Contraindications

The implantation of a disc prosthesis is not a panacea for the elimination of back pain. On the contrary, most degenerative spinal diseases are a contraindication to the implantation of a disc prosthesis. The reason is quite simple: the implantation of a disc prosthesis merely eliminates the back pain caused by the diseased disc itself.

For this reason, a prerequisite for the implantation of a disc prosthesis is that no other wear-related diseases of the spine may be present that could be the cause or contributory cause of the back pain. In these cases other surgical procedures are used. Otherwise, the not exactly small and cheap operation cannot be successful and the pain existing before the operation will remain almost unchanged or even worsen afterwards. Among the contraindications are

Acute herniated disc of the lumbar spine (disproportionate surgery)
Osteoporosis (danger of the intervertebral disc collapsing into the adjacent vertebral bodies)
Advanced age (mostly additional wear of other vertebral body structures, often poor bone quality)
Vertebral body slippage (spondylolisthesis (cause of pain is not treated))
Wear of the vertebral joints (spondylarthrosis (cause of pain is not treated))
Spinal canal stenosis (cause of pain is not treated)

Advantages of the disc prosthesis

Until recently, the classic surgical procedure for disc-induced back pain (no herniated disc! ), as well as for acute herniated discs in the cervical spine, was the stiffening surgery of the spine with removal of the disc and fusion of the vertebral bodies with each other. This is an established procedure with good surgical results.

A major disadvantage of this surgical procedure, especially in the lumbar spine, is the greater trauma compared to disc prosthesis implantation, since the operation is performed on the back through the muscle and ligamentous apparatus of the spine. This results in a longer recovery time (rehabilitation) for the patient compared to the implantation of a disc prosthesis. The greatest advantage of the disc prosthesis is the preservation of the natural mobility of the spine.

For the following reason: A stiffening operation on the spinal column disrupts the natural transmission of force in the spinal column and overloads the very intervertebral discs adjacent to the stiffened spinal section. The result can be a renewed disc-induced back pain due to premature wear (subsequent degeneration). Investigations of the cervical spine have shown that intervertebral discs in the immediate vicinity of a vertebral body fusion are loaded on average 73% more than usual.

The movement of the intervertebral disc prosthesis is intended to place a natural load on all sections of the spine and prevent subsequent degeneration of the adjacent segments. Long-term studies on this are still missing. Nevertheless, the mobility of the intervertebral disc prosthesis is at least given and after at least 1 year is on average 8° for the segment L5/S1 and 10° for the segment L4/5. To what extent this mobility can be maintained over the years is not yet certain. – Intervertebral disc

Vertebral body
Spinal cord
Slipped disc