Lumbar Hybrid Disc Replacement

Devices are being developed for the lumbar spine to restore the function of all or part of the degenerative disc. By replacing a collapsed, faulty, painful degenerative disc with a mobile artificial disc replacement motion is restored and theoretically adjacent, or nearby disc degeneration can be prevented.

The Lumbar Artificial Disc replacements have been approved for use in one degenerative level by the Food and Drug Administration. However, some patients have multiple levels of lumbar degenerative disc disease (More than one degenerated disc). The hybrid procedure was conceived in efforts to address this subset of patients. A Hybrid Lumbar procedure is any combination of a fusion and an Artificial Disc Replacement in the same spine. Patients who may benefit from a Lumbar Hybrid Arthroplasty usually fall into one of five groups.

  • Patients with more than one contiguous degenerated disc in their spine
  • Patients who have had a prior anterior fusion, and are now developing adjacent level disc disease
  • Patients who have had a prior posterior fusion, and are now developing adjacent level disc disease
  • Patients with more than one degenerative disc at skip levels
  • Patients not interested in multiple level disc replacements

Dr. Pablo Pazmino has combined these new advancements in technology, with arthroplasty concepts and lessons gleaned from his Orthopaedic Arthoplasty experience, and is now applying these towards arthroplasty of the spine. Dr. Pablo Pazmino's Orthopaedic knowledge includes concepts such as modularity, revision surgery, bone-implant interfaces, impingement, wear properties, fixation techniques, porous-coated implants, ceramics, plasma-sprayed implants, and high-density polymer mobile bearing surfaces.

Dr. Pablo Pazmino has presented nationally on Outcomes specifically related to Lumbar Hybrid Arthoplasty in the largest patient series reported to date. Outcomes evaluated by Dr. Pablo Pazmino included when patients returned to work,driving, sports and sexual activities in patients who had the procedure and were followed afterwards. Click here to view the research report.



Lumbar degenerative discs, herniations, or slipped discs, can lead to chronic pain and stiffness in the lower back and buttocks that may radiate into to the lower legs, calves, feet or even toes. Patients may experience some or all of the following symptoms:

  • Lower Back pain (Which may be worse with upright activity)
  • Buttock pain
  • Back stiffness (Which may be worse with certain work activities)
  • Numbness in the thighs, calves, feet and toes
  • Weakness in the legs, thighs, calves, feet and toes
  • Trouble walking because of weakness in the legs or loss of balance
  • Grinding or popping sounds or sensations in the lower back
  • Muscle spasms (Which may originate from the back or lumbar paraspinal muscles)
  • Headaches
  • The condition can cause irritability, fatigue, and sleep disturbances
  • This may impair the ability to work or your daily activities.


During your consultation, Dr. Pablo Pazmino will take a complete medical history to rule out other conditions that can cause symptoms similar to lumbar degenerative discs, herniations, or slipped discs. Dr. Pablo Pazmino will also perform a complete and thorough physical examination. Radiography (X-rays) and other diagnostic imaging tests (MRIs, EMGs, CAT scans) will then be reviewed so that Dr. Pablo Pazmino can evaluate your bony quality, any neural compression, bone spurs and other abnormalities to reveal the extent of damage to the lumbar spine.



At Santa Monica Spine / Beverly Spine we pride ourselves in our duty to educate our patients. Dr. Pablo Pazmino uses his background as a former teacher to ensure that you understand your pathology, imaging (X-rays and MRI) and treatment options completely during each visit. Our patients often comment they are amazed at the amount of time and effort we take to review their studies. Many have never had this experience before and feel like they are a true part of the decision making process. We want our patients to be involved in every step of the process and we feel education is the first step towards achieving that goal together.

Medical History

At Santa Monica Spine / Beverly Spine we are very thorough. Dr. Pablo Pazmino will need a complete history of any medical illnesses, surgeries, or chronic conditions which you may have or for which you have seen other physicians in the past.

More specifically we will require a history of your back and leg pain itself. What is the exact location of the pain? When did the problem begin? What does the pain feel like? Has your back been injured before? Have you previously been treated for back or leg pain?

Nonsurgical Treatment

Symptoms of Lumbar degenerative discs, herniations, or slipped discs may last for several months or become chronic. Most patients with Lumbar degenerative discs, herniations, or slipped discs or Radiculopathy can be treated non-operatively. Dr. Pablo Pazmino may recommend a course of physician guided conservative management.

  • Rest. A short course of bed rest or a brace may be used to limit painful lumbar motion and relieve irritation.
  • Medication. Dr. Pablo Pazmino may prescribe nonsteroidal anti-inflammatory medications (NSAIDs) or other non-narcotic pain relievers to relieve your pain and reduce swelling.
  • Acupuncture. Dr. Pablo Pazmino works with a team of Acupuncture specialists and may recommend this if indicated for your specific set of symptoms.
  • Chiropractic Management. Dr. Pablo Pazmino works with a reliable team of Chiropractors and may recommend this if indicated for your symptoms
  • Physical therapy. A course of therapy guided by Dr. Pablo Pazmino may include hot and cold therapy, ultrasound or an active exercise program which may help relieve symptoms. Exercises may include core body strengthening, lumbar and lower extremity stretching, and aerobic exercises. Patients may also receive gentle massage and perform activities to improve posture.
  • Injections: A series of selective nerve root blocks or epidural injections of a cortisone-like drug may lessen nerve irritation and allow more effective participation in physical therapy. These injections are given on an outpatient basis over a period of weeks. Dr. Pablo Pazmino only works with a small group of physicians who he trusts to perform these injections. Click here to see some of the recommendations Dr. Pablo Pazmino makes in regards to injections and pain management physicians.

Nonsurgical treatment may take away most of the symptoms, but it does not treat the underlying structural cause. Follow-up visits are necessary so Dr. Pablo Pazmino can check if symptoms have gotten better, worse, or have stayed the same.

Surgical Treatment

For some patients with significant pain and weakness, after failure of conservative management, Dr. Pablo Pazmino may recommend a surgical treatment option. The surgical treatment options may vary and depend on the individual patient and their pathology. Surgery may be necessary for patients with progressive neurologic symptoms or severe pain that does not improve with other treatments. Surgery may remove bone spurs or disc material (Decompression) and provide lasting pain relief.

In our practice, surgery is always reserved as a last option, but when necessary can have excellent results and often can improve your overall quality of life. If surgical treatment is warranted Dr. Pablo Pazmino can offer a variety of procedures for treating Lumbar degenerative discs, herniations, or slipped discs.

When Should You Seek Medical Care?

If severe pain occurs following an injury (motor vehicle accident, diving accident, or fall), a trained professional, such as a paramedic, should immobilize you to avoid the risk of further injury and possible paralysis. Emergent medical care should be sought immediately.

Immediate medical care should also be sought when an injury causes pain in the neck that radiates down the arms and legs.

Radiating pain, or numbness in your arms or legs which causes weakness in the arms or legs without significant neck pain should also be evaluated.

If there has not been an injury, you should seek a Spinal Evaluation with Dr. Pablo Pazmino when pain is:

  • Continuous and persistent
  • Severe
  • Accompanied by pain that radiates down the arms or legs
  • Accompanied by headaches
  • Accompanied by numbness, or tingling
  • Accompanied by weakness!

Many patients seek care for Lumbar Hybrid Disc Replacement pain by Dr. Pablo Pazmino because as an Orthopaedic surgeon he is specifically trained to diagnose, treat, and help prevent problems involving the muscles, bones, joints, ligaments, and tendons. Although Dr. Pablo Pazmino confines his practices to Spinal pathology he also treats a wide variety of diseases, injuries, and other conditions, including Spondylolisthesis .