Cervical spine disc prosthesis

Disc endoprosthetics – a surgical method for the spine that preserves movement and function The implantation of a disc prosthesis is a globally recognised method for treating symptomatic degenerative disc disease. Conservative therapy should be attempted for at least 6 months beforehand. If this is unsuccessful, or if uncontrollable pain or nerve disorders occur, health insurance companies in Switzerland will cover the cost of the operation, provided that no more than two intervertebral discs are affected and there is no primary osteoarthritis of the facet joints. The operation is performed under general anaesthesia through the abdominal wall. Depending on the type and height of the diseased intervertebral discs, access to the spine is gained either via a transverse incision in the lower abdomen or a longitudinal incision in the skin of approx. 4-6 cm. As a rule, the peritoneum remains closed so that damage to the intestines and abdominal organs can be avoided. After the large vessels and nerves located at the front of the spine – the abdominal aorta and vena cava – have been carefully moved to the side, the corresponding disc is exposed. The anterior longitudinal ligament or disc ring is opened and the defective disc is completely removed.

The viscoelastic disc prosthesis (VTDR) is a new viscoelastic disc prosthesis used to treat disc degeneration. The unique design of this latest-generation prosthesis offers the following advantages: – Restoration of normal mobility and stability in the affected segment. – Lifelike 3D imitation of the human intervertebral disc. – Normal cushioning effect as with the natural intervertebral disc. – Full load-bearing capacity of the spine. – Restoration of the natural function of vertebral joints, muscles, ligaments and tendons.

VTDR consists of two titanium end plates and an elastic core that is firmly welded to the end plates. The elastic polyurethane-silicone core allows free movement in all directions. It is able to absorb shock and distribute weight naturally, with the material designed in such a way that the elastic core becomes stiffer and firmer as the pressure increases. In this way, the load on the spine is absorbed in the same way as a natural intervertebral disc.
Implantation of two viscoelastic disc prostheses between the fourth and fifth lumbar vertebrae and between the fifth lumbar vertebra and sacrum

What happens after the operation?
You will remain in hospital for a few days after the operation. This is usually around 3–4 days after an operation on the cervical spine and around 6–7 days after an operation on the lumbar spine. As the prosthesis is normally immediately stable in terms of movement and pressure, you will be allowed to get up just one day after the procedure. In contrast to fusion surgery, you may sit during this time, but you should avoid leaning forward under stress, hyperextension, lifting heavy objects and abrupt twisting of the spine. However, “natural” movements are permitted. This is followed by special follow-up treatment (physiotherapy, mobilisation, muscle building, etc.). After approximately 3 months, the prosthesis is usually firmly integrated into the bone. This is checked during a follow-up examination using X-rays. Mandatory follow-up examinations and documentation of findings in the SWISS Spine Register are carried out at regular intervals, guaranteeing you the greatest possible safety and care with this surgical method.

References

Berg, Js., Anthony, T., Bruski, R., et al. (2009) Total Disc Replacement Compared to Lumbar Fusion: a Randomised Level I trial With 24 Year Follow Up, Eurosurgery Spine, Volume 18, Issue 10, pages 515-524; Publisher: Springer Berlin Heidelberg New York

Zigler, Seiderman R., Isaacs R.E. et al. (2011) Results of the Prospective, Randomised, Multicentre Food and Drug Administration Investigational Device Exemption Study of the ProDisc-L Total Disc Replacement versus Circumferential Fusion for the Treatment of 1-Level Degenerative Disc Disease, Spine, Volume 13, Issue 5, Pages 501-511

Aesculap Implant Systems, Volume 18, Issue 01, Page 02 – 86), Springer Med Verlag Berlin Heidelberg New York

Fernström, U. (1966) Arthroplasty with intercorporal endoprosthesis in herniated disc and in painful disc. Acta Chir Scand Suppl., 357:154-159, Acta Chirurgica Scandinavica

Single-Level Lumbar Disc/Spondylolisthesis; Back Pain With Total Disc Arthroplasty Utilising the ProDisc-LPSPN, Volume 31, Number 10, Barnes, Page 1659–68, Lippincott Willkins & Wilkins Inc., Philadelphia

Zigler, H. E. d’Altri, H. E., Smoot, B. R., et al. (2013) Results of the Prospective, Randomised, Multicentre Food and Drug Administration Investigational Device Exemption Study of the ProDisc-C Total Disc Replacement versus Anterior Discectomy and Fusion for the Treatment of 1-Level Symptomatic Cervical Disc Disease, Spine Journal, Volume 13, Issue 10, Pages 1370-1378