Intervertebral disc endoprosthetics is the insertion of an artificial intervertebral disc, a so-called intervertebral disc prosthesis. This disc replacement can eliminate disc-related pain and maintain the mobility of the spine.
The spine consists of 24 vertebrae, which are made up of a compact vertebral body and a hole formed by the vertebral arches.
The holes form the spinal canal (nerve canal) by lining up the vertebral bodies . This is where the spinal cord, part of the nervous system , runs. The spinal cord nerves (spinal nerves) emerge from the spinal canal between the vertebral arches.
As a kind of shock absorber, the intervertebral discs connect two vertebral bodies with each other. This is why the intervertebral disc is also called the intervertebral disc. It consists of an outer fibrous ring and a centrally located gelatinous nucleus. The gelatinous core in particular absorbs shocks to the spine.
In the course of life and with constant strain, the water content in the gelatinous nucleus decreases. The intervertebral discs become thinner and pathological changes (wear and tear) can occur in the bone of the vertebral bodies.
Small tears in the fibrous ring can cause the gelatinous core to protrude through the fibrous ring. This leads to a herniated disc. This can then press on the spinal nerves or the spinal cord, causing severe pain and neurological deficits.
A herniated disc in the lumbar spine manifests itself through severe lower back pain, muscle tension, sensory disturbances or even paralysis @ Henrie /AdobeStock
A prosthetic disc consists of two metal plates that are attached to the vertebrae and a movable plastic core. Doctors typically insert them from the front, i.e. through the neck or abdomen.
The prosthesis replaces the disc, relieving pain and reducing pressure on the spinal cord and nerves @ Foxstudio /AdobeStock
The main reason for the implantation of disc endoprostheses is pain and/or neurological deficits.
These are the result of age-, stress- or disease-related changes to the intervertebral disc or vertebral body.
In the case of a herniated disc, doctors remove the disc material to relieve the pressure on the nerves. By inserting a disc prosthesis, they restore the correct distance between the vertebral bodies. The mobility of the vertebrae is usually retained.
In the case of spondylosis, degenerative changes occur in the vertebral bodies as a result of prolonged incorrect loading and excess weight.
New bony structures form, which exert pressure on the spinal nerves. Or lead to stiffening of the spine.
Before inserting the disc prosthesis, doctors remove the new bony formations.
If intervertebral discs and adjacent bone structures are degeneratively altered, osteochondrosis is present.
Specialists in intervertebral disc endoprosthetics also treat mild forms of myelopathy (spinal cord damage) caused by a narrowing of the spinal canal. Doctors refer to this as spinal stenosis or spinal canal stenosis.
In the case of spinal stenosis, there is a narrowing and pressure on the nerves within the spinal canal @ Axel Kock /AdobeStock
Non-specific low back pain can also be an indication for an artificial disc if the cause of the pain comes from the intervertebral disc.
By interviewing the patient (medical history) and carrying out a physical and clinical examination, doctors can usually narrow down the causes of the symptoms.
Imaging procedures allow experts in intervertebral disc arthroplasty to get a picture of the
X-rays of the spine show changes to the vertebral bodies (such as spondylosis). The doctor can assess the intervertebral spaces. It can also be used to produce functional images to check stability and mobility.
An X-ray image with contrast medium can show a damaged intervertebral disc @ endostock /AdobeStock
The doctor can also use magnetic resonance imaging (MRI) or computer tomography (CT) to assess the intervertebral discs and the spinal canal. Possible herniated discs can be detected in this way.
Myelography is now only rarely used. Doctors inject contrast medium into the spinal canal in order to see the spinal cord and spinal nerves better.
Before a possible disc prosthesis operation, doctors may inject a contrast agent directly into the disc space (discography). This allows them to see the spread in the X-ray image. Depending on the distribution of the contrast medium, they can draw conclusions about the type of disc damage.
The range of services offered by a specialist in intervertebral disc endoprosthetics includes the following methods:
Experts in intervertebral disc endoprosthetics are usually specialists in orthopaedics and trauma surgery or specialists in neurosurgery. They have particular experience in the implantation of intervertebral disc prostheses.
When deciding for or against an operation, they weigh up the opportunities and risks. They consider possible alternatives to an endoprosthesis. They guarantee high quality surgical care through certification.
The Leading Medicine Guide's quality assurance is ensured by the following acceptance prerequisites.
