Lumbar disk replacement substitutes a worn or degenerated disk in the lower part of the spine with an artificial disk made of metal or a combination of metal and plastic. The goal of the procedure is to relieve lower back pain while, at the same time, maintain normal motion for patients. Robert F. McLain, M.D., a spine surgeon at the Spine & Orthopedic Institute at St. Vincent Charity Medical Center, is a specialist in this advanced surgical procedure. 

Dr. McLain was featured among three “Champions of Care” in the January 2020 issue of Cleveland Magazine for the life-changing surgery he performed on Akron firefighter and paramedic Steve Arce. The text of Steve’s story is below. The full article is available here.

Akron firefighter and paramedic Steve Arce was taking 3,200 milligrams of ibuprofen daily to manage extreme lower back pain, but this triggered stomach ulcers. “I felt like I was my grandpa,” he quips, sharing how he’d wake up an hour earlier just to get moving in the morning.

But it was pain that the 38-year-old worked through, no matter what. “I just kept going,” says Arce.

What began as lingering back pain a few years ago compounded.

Eventually, a disc in his lower spine had deteriorated completely and his lower vertebrae were fusing together.

“I played this cat-and-mouse game where I’d work a 24-hour shift, I’d be in pain, then I’d be off for 48 hours,” Arce says. “I’d come home and do nothing the next day, and by the second day I was a little better. I tried to be in the gym to strength train, but it hurt really bad.”

The pain got so bad that after lifting weights one day, he made an appointment. “After an MRI, the doctor said, ‘I can’t send you back to work,’ ” Arce recalls.

This crushed him. He petitioned for light duty and was scheduled in the office, a major downshift from racing to fires and working in the trenches of medical emergency.

In the meantime, Arce considered surgery options. Nearly 80% of American adults experience lower back pain at some point, according to the National Institute of Neurological Disorders and Stroke. Most recover with nonsurgical treatments. Arce was not in that camp.

He knew other firefighters who had gone through spinal fusion surgery, which permanently joins two vertebrae, fusing the spine into alignment. But that can limit range of motion.

Because he wanted to be able to pursue an active lifestyle, Arce looked into an alternative: lumbar disk replacement, which substitutes a worn or degenerated disk with an artificial disk. It alleviates lower back pain while allowing for normal range of motion.

Arce consulted with Dr. Robert McLain, a spine surgeon at St. Vincent Charity Medical Center, who was one of the principal investigators in early FDA trials for the procedure. 

“Steve was a really good candidate for lumbar disc replacement because he is a young, fit, healthy man who might have been impaired by the stiffness of a spinal fusion,” McLain says. “He was still mobile yet had bad back and disc-related pain.”

That pain felt like a “direct pinch” in the tailbone that ran down Arce’s left leg, often all the way to his ankle. “I’d go numb and my leg would give out,” he describes.

“Plenty of times, I’d be carrying a patient out of a house and we’d get over to the cot, and I’d drop to my knees and feel like I was seeing red,” Arce says. “I wanted to vomit the pain was so bad, and it came from certain movements I could not predict. Especially with this job, you’re never doing anything in a normal, orderly fashion. It’s, ‘Let’s figure out how to do this and get it done.’ ”

In patients who qualify for the surgery, they can achieve full range of motion and sustain vigorous athletic and work activity following the procedure compared to fusion patients, who often must wear a brace for six to 12 weeks before they can bend over as they wait for the fusion to occur, and many will not return to work for up to three months post-surgery.

“You can get back to activity faster [with lumbar disk replacement], and limitations are less since you don’t need to wait,” McLain explains.

If disc replacement is an option, McLain encourages patients to consider it, saying it’s worth getting a second opinion to learn whether the procedure is a solution for back pain.

For Arce, after a few days in the hospital for surgery, he returned home and began working with a physical therapist immediately. He stayed on light-duty at work for six months, then returned to the field. He runs at least three miles every other day, and focuses on strength training and balance exercise.

“I’m back on a big, red firetruck,” he says. “I feel like a new man.”

Robert F. McLain, M.D., a spine surgeon in the Spine and Orthopedic Institute at St. Vincent Charity Medical Center, has more than 20 years of experience in disc replacement surgery, and has served as an instructor and educator in disc replacement surgical training, as Principal Investigator for an FDA cervical disc replacement clinical trial, and provides both lumbar and cervical disc replacement to carefully selected patients who need those procedures. To schedule a consultation, call 440-248-1297.