Prosthetics of the Intervertebral Disc

Replacement of the intervertebral disc in the event of wear makes it possible to maintain the mobility of the spine and to cure pain. The disc prosthesis is a potential alternative to spinal fusion, which also reduces pain but also reduces mobility. The use of an artificial disc is no longer rare today, but can only be done in certain cases. In general, a disc prosthesis is used when the natural disc is severely damaged by spinal diseases and it comes to pain and impairment in everyday life by lowering the vertebral bodies together.

An artificial intervertebral disc is usually used only when intervertebral disc-related back pain and spinal column disorders continue despite conservative therapies such as physiotherapy and drug-based pain treatment and may even get worse and are associated with paralysis and reduced mobility. A prerequisite for the implantation of an intervertebral disc prosthesis is also that a maximum of three adjacent intervertebral discs are affected by degenerative changes.

By implanting an artificial intervertebral disc on the one hand, the disc-related back pain to be eliminated and on the other hand, the natural mobility of the spine can be obtained.

Depending on the location of the artificial intervertebral disc, a distinction is made between two types of intervertebral disc prostheses. These include the cervical spine cervical disc prosthesis and the lumbar spine lumbar disc prosthesis. In addition, with the semi-constrained and non-constrained artificial discs, two different degrees of coupling are available, depending on the extent of the degenerative changes to the disc.

Each of these types of intervertebral disc prostheses can be individually tailored to the body dimensions of each patient. On the one hand, different sized metal plates and different high sliding cores are available. On the other hand, there are artificial discs with different angles of inclination, which can be adapted to the curvature of the spine region to be supplied.

The insertion of an artificial disc is always done from the front, regardless of whether the cervical or lumbar spine is affected. Typically, an intervention lasts between 90 and 120 minutes, depending on the location of the affected disc and degree of degeneration. Like any surgical procedure, the insertion of an intervertebral disc prosthesis involves some risk. However, one must distinguish here the complications that can arise through the procedure itself and those that are caused by the artificial disc.

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Prosthetics of the intervertebral disc is a complicayed method of state-of-art surgical invasion that allows removing an intervertebral disc and replace it with a prosthesis. 2020-03-30 Prosthetics of the Intervertebral Disc
More About Prosthetics of the Intervertebral Disc

The main indication for prosthetics of intervertebral disc is spinal hernia with nerve entrapment caused by degenerative changes of intervertebral disc. Prosthetic surgery is also prescribed in the following cases:

  • osteochondrosis vertebralis;
  • durable low back pain that is localized between the 12th pair of ribs and gluteal furrows;
  • damage of structure of vertebral disc, loss of its height;
  • narrowing of radicular foramen of the spinal cord (foraminal stenosis).

Prosthetics of intervertebral disc allows to:

  • eliminate pain;
  • save mobility of the spinal cord and improve life quality;
  • take a long-term effect from treatment;
  • restore work productivity and get back to normal lifestyle quickly;
  • continue doing sports and exercising.

The structure of intervertebral disc

Modern intervertebral disc prostheses have a natural physiology and can restore spinal cord mobility in six directions, including crunching and sprain. They perfectly imitate the anatomy of the human spinal cord and possess all the necessary biochemical characteristics. In addition, their shape and material features allow you to save neighboring vertebrae and strictly fix them. That is why artificial discs are not discarded by the patient's body, and rehabilitation does not require much time.

The intervertebral disc prosthesis is made of titanium and polymers. Today, new types of bioprostheses are successfully used: their properties are close to human organic tissues. The implant has two movable loops, and its outer plates repeat the shape of the vertebrae, to which the artificial disk will fit. A movable core is placed inside the prosthesis, which allows you to move the new joint in all directions. All elements of the device repeat the functions of the fibrous ring and the pulpous nucleus of the natural intervertebral disc.

Implants of intervertebral discs: types, peculiarities, advantages

Intervertebral implants can differ depending on the material, which defines the area where the device will be used, and its advantages.

One type of prosthesis is made of cobalt-molibdenic plates covered with titanium: it ensures simple and efficient growth of prosthesis to the bone. Between the plates, a nucleus responsible for segment mobility is placed. Such devices are used for disc replacement in the neck-bone. If discs in lumbar vertebra are replaced, prostheses made of cobalt-chrome-molibdenic plates covered with titanium alloy are used. The construction of such implant is similar to the previous one.

However, this is not the only type of implants used today. Surgeons start introducing revolutionary biological prosthesis of intravertebral discs that have features maximally close to natural discs’. Such implants are made of collagen which promotes efficient growth of prosthesis into natural tissues and prevents its wearing.

Besides, modern types of intravertebral discs prostheses can be divided into three main categories:

  • spherical implants – their construction reminds of a sphere placed in the hollow part of nucleus pulposus;
  • mechanical implants – such prostheses consist of plates with a nucleus in the center and allow fully restoring functions of the spinal cord;
  • physiological prostheses – their nucleus is made of polyurethane or hydrogel, and it restores the disc while absorbing and emitting fluid from intervertebral cavity which helps to distribute load optimally.

When this or that type of intervertebral implant is chosen, a doctor should take many factors into consideration, including the peculiarities of condition and its stage, patient’s age, physiological features, etc. For example, when intervertebral discs are replaced in men with a strong muscle frame, prostheses that save joint movement should not be used. In this case, the choice of prosthesis should be individual.

How prosthesis operation is performed?

Minimally invasive operations for disc replacement on the spinal cord are performed in two stages:

  • removal of the damaged disc;
  • installation of prosthesis.

Before the operation, a patient goes through analyses and diagnostics with ultrasound and MRT. The obtained data will help doctor to decide whether full or partial replacement of intravertebral disc is required, and find a suitable prosthesis.

It should be noted that prosthetics of intravertebral disc is a serious surgical invasion, because it affects nervous spinal cord. However, modern German medicine has rich experience of minimally invasive operations on the spinal cord, which allows reducing the risk of damage to minimum. The operation is performed under general anesthesia and lasts for about two hours.

During the procedure, a doctor makes a small cut (not more than 6 cm) and fully removes the intravertebral disc. If the operation is made in the cervical part of the spinal cord, the cut is made on the neck from the left side. If it’s made in the lumbar spine – the cut is made on the abdomen, between the hipbone and the navel. Such access to the spinal cord reduces the risk of damage of spinal nerves.

After that, a special construction that holds the lower part of foramen intervertebrale is installed, after which the surgeon removes vertebral osteophyte, small hernias that push on the spinal cord and nerve roots. At the final stage of the operation, optimal height of the intravertebral disc is adjusted, then the construction is removed for a prosthesis to be installed on its place. This manipulation is made with the help of a microscope only and with X-ray imaging.

Post-surgery period

Rehabilitation after intervertebral disc prosthetics is very important. After two hours of surgery, the patient is allowed (and even recommended) to move freely, even if he experiences minor postoperative pain.

Drugs for the treatment of thrombosis are prescribed before spinal surgery and when the patient goes home. A few days after the operation, an ultrasound scan is performed to make sure that the blood flow in the legs and pelvic area is normal. If there are no complications, the patient can leave the hospital after 3-4 days.

Within 1.5 months after surgery, the patient should wear a special soft bandage (all the time, except during sleep). During this period, the patient is prohibited from driving a car, motorcycle or any other vehicle.

Removal and fixation of the intervertebral disc prosthesis is monitored after a certain period of time using radiography. At the end of the rehabilitation period, all restrictions on movement are canceled, and the patient can return to his normal lifestyle and routine tasks, including playing sports, exercises, driving, physical work, etc.

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Latest News in Prosthetics of the Intervertebral Disc

The first 3D-printed spine implant in Germany was used in Görlitz

04.03.2019

The operation was without complications. For medicine, however, this is just the beginning: in the future, such implants must be completely tailored to the patient. This is possible when CT scan and 3D printing are combined.

Tools, sculptures and entire houses can nowadays be produced with the 3D printer. A new area that has conquered printing technology is medicine. For some time, hip prostheses have been manufactured in Germany in this way. And in the US, you even dream of a real 3D-printed heart.

But last week there was a new success story from Görlitz Hospital. There, doctors have successfully implanted a spine from the 3D printer for the first time. "The implant we have is not just the first 3D-printed implant, it's the first functional implant," says chief physician Dr. med. Marcus Eif from Görlitz Hospital, who performed the operation. In practical terms, this means that the implant implanted in this way can adapt to the needs of the spine in the patient, thereby aligning the spine even better.

However, the advantages for the chief physician are not there: the implant is shaped so that it has a "very slim silhouette" when penetrating and only unfolds later. Therefore, the surgeon must less strain on the vertebrae and muscles than on a rigid implant. The optimized alignment of the spine also reduces the likelihood that the spine will continue to degenerate and require reoperation.

The operation with the implant was "without any complications," the physician explains. Also the controls after the surgery had shown good results. The desire to carry out such an operation had existed for some time, notes Eif. But only with the CE certification of the implant, it would have been possible. That's why the doctors started using this form of implantation last week and have already treated the third patient, "because it's simply a very good symbiosis for the surgeon and the patient."

Incidentally, the implants would get even better in the future, emphasizes Eif. Then the patient would first be scanned with the CT scanner and the printer programmed with the data obtained, so that "an individual implant at a reasonable price" could arise. Although there are currently various "adjustment options", but the implants would ultimately still "off the shelf".

The implants currently used in Görlitz consist of titanium dust, which is melted point by point with a 3D printer, gradually acquiring the three-dimensional shape of the replacement disc.

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