没有处方的情况下购买的药物、补品或草药.

During the days before the surgery:

• Prepare your home for when you leave the hospital.
• If you are a smoker, you need to stop. 那些患有热带性结核病并继续吸烟的人可能也不会痊愈. Ask your provider for help quitting.
• One week before surgery, 你的十大赌博平台排行榜可能会要求你停止服用使你的血液更难凝结的药物. 包括阿司匹林，布洛芬(Advil, Motrin)，萘普生(Aleve，萘普生).
• If you have diabetes, 心脏病, or other medical problems, 你的外科十大赌博平台排行榜会要求你去看治疗这些疾病的十大赌博平台排行榜，以确定手术对你是否安全.
• 如果你已经喝了很多酒，和你的十大赌博平台排行榜谈谈.
• 询问你的外科十大赌博平台排行榜，在手术当天你还应该服用哪些药物.
• Let your surgeon know right away if you get a cold, 流感, 发热, 疱疹爆发, or other illnesses you may have.
• 你可能想去看物理治疗师，学习在手术前要做的运动.

On the day of the surgery:

• 按照指示，在手术前不要喝或吃任何东西. This may be 6 to 12 hours before surgery.
• 用一小口水服用十大赌博平台排行榜告诉你的药物.
• Your surgeon will tell you when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

You will stay in the hospital 1 to 2 days after surgery. 你的外科十大赌博平台排行榜会鼓励你站起来，并在麻醉消失后开始走路. 你可能需要戴一个束腹支架来支持和更快的愈合. In the beginning, you'll be given clear liquids. You'll later progress to a liquid and semi-solid diet.

Your surgeon will ask you not to:

• Do any activity that stretches your spine too much
• Take part in activities that involve jarring, 弯曲, 手术后至少3个月不能进行驾驶和搬运重物等扭转运动

Follow instructions on how to take care of your back at home.

术后3个月你就可以恢复正常活动了. 

Outlook (Prognosis)

腰椎间盘置换术后并发症的风险较低. 手术通常比其他手术更能改善脊柱的运动。脊柱外科手术). 这是一个安全的过程，手术后疼痛很快就会缓解. 与其他类型的脊柱手术相比，脊髓肌(椎旁肌)损伤的风险较小.

参考文献

Derman PB, Zigler Je, Guyer RD, Blumenthal S, Lieberman IH. Lumbar disk arthroplasy. In: win HR, ed. Youmans and Winn Neurological Surgery. 8日艾德. Philadelphia, PA: Elsevier; 2023:chap 356.

Duffy MF, Zigler JE. Lumbar total disk arthroplasty. In: Baron EM, Vaccaro AR, eds. Operative Techniques: Spine Surgery.3日艾德. Philadelphia, PA: Elsevier; 2018:chap 42.

Gardocki RJ, Park AL. Degenerative disorders of the thoracic and lumbar spine. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14日艾德. Philadelphia, PA: Elsevier; 2021:chap 39.

Johnson R, Guyer RD. 腰椎间盘退变:前路腰椎椎间融合、退变和椎间盘置换术. In: Garfin SR, Eismont FJ, Bell GR, Fischgrund JS, Bono CM编. Rothman-Simeone and Herkowitz's The Spine. 7日艾德. Philadelphia, PA: Elsevier; 2018:chap 49.

齐格勒J, Gornet MF, Ferko N, Cameron C, Schranck FW, Patel L. 腰椎全椎间盘置换术与外科脊柱融合术治疗单节段退行性椎间盘疾病的比较:随机对照试验5年结果的荟萃分析. 全球脊柱J. 2018;8(4):413-423. PMID: 29977727 pubmed.ncbi.nlm.国家卫生研究院.gov / 29977727 /.