Dr. Rick Delamarter

I am taking a day off work to drive up to L.A. for this appointment to discuss lower back pain, disc replacement, etc. (Spine Institute 1304 20th Street #400 Santa Monica, CA 90404)

First I met with Delamarter's nurse assistant Cheri Phillips who did all the usual tests (e.g., walk on heels and tiptoes; lean forward, back, and side-to-side; check reflexes, etc.) We then discussed my symptoms and history for awhile, then she left and returned shortly with the doctor.

Delamarter was very knowledgeable, professional, competent, and confident -- all good things I would want in the surgeon who might end up performing back surgery on me. He pretty much cut to the chase and after going over my imagery with me (and quickly realizing that I was more educated than most patients) he proclaimed that he wanted to do a 2-level disc replacement. The fact that he wanted to perform a disc replacement was no surprise, but doing a 2-level was. It does make sense though as my L5/S1 is pretty much gone, and the L4/L5 is starting to go. And, as he said, why replace one and then have to go in and do the second one shortly thereafter? Why not do them both at one time? If the L4/L5 is going to continue to deteriorate (something which I had not really allowed myself to consider) then it's probably the right call. He mentioned in passing that he had just been at a conference in Miami where he presented a paper on the results of 2-level disc replacement compared to 2-level fusion, and his conclusions were that the 2-level replacement was clearly superior, even significantly better than the 1-level vs. 1-level comparison.

Pointing at a plan view of my vertebra, he said that the one major concern was the status of my left facet joint which was showing noticeable arthritis and could worsen. Apparently if it gets bad enough, then that could rule out the disc replacement procedure and leave fusion as my only option. However, he said that an artificial disc could potentially arrest the worsening arthritis.

After Delamarter's spiel began the disc replacement Q&A process for which I had thankfully prepared by earlier writing down several questions. First off was the short-term recovery. He said the patient spends 2-3 days in the hospital although can walk almost immediately. Patient is off of work from 1-2 weeks, although some people need 6-8 weeks to recover sufficiently (knowing doctors and my prior knee surgery experience, I imagine the latter to be more accurate). He said that patients are able to resume full activity (including basketball!) after a few months of rest and physical therapy (core strengthening).

Next, I asked about the long-term prognosis. As I well knew they've only been doing the procedure for 5-6 years here in the US of which he was part of the initial study and has thus been doing them as long as anybody here in this country. According to Delamarter, they've been doing them for approx. 18 years in Europe but he says their data collection is not as reliable. He has had disc replacement patients with 6 years and counting who are experiencing no problems. I asked if the disc replacement was good for life (saying I planned to live another 40-50 years, ha!) and he said that the disc design looks good to last that long, but who really knows? I asked if there had been any problems with the artificial disc? in the body and he went down my list and said "no" to each concern: failure, breakage, subsidence, expulsion / rejection, deterioration.

I was curious about how experienced? he was doing disc replacement. He flatly stated that he had done more disc replacements than anyone else in the US. In all, he has done almost 1,000 procedures including around 700 on the lower back. He claimed a success rate of 90% saying that only 1 in 10 patients had continuing significant symptoms (i.e.: pain) after the disc replacement. (the nurse had previously mentioned a success rate of 95%)

Next I asked him to discuss risks of the procedure. I had heard from other doctors that coming in from the front could present problems due to the presence of large (femoral) blood vessels. He said the risk was less than 1% and that he had an excellent team of doctors to assist in the operation. I asked him about the risk of infection, and as he knocked on the table said that he had never had a problem and the risk was less than 1%.

I wanted to hear about the risks of waiting or not getting the procedure. He said that my arthritis and/or bone spurs could worsen and probably would although the time frame was unknown. Things could get worse in anywhere from 6 months to 10 years but eventually disc replacement might become a non-option whereupon a fusion would be the only possibility. I asked about spondylolisthesis which I had read in a paper as being something that could preclude disc replacement. He said that referred to lateral slipping of the vertebrae and that I did not show significant signs of this problem (certainly less than Stage 1).