Lumbar disk prosthesis

Implantation of a disk prosthesis

Degeneration of spinal disks can lead to severe chronic or intermittent back pain with or without radiations into the legs. This pain can have considerable impact on daily life activities. Many patients with degenerative spine disease had disk prolapses in their previous medical history. Whereas on x-ray images disk degeneration will not be readily detectable, the degenerative structures can be clearly seen on magnetic resonance images.

However, the most important question is if the visible degenerative changes correlate to the prevailing symptoms. It could be shown, that patients without back pain often show considerable degenerative changes, whereas other patients with “normal” MRI findings suffer from most severe pain. In other words: imaging techniques alone cannot lead to an adequate problem solving.

 Before a decision for surgery is made a thorough physical examination and evaluation of images is required. i If MRI findings fit to the prevailing symptoms – the solution for the problem is possibly near at hand.

 

bandschprot1If MRI findings fit to the prevailing symptoms – the solution for the problem is possibly near at hand.

Thanks to progress in implant development modern artificial disk replacements are fitted ideally to the functional setting of the lumbar spine and allow for natural movement – preserving by this means the mobility of the lower back. 

Additionally their elasticity lets them work as shock absorbers just like their natural counterparts. This helps to prevent the adjacent sections of the spine from undue stresses.

 

How is surgery carried out?

 

If all diagnostic findings show that a defective spinal disk is responsible for the prevailing symptoms – the desire for a „repair“ or „renewal“ is comprehensible.

The therapeutic principle is always the same: The disk tissue is removed to the greatest possible extent while the important outer fibrous ring is preferably maintained.

To prevent a collapse of the intervertebral space, at the place of the defective spinal disk an artificial replacement must be implanted (disk prosthesis, cages etc). Due to its functionality, a disk prosthesis appears as a very valuable alternative for one or more degenerative spinal disks.

 

 

 

 The intervention is done under general anesthesia and takes about two hours. Already two hours after the surgery you can walk by yourself and two days later you may go back home again.

Insertion of an artificial disk replacement is done through a small incision – mostly at the abdomen. After removal of the prolapsed disk the artificial disk replacement is adjusted between the vertebrae.

It is fixed with two titanium plates allowing for optimal adhesion of the implant to the bone so that a loosening is mitigated. Between the two titanium plates there is a polymeric nucleus (polyethylene) and another polymer (polyurethane) is used to encase the prosthesis and to seal it off the surrounding tissues.

 

What post-operative care is necessary?

As a rule patients are able to leave the recovery room by themselves two hours after the intervention. The first day after the surgery you may eat light fare. To prevent thrombosis before the intervention and until discharge from hospital patients will be given heparin.

After about 4 days you may leave the clinic and go back home. It is necessary to wear a bandage for approximately 4 weeks. Then an individually targeted and professionally supervised physiotherapy is recommended.

You may drive your car or ride your bicycle as soon as your abdominal scar has healed. After proper position of the implant has been verified by x-ray imaging, it will stand all usual stresses from fast walking to jumping to falling.

 

When may I resume my sports activities?

After about six weeks you should be able to go swimming or to ride your bicycle. Your may gradually resume your usual sports activities after 9 to 12 weeks.

When can I go back to work?

After six weeks you can resume simple office work and slight physical work. You shouldn’t do any hard physical work during the first 12 weeks and then only gradually increase.

What is the success rate? And what are the risks?

In the international scientific literature success rates of more than 85% are quoted.

 

With an experienced spine surgeon and modern implants the complication risk is very low. Most common risks are:

  • Insufficient pain relieve (10-15%)
  • Remaining radiating pain (5%)
  • Deep venous thrombosis (1%)
  • long-term degeneration of the facet joints (no % data available)
  • malposition / sinking of the prosthesis. This occurs mainly due to low bone density (women > 45 years)

Pain may persist after any surgery; however, the probability for a re-operation is about 50% smaller with prosthesis than with fusion surgery.

Also the number of patients that are able to resume their work without any restrictions is much higher after a prosthesis than after a fusion surgery. (Source: Round Tables In Spine Surgery, Volume 1 o Number 4 o 2006, B. Conix, R. Hes, Middelheim, Antwerpen)

 

At a glance!

 

The most important facts at a glance for your convenience

 

Fusion surgery

Artificial disk replacement

Risk

  1. The vertebral bodies are fused after the surgery, the natural mobility of the cervical spine is lost. This may lead to undue stresses on adjacent segments
  2. For fusion either a bone graft must be implanted (pain at the harvesting site at the iliac crest) or a metal implant is used (foreign body). Mostly and additional metal fixation system is required.
  3. There is a risk of injury to the nerve roots from the used fixation screws. This may lead to transient or permanent neurological signs.
  1. Natural mobility of the affected motion segment is greatly restored by surgery
  2. Injury of nerve root is extremely rare
  3. Fusion of the motion segment is not necessary

Pain

  1. Symptoms often prevail after surgery or new symptoms arise from surgery
  2. In the cervical spine surgery is mostly done from the back. This frequently leads to permanent symptoms in the neck musculature
  1. Origninal neck pain is mostly gone directly after surgery. Slight remaining musculary disturbances rapidly resolve.
  2. Surgery is carried out through a small incision (3-5mm) from the front.

After the intervention

  1. As a rule return to full activity takes 6 weeks.
  1. Patient can return to slight movements of the neck already 3 hours after the intervention while wearing a specially adapted neck brace.

Hospital stay

  1. 1-2 weeks
  1. 3-6 days

Surgery

  1. Substantial removal of bone substance
  2. often the vertebral bodies are fixed with metal, carbon or PEEK cages and a metal plate
  1. Only the pain causing disk is removed
  2. Access is achieved through a 3-5 cm skin incision from the front.
  3. A fixation through cages and metal plates is not necessary
  4. Mobility and stability of the spine is preserved

Sport

  1. Sports activities are virtually impossible
  1. After rehabilitation you can resume your usual sports activities

Schedules

  1. Long waiting times are not unusual
  1. In acute cases surgery is possible mostly within one week.
 

 

 

 !!! Mobility and normal function of the spine are maintained !!!

 

All advantages at a glance:
  •  Up-to-date artificial disks provide for a natural mobility and ideal functionality of the damaged lumbar spine
  •  Progressive degeneration of adjacent segments can be mostly prevented
  •  You will be able to stand or walk by yourself directly after the intervention
  •  Short hospital stay: in general you may go back home four days after the intervention
  •  Fast convalescence and healing
  •  Already six weeks after the surgery you may largely resume your usual activities
  •  Short recovery times and fast return to work (4-6 weeks)
  •  A high success rate of about 85%

 

 

 

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Reviews

I needed to tell just one sentence and diagnosis was established and then also confirmed by imaging techniques. Neither the orthopedic specialist nor the radiologist I had visited before, had identified the herniated disc. They told me to do some sports and that surgery would not help. Immediately after the surgery in the ATOS clinic, my symptoms disappeared and I was also pain free. Absolute number 1 address for spinal disc problems.

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