Lumbar Artificial Disc Replacement: D.N.

D.N. is a 36 year-old male with nearly 20 years of progressive low back pain. He loves to mountain bike and hike but his progressive low back pain was preventing him from doing these activities that he enjoys. This pain was likely from a degenerative disc at L5-S1. He then had a disc herniation at L5-S1 that caused radiating pain down into his buttock, thigh and leg into his foot, which prompted him to undergo a microdiscectomy that temporarily improved his leg pain. However, his pain returned and worsened and his low back pain also worsened. He was unable to mountain bike and hike and even had difficulty doing regular daily activities such as sitting and driving. He had failed all non-surgical treatments including physical therapy and injections. We therefore made the decision together to treat him with an anterior lumbar discectomy and artificial disc replacement.

Pre-surgical XRAYs of the lumbar spine showing extensive collapse of the L5-S1 disc. His other disc spaces look well maintained. Prior to deciding to perform an artificial disc replacement I performed extensive analysis of imaging, making sure that his pelvic tilt and pelvic incidence were not too great to prevent successful outcome after an artificial disc replacement.

Pre-surgical CT scan of the lumbar spine confirms near complete collapse of the L5-S1 disc. I also use a CT scan to evaluate the facet joints. This is an important thing to look at when deciding whether a patient is an ideal candidate for an artificial disc replacement.

After surgery he was discharged from the hospital one day after surgery and was walking well. By his 6 weeks post-surgical visit he was off all of his pain medications and walking 3 miles per day with minimal back pain and no leg pain. At 3 months post-op he reports that for the first time in 15 years he has zero back pain and no leg pain. He is back to participating in long hikes and is back on his mountain bike. Although not every patient achieves this kind of amazing result, this case highlights how an excellent outcome with an artificial disc replacement can be truly life-changing!

Post-operative XRAYS show optimal placement of the Aesculap ActivL artificial disc at the L5-S1 level and good motion during flexion and extension bending.

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