The Operation

How long does the surgery take?

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 incision is made at the front of the body through the lower part of the abdomen with the patient lying 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 and another few centimetres above this for the L4/5 disc. The incision can be as little as 5 or 6 cm (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 affected 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 are 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 trial implants and X-ray control. Once the trial has been positioned, it then acts as a guide for the surgeon to make carefully placed cuts in the vertebrae which the keels of the implant endplates will rest on. At this stage the disc replacement itself can be inserted: first the trial is removed and then the artificial disc is mounted on an introducer. The implant is carefully positioned in a progressive manner, checking with X-ray control at each step.

The following short video shows each step in the procedure.

M6-L Surgical Technique

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