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Prodisc Total Disc Replacement

What is Prodisc ?

The Spine Solutions “Prodisc” is an artificial disc specifically designed to replace
a degenerated disc in the lumbar spine. It serves to restore normal dynamic
spinal function, stability and range of motion. It also aims reduce the effects of
disc disease and to minimise or remove the pain source associated with this
common condition. Prodisc has been implanted in more than 3,000 patients
worldwide with a proven history of success using evidence based clinical
outcomes.
 

Clinical Background
 

Degenerative Disc Disease (DDD) is a gradual spinal disease process that compromises the spine as people become older. It generally starts in the 30’s
and continues to become worse with age. It can also be caused by injury to the spinal column or other related factors. The general symptoms may include chronic
low back pain, acute low back pain, pain radiating to the legs or weakness in leg muscles. Roughly 75% of all adults will experience back pain but only 1-2% will
ever require surgery for their back pain. A degenerative change in the lumbar
spine (in the lower back) typically causes changes in the structure and normal function of the spine. The lumbar spine is made up of several vertebrae and
between each of these vertebrae are cartledge-like discs that serve as shock absorbers. With time, an ageing disc (or more than one disc) will lose its resilience and height. This loss of height and ability to withstand normal weight bearing
loads usually leads to impingement of nerves by surrounding joints. It also can
lead to rupturing of the disc and potential spinal instability.

Treatment options for DDD

The general course of treatment for DDD starts with conservative management
such as short term bed rest, medication analgesics and anti-inflammatory drugs), physiotherapy, physical therapy, and other nonsurgical therapies. If symptoms
do not respond to these types of treatment over the long term (usually at least
6 months), then surgical intervention is usually considered as the next step.
There are various surgical options for the treatment of DDD. In order of their invasiveness these interventions include minor procedures such as intra-spinal injections to limit pain, partial or complete disc removal (discectomy) , total disc replacement (disc arthroplasty) and spinal fusion surgery. In fusion surgery a scaffolding is implanted to “fuse” the affected section of the spine. Fusion is the
last resort (and the most invasive) in the treatment cascade and its long term
success is largely open to debate.

Fusion is still a widely used treatment for many patients but for some patients
disc arthroplasty may be a more appropriate choice. By now you will have been diagnosed by your surgeon and it has been decided that you are a good
candidate for total disc replacement.

Total Disc Replacement with Prodisc

Total disc replacement with the Prodisc artificial disc represents a revolution in
spinal surgery outcomes for patients. Surgeons have been waiting many years for this proven technology to become available for patients. The main goals of total
disc replacement are to restore the normal range of motion in the spine, to re-establish stability in the spine and to minimise the painful effects of disc degeneration.

How is the procedure done?

The surgical procedure usually takes around 2-3 hours and will require a general anaesthetic. The PRODISC technique approaches the affected spinal level from
the front (i.e. your lower abdomen). A small 7cm incision is made here to allow
exposure to the spine. The disc material at the level to be replaced is carefully exposed and removed. The Prodisc artificial disc is then implanted between the vertebrae at the affected level in your spine. The Prodisc is essentially a ball
and socket joint that is designed to restore disc function, the geometry and
motion of the lumbar disc.

Pre-Operative Instructions

Smoking is prohibited for 4 weeks before your operation and for 12 weeks after surgery. Research suggests that smoking decreases bony ingrowth into the
metal plates of the prosthesis and adversely affects the overall success of the procedure. Alcohol should be limited as much as possible 1 week before your surgery.

Preparation for surgery

If you are on medications, these may need to be discontinued before your
surgery as the blood thinning agents in them can increase swelling and
discomfort. If you have any questions regarding medications please ask
your doctor. Ensure you have someone you can rely on for support during
your first 2 days at home. You will also need to organise transport home
from thehospital.

1 day before

Fast from the specified time given to you by the hospital. Ensure you have relevant phone numbers you may need. Remove any obstacles in your home that you could fall over. Remember any X-Rays and CT scans that your surgeon does not already have.

What to expect following your surgery

Length of stay
Expect to be in hospital for 3-4 days. This can vary a little depending on how
you feel and the extensive nature of the operation.

Pain
From the time you wake up from the anaesthetic you should feel relief from your back, leg or arm pain. You will however experience pain associated with the operation itself. The recovery staff will observe you closely and ensure that pain relief is available to you if you need it.

Drains
You may have a wound drain that will be removed within 36 hours.

Calf stimulators
You will wake up with compression (massage) devices on your calves. These will
stay on your legs (while in hospital) until you are up walking to reduce the risk of deep vein thrombosis (DVT).

Urinary Catheter
It will be necessary for you to have a catheter while you are asleep. This will be removed once you are up and about. Removal is not painful and takes only a few seconds.

Ileus
During the operation the bowel is retracted to the side. This can cause your
bowel to become a little sluggish for a few days following surgery but this
should resolve by itself.

Your surgeon will set out specific recovery steps for you that you will need to
strictly follow. This will limit your movement in many respects, especially when
lifting objects. The key points being: Bending from the waist is not recommended
for 6 weeks. Lifting anything greater than 5 or 6kg is not recommended for 3 months. Twisting is acceptable as long as it is done in a slow and controlled
manner at all times. You should wait for 6 weeks before driving a car.

Drive for short periods then gradually extend this. Make sure you take regular standing breaks every 45 minutes on linger journeys. Avoid impact type sports
such as heavy jogging, tennis, etc for 3 months. Light walking and swimming are generally good for recovery.

Commonly asked questions

When do I see my surgeon ?
You will be seen in the surgeon’s rooms on about day 10 following your surgery
and again about 6 weeks later to monitor your progress condition.

When can I have a Shower?
You can have a shower the day following your surgery with the help of a nurse.
If your dressing gets very wet just gently pat it dry with a towel do not rub it. If
you have a waterproof dressing, then drying may not be
necessary.

Do I have stitches to come out?
You may have a wound drain in your stomach over night that will be removed
the following day. The stitches are under your skin so removal is not necessary.
When you are seen in the rooms on day 10 your dressing will be removed and
the incision line cleaned.

Is there a certain position that I should be in to sleep at night?
The most important thing is for you to be comfortable. The ideal position is lying
on your back with a pillow under your knees. This however is not compulsory,
so if lying on your side is more comfortable then do so. Avoid extending (arching) your lumbar spine backwards.

How long is it before I can drive a car?
The recommendation is to wait 6 weeks before driving a car. At first only for
short periods at a time then as you feel more comfortable you can increase the driving time.

When can I go back to work?
This is assessed on an individual basis. Generally if you have a physically
demanding job it may take 3-4 months, whereas a less physically demanding job
will take less time.

When is it safe to engage in sexual relations following the surgery?
This is a very personal issue and it is up to you and your partner as to when
you feel ready. Clinically, a 3-4 week period is recommended before you resume sexual activity providing you are the less active partner. Thereafter such activity
has to be in keeping with the above guide lines. NB: It is very important that you
do not arch your back for the first 4 months.

When is it safe to lift / bend / twist at the waist?
Bending from the waist is not recommended for the first 6 weeks. Lifting anything greater than 5-6 kg is not recommended for 3 months and twisting is ok as long
as it is done in a controlled manner at all times.

What are the potential risks with disc replacement surgery?

Potential complications with total disc replacement are few, but it is important to be aware of them before your operation. The risks are similar to those in anterior fusion surgery particularly during the surgical approach to the disc. This is because the surgeon needs to go through muscles and intricate areas of blood vessels adjacent to the spine. Your surgeon will explain to you in more detail the potential complications so that you clearly understand these issues. Your doctor will discuss these potential risks with you before your operation. It is important that you fully understand the possible risks and complications associated with spinal disc surgery.

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