Article
Disk prosthesis - results and alternatives
Search Medline for
Authors
-
M. Kapella
- Asklepios Klinik Birkenwerder, Hubertusstr. 12-22, 16547 Birkenwerder, Orthopädie, Berlin
-
E. Weber
- Birkenwerder
-
R. Kreusch-Brinker
- Schwarzach
| Published: | June 13, 2005 |
|---|
Outline
Text
The SB disc prosthesis was developed beginning of the eighties and was implanted in a larger number at the Charite, University of Berlin. Because of surgical technical failure rate and no attention of the orthopaedic scene it was forgotten for a decade but revised in the beginning nineties.
Disc prosthesis are implanted in our hospital since 1999 for special indication. As there are:
Mono- or bisegmental lumbal disc degeneration with signs of instability -seen in the function-x rays- and or a functional spinal stenosis seen on a lumbar myelogramm.
The patient should not be older than 50 years and had preferably no previous operation (Discectomy).
The previous conservative treatment should have been unsuccessful.
With this indication we operated on 144 patients 179 disc prosthesis. The age was on average 42 years (28-55). 54 patients had an operation on the lumbar spine before (dorsal or ventral approach).
All of them had a history of back pain for on average 3 years (1,5 -10 y) and pseudoradicular symptoms without an exact neuromuscular deficit. The patients have been investigated prospectively and have been controlled at least six months later y-rayed in function and bending and examined and a neuromuscular status has been written.
91 of 144 patients showed a very good to good result up to nearly painfree and symptomfree
results and with good ROM of the body (stem). 22 patients, whereas 16 of the 54 preoperated patients, did not have any change of their symptoms like a pseudoradicular syndrom.
The y-rays showed good function of the prosthesis in 94 of the 144 patients. 16 prostheses had to be removed and a spondylodesis had to be performed. 15 patients of 144 had an additive dorsal decompression. In 3 cases a dislocation of the prosthesis due to a fracture of the vertebral body ( or vertebral arch) happened. One lesion of the sacral plexus was seen.
If the lumbar spine prosthesis does not work the fusion has to be a complete ventral and dorsal instrumentation, the dorsal instrumentation is not sufficient.
The alternative is a ventro-dorsal fusion but with a slightly different indication. Decompression is no alternative because of instability growth.
The disc prosthesis can be recommended in degenerative discs with special indication.
