Intervertebral disc prosthesis

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Artificial disc prosthesis in the lumbar area
Anatomical structures of a movement segment of the lumbar spine ; Front-right side view. Shown dark blue are u. a. the laterally separating nerve roots .

The disc prosthesis also fully motion-preserving total disc prosthesis (English Total disk arthroplasty (TDA)) is the surgical insertion and anchoring a spinal disc replacement implant in the intervertebral space. An implant is an artificial material inserted in the body that is intended to remain there permanently or at least for a longer period of time. There are intervertebral disc prostheses for the cervical and lumbar spine .

The vertebral bodies , corpus vertebrae, are each provided with a cover plate at the poles pointing to adjacent vertebrae. Between these cover plates, neighboring vertebrae are connected to one another with a fibrous cartilage by an intervertebral disc and by two ligaments, the anterior longitudinal ligament and posterior connective tissue. The vertebral body is a supporting and load-bearing molded part of the vertebra.

Depending on the manufacturer, the implant for the intervertebral space generally consists of two plate-shaped support structures (upper and lower contact surfaces with the vertebral body) and an intermediate plastic core, mostly made of polyethylene , which enables mobility in the segment (ball joint principle). The panels to be anchored to the respective top or bottom plate of the vertebral body are made of a cobalt - chromium - molybdenum - alloy manufactured with a titanium were coated alloy; this is characterized by a high level of body tolerance. The upper contact surface establishes the connection to the base plate of the vertebral body, while the lower contact surface is used to rest against the cover plate of a vertebral body adjoining the implant below.

The indication arises above all if there is or is significant degeneration of the intervertebral disc system ( nucleus pulposus and fibrous ring, annulus fibrosus disci intervertebralis ) with or without accompanying inflammatory reaction (see also herniated disc ). With such a finding , the goal is to completely remove the degenerated intervertebral disc while maintaining the biomechanical and physiological functionality. Instead of the intervertebral disc system, an intervertebral disc prosthesis is inserted between the two vertebral bodies in the corresponding vertebral segment. The total disk arthroplasty (TDA) can then completely take over the function of a natural disc. This leads to a reduction or even complete disappearance of the original painful situation .

Operative procedure in the lumbar area

The operative-surgical intervention takes place in the supine position. First, a five to seven centimeter long skin incision (paramedian incision) is made between the belly button and the pelvic bone in an incision running parallel to the sagittal plane . Then, without opening the abdominal cavity, one penetrates in the retroperitoneal direction after exposing the ureter . While protecting the large abdominal vessels ( inferior vena cava and aorta ) and the nerves, the intervertebral disc is exposed and then gradually removed. The respective top and bottom panels are then roughened. Osteophytes that are pressing the nerve roots can also be removed. The intervertebral disc space is then restored to its original height and the prosthesis is firmly anchored to the vertebra. After the individual assessment of the case, one or more intervertebral discs are replaced with prostheses. The procedure is carried out under x-ray control . Overall, the procedure takes about two to three hours and is performed under general anesthesia with or without an epidural catheter . It should be noted that the higher lumbar segments, above L 3 or L 4, represent the technically more difficult situs with regard to their operative access .

literature

  • Mario Čabraja: The treatment of degenerative diseases of the spine through fusion and movement- preserving surgical procedures. Habilitation thesis, subject neurosurgery. Medical Faculty Charité-Universitätsmedizin Berlin February 9, 1976
  • Ogon M., Becker S., Chavanne A., Meissner J., Tuschel A .: The intervertebral disc prosthesis on the cervical spine. Journal for Mineral Metabolism & Musculoskeletal Diseases 2006; 13 (1), 14-17
  • P. Fritzell, O. Hägg, P. Wessberg, A. Nordwall: 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. In: Spine. Volume 26, Number 23, December 2001, pp. 2521-2532, PMID 11725230 .
  • JC Le Huec, H. Mathews, Y. Basso, S. Aunoble, D. Hoste, B. Bley, T. Friesem: Clinical results of Maverick lumbar total disc replacement: two-year prospective follow-up. In: The Orthopedic clinics of North America. Volume 36, Number 3, July 2005, pp. 315-322, doi : 10.1016 / j.ocl.2005.02.001 , PMID 15950691 .
  • RD Guyer, PC McAfee, SH Hochschuler, SL Blumenthal, IL Fedder, DD Ohnmeiss, BW Cunningham: Prospective randomized study of the Charite artificial disc: data from two investigational centers. In: The spine journal: official journal of the North American Spine Society. Volume 4, Number 6 Suppl, 2004 Nov-Dec, pp. 252S-259S, doi : 10.1016 / j.spinee.2004.07.019 , PMID 15541674 .
  • S. Blumenthal, PC McAfee, RD Guyer, SH Hochschuler, FH Geisler, RT Holt, R. Garcia, JJ Regan, DD Ohnmeiss: A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes. In: Spine. Volume 30, Number 14, July 2005, pp. 1565-1575, PMID 16025024 .
  • PC McAfee, B. Cunningham, G. Holsapple, K. Adams, S. Blumenthal, RD Guyer, A. Dmietriev, JH Maxwell, JJ Regan, J. Isaza: A prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part II: evaluation of radiographic outcomes and correlation of surgical technique accuracy with clinical outcomes. In: Spine. Volume 30, Number 14, July 2005, pp. 1576-1583, PMID 16025025 .
  • WS Zeegers, LM Bohnen, M. Laaper, MJ Verhaegen: Artificial disc replacement with the modular type SB Charité III: 2-year results in 50 prospectively studied patients. In: European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. Volume 8, Number 3, 1999, pp. 210-217, PMID 10413347 , PMC 3611160 (free full text).
  • M. Putzier, JF Funk, SV Schneider, C. Gross, SW Tohtz, C. Khodadadyan-Klostermann, C. Perka, F. Kandziora: Charité total disc replacement - clinical and radiographical results after an average follow-up of 17 years. In: European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. Volume 15, Number 2, February 2006, pp. 183-195, doi : 10.1007 / s00586-005-1022-3 , PMID 16254716 , PMC 3489410 (free full text).
  • AA Patel, DS Brodke, L. Pimenta, CM Bono, AS Hilibrand, JS Harrop, KD Riew, JA Youssef, AR Vaccaro: Revision strategies in lumbar total disc arthroplasty. In: Spine. Volume 33, Number 11, May 2008, pp. 1276-1283, doi : 10.1097 / BRS.0b013e3181714a1d , PMID 18469704 (review).
  • MR Zindrick, MN Tzermiadianos, LI Voronov, M. Lorenz, A. Hadjipavlou: An evidence-based medicine approach in determining factors that may affect outcome in lumbar total disc replacement. In: Spine. Volume 33, Number 11, May 2008, pp. 1262-1269, doi : 10.1097 / BRS.0b013e318171454c , PMID 18469702 (review).

Web links

Individual evidence

  1. ↑ Firsching, Raimund; Jöllenbeck, Boris; Hahne, Rainer: Cervical disc prostheses. Dtsch Arztebl 2005; 102 (31-32): A-2178 / B-1838 / C-1741.
  2. ^ Gravius, Sascha; Weißkopf, Markus; Ohnsorge, Jörg Alexander Karl; Mouse, Uwe; Niethard, Fritz Uwe; Wirtz, Dieter Christian: The lumbar disc prosthesis. A narrative overview. In: Dtsch Arztebl 2007; 104 (38): A-2592 / B-2290 / C-2222