Total Disc Replacement (TDR) in the lumbar spine

Why is TDR performed?

TDR in the lumbar spine is an alternative to treat chronic low back pain caused by degenerative disc
disease in one or more inter-vertebral discs. (Fig.1)

Fig. 1. Diskdegeneration

What is done during TDR?

The procedure is done through a skin incision in the abdomen, and reaches the spine from front. The
painful disc is removed and replaced with an artificial disc. Below different brands of prostheses are
shown and X-ray pictures of postoperative control.

How well might I be after the treatment?

The result is highly dependent on how much effort you put in muscle stretching and exercise both
before and after the operation. It is also crucial that you follow instructions for your posture
postoperatively. 86% of our patients report to be much better or totally pain free after TDR. The rest
of the patients are spread between better, unchanged or worse.

What is most important for me to considerer after the treatment?

Regardless of the number of segments treated, it is important to realize that due to the approach
through the abdomen, the structures binding the front of the vertebras together is weakened. As a
result of this you will experience a reduced ability to avoid extension (backward bending) in treated
segments for a prolonged period of time. You will be instructed to change your posture to avoid the
risk of harmful extension during this time. It is very important that you adhere to this even after you
have fully recovered from the surgery and is back in your normal life.

Are there any risks involved in this kind of treatment?

Yes, as is the case with all surgical procedures, also spinal surgery involves risks. Even if the risks
with this type of treatment are small, there are no guaranties against complications. The general risk
for an infection of the wound after spine-surgery is 1%, major bleeding 0.1%, lower extremity
thrombosis 0.1-1% and any nerve affection 2-3%.
These risks seem reduced when TDR is performed, but instead a specific risk exists. This risk is the
affection of the sympathetic chain, that runs at each side of the frontal spine. This net of tiny nerves
might be stretched during surgery or affected by local swelling postoperatively. An affection of some
of these these nerves is usual recognized as a feeling of an increased temperature in one foot and
less sweating of that foot. If these symptoms occur they are almost always transient, but might
persist several months. Other nerve affection after TDR surgery is extremely rare, but might be
numbness, weakness or pain, and also this almost always transient.
Prophylactic antibiotics, that are administrated intra-venous to all patients before and after surgery
aim to reduce the risk of infection.
Prophylaxis against thrombosis is achieved pharmacologically and through early mobilization and inbed exercises.

What will happen once I am through surgery and how long will I be in bed?
The first couple of hours you will spend in the recovery ward. You will be instructed/helped spend this
time laying with flexed hips. In the afternoon you will get out of bed shortly to stand and walk a little,
but with an assisting nurse the first couple of times. From this on you are allowed to move freely with
the limitations that the wound-pain might produce, but have to avoid extension of your back (see
above). You will be encouraged to be out of bed, preferably walking as much as possible. The first
times you might appreciate a support, but walks along our corridors is part of your rehabilitation and
will add to getting you bowel working. You will also be free to eat and drink as soon as you want after
surgery. During surgery, you will receive a urine-catheter that is removed the morning after the
operation. The first day after surgery plain X-rays are taken.

Nonsurgical Treatment of Scheuermans disease

Treatment for Scheuermans disease depends on the individuals situation. Several factors determining the
best treatment include:

Severity of the curvature in the back

Amount of flexibility in the area

Whether the individual is expected to continue to grow

Concerns about appearance

Patient preferences

In considering treatments for Scheuermanns disease, its helpful to understand the anatomy of the upper
back, or thoracic spine. Human spines are designed to curve, but if the curvature reaches 45 degrees or
more, its considered abnormal. Allowing an abnormal curvature to continue could cause considerable pain
and disfigurement over time.

Observation and Bracing

A young person with a slight curvature who is still growing, shows no sign of the curvature worsening, and has
mild or no pain may not require intervention. Instead, the individual could be monitored by a doctor and
undergo periodic X-rays, or other tests, to track the curvature. If the curvature worsens, more active treatment
would be recommended.
A patient with a more advanced curvaturebut with more than a year of growth leftwould typically receive
more intensive treatment. A back brace would usually be prescribed. Braces can stop or reverse the extra
curvature during the growing years by making the front of the vertebrae more upright, which may also reduce
pain.
To be most effective, braces should be worn almost all the time, at least at first. Depending on the severity and
progression of the curvature, patients may be prescribed a brace for one to two years. Braces can be helpful
with curvatures of up to 75 degrees. At one time, braces were thought to be ineffective once spine growth was
complete, but recent research indicates there is still a good chance of success after growth has ended.1
While braces were once considered bulky and uncomfortableand often rejected by self-conscious teens
the situation has improved considerably and braces have become less obtrusive and more lightweight. Some
of these custom-molded braces can be worn undetected under clothes and allow the young person to take
part in activitiesincluding many sports.
Many doctors now recommend these kinds of braces, including the kyphologic and thoracolumbosacral
(TSLO)-style Boston braces, over the older, larger Milwaukee brace.2