Intervertebral disc prostheses are operated on from the front (neck or abdomen), regardless of whether the cervical or lumbar spine is affected. An example (picture below) is the implantation in the lumbar spine. Within the framework of a disc prosthesis implantation, various surgical steps must be performed.
Since not every operation follows the same pattern, the decisive and most important steps of a disc prosthesis implantation are described 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 show which steps can 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 quite possible. – General anesthesia of the patient
- Positioning the patient in the supine position
- Skin disinfection and sterile draping
- Approx.
8 cm long longitudinal or transverse skin incision, depending on the height of the disc to be operated on
- Splitting of the abdominal muscles
- Retroperitoneal access via the psoas muscle
- Identification of the disc height while sparing the large abdominal vessels and sensitive nerve plexuses (Plexus hypogastricus superior)
- Clearing the intervertebral disc space from the front
- Freshening of the vertebral body base and cover plates
- Spreading (distraction) of the disc space
- Insertion of the disc prosthesis in correct position under X-ray control (central in front view, relatively far back in side view)
- Insertion of wound tubes (drainages)
- Skin suture. The figure shows a stained disc prosthesis of the cervical spine for better visualization. A very hard plastic material lies between the metal discs, which are attached to the vertebral bodies.
Complications
Complications resulting from anterior access can be distinguished from those caused by the implant. Overall, serious complications with the implantation of a disc prosthesis are rare. Possible complications due to access Possible complications due to implant
- Lumbar spine: scar fracture, abdominal wall fracture, 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, wound healing disorder, thrombosis, pulmonary embolism, etc. – Implant migration, implant subsidence, dislocation of the plastic core, plastic abrasion (wear)
Further complications
The postoperative follow-up treatment will probably not be carried out in any hospital in the same way. On the one hand, this is due to the experience of the surgeon, on the other hand, individual peculiarities of the operation are taken into account in the postoperative treatment plan (e.g. surgery of several disc prostheses, disc height, complications, etc.). The postoperative treatment should always be determined individually by the surgeon.
Without therefore 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 light orthopaedic functional bodice. – Learning of back-friendly everyday behaviour. – Discharge after approx.
1 week or after thread pulling on the 11th or 12th postop. day. – Longer periods of sitting (more than 1 hour at a time) should be avoided at home.
- No lifting or heavy carrying during the first 6 weeks. – Rehab measures from the 6th week postoperatively. – Ability to work between the 6th and 12th week postoperatively.
- Swimming and cycling from the 4th -6th post-op week. week. – Strongly straining back sports (e.g. tennis, skiing etc.) only from 6 months postop. – X-ray control after about 6 weeks.
