Operation to insert a prosthetic disc
Intervertebral disc prostheses are operated on from the front (neck or abdomen), regardless of whether they are on the cervical or lumbar spine.
Exemplary (Picture below) is the implantation at the Lumbar spine mentioned.
As part of a Intervertebral disc prostheses -Implantation, different surgical steps must be performed. Since not every operation proceeds according to the same scheme, the crucial and most important steps of a disc prosthesis implantation are outlined below. The individual steps mentioned below do not claim to be complete, nor are they listed in strict chronological order.
They are only intended to indicate which steps can usually be expected in any case. The actual operation time is between 90 and 120 Minutes. However, since there are always individual differences, deviations both upwards and downwards are entirely possible.
- General anesthesia of the patient
- Position the patient in the supine position
- Skin disinfection and sterile draping
- Approx. 8 cm long longitudinal or transverse skin incision, depending on the height to be operated on Intervertebral disc
- Splitting the abdominal muscles
- Retroperitoneal access via the Psoas muscle
- Identification of the height of the intervertebral discs while protecting the large abdominal vessels and sensitive nerve plexuses (Superior hypogastric plexus)
- Clear out the intervertebral disc compartment from the front
- Freshening the vertebral body baseplates and cover plates
- Spreading (Distraction) of the disc space
- Bringing in the Intervertebral disc prosthesis in the correct position under X-ray control (central in the view from the front, relatively far back in the view from the side)
- Insertion of wound tubes (Drainages)
- Skin seam.
Intervertebral disc prosthesis of the cervical spine
The illustration shows a colored disc prosthesis of the cervical spine for better illustration.
A very hard plastic lies between the metal disks that are attached to the vertebral bodies.
A distinction can be made between complications that result from the anterior approach and those that result from the implant.
Overall, serious complications in the implantation of a disc prosthesis are rare.
Access-related complication possibilities
- Lumbar spine: Incisional hernia, abdominal wall hernia, peritoneal injuries, intestinal injuries, bladder injuries, intestinal paralysis, ureter injury, retrograde ejaculation disorder, vascular injuries, nerve root irritation
- Cervical spine: vascular injuries, nerve injuries, temporary or permanent hoarseness
- General complications: infection, impaired wound healing, thrombosis, pulmonary embolism, etc.
- Implant migration, sinking in, dislocation of the plastic core, plastic abrasion (wear)
Postoperative follow-up treatment will probably not be carried out in any hospital straight away. On the one hand, this depends on the surgeon's experience, and on the other hand, individual features of the operation are taken into account in the follow-up treatment plan (e.g. operation of multiple disc prostheses, disc height, complications, etc.). The surgeon should always determine the follow-up treatment individually.
Without being able to go into details, the following applies to many patients after uncomplicated, monosegmental implantation of a disc prosthesis:
- Getting up on the 1st postoperative day.
- Removal of the wound tubes on the 2nd postoperative day.
- Physiotherapy (static abdominal and back muscle training).
- Possibly. Prescription of a lightweight functional orthopedic corset.
- Learning of back-friendly everyday behavior.
- Discharge after approx. 1 week or after pulling the thread on the 11th or 12th postop. Day.
- At home, long periods of sitting (over 1 hour at a time) should be avoided.
- No lifting or heavy carrying for the first 6 weeks.
- Performing a rehabilitation measure from the 6th postoperative week.
- Ability to work between the 6th and 12th postoperative week.
- Swimming and cycling from 4th to 6th grade postop. Week.
- Highly stressful back sports (e.g. tennis, skiing, etc.) only from 6 months post-op.
- X-ray check after approx. 6 weeks.
Chances of success
As already mentioned, modern intervertebral disc prostheses have only been implanted to a significant extent for a relatively short time (for 4-5 years). Therefore, there are no long-term studies on the durability of these prostheses. It has also not yet been proven that the intervertebral disc prosthesis prevents subsequent degeneration of the neighboring segments.
The short to medium-term results after disc prosthesis implantation are good to very good. In most examinations, the good to very good results are over 90%. At 4%, revision operations are less common worldwide than for vertebral body fusion (approx. 10%).