Download PDF
Die Wirbelsäule 2018; 02(03): 239-255
DOI: 10.1055/a-0436-4083
CME-Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Künstliche Bandscheibe in der Lendenwirbelsäule – Hype oder Hope?

Klaus J. Schnake
Subject Editor: Wissenschaftlich verantwortlich gemäß Zertifizierungsbestimmungen für diesen Beitrag ist Dr. med. Klaus John Schnake, Fürth.
Further Information

Publication History

Publication Date:
21 August 2018 (online)

    Permissions and Reprints

Der künstliche Ersatz einer lumbalen Bandscheibe hat für anhaltende Kontroversen gesorgt, dabei gibt es in der Wirbelsäulenchirurgie praktisch keine andere operative Technik mit einem Implantat, über die mehr und bessere Studien durchgeführt wurden. Trotzdem wird die Diskussion häufig immer noch emotional geführt. Während im Bereich der großen Gelenke der Extremitäten heute kein Zweifel mehr an der Effektivität des künstlichen Gelenkersatzes besteht, ist die Situation an der lumbalen Wirbelsäule noch nicht abschließend geklärt.
Kernaussagen

  • Die lumbale Bandscheibenprothetik ist ein sicheres und wirksames Verfahren.

  • Die sinnvollste Indikation stellt der axiale, lumbale Rückenschmerz bei monosegmentaler Bandscheibendegeneration dar.

  • Im Vergleich zur Fusion ergeben sich in den ersten 2 Jahren Vorteile im Hinblick auf VAS (Visuelle Analogskala zur Schmerzmessung), ODI (Oswestry Disability Index) und Hospitalisationszeit.

  • Bei Beachtung der Indikationen und Kontraindikationen werden klinisch gute Ergebnisse auch nach bis zu 10 Jahren beobachtet.

  • Im Vergleich zur Fusion lassen sich die Raten an Anschlussdegenerationen und Facettenarthrosen nach aktuellem Wissensstand mit einer Prothese nicht senken.

  • Die Komplikations- und Revisionsraten entsprechen denen der Fusionsoperationen.

  • Bisegmentale Versorgungen führen zu schlechteren Ergebnissen als monosegmentale.

  • Aufgrund der zahlreichen Kontraindikationen kommt nur ein geringer Anteil von Patienten für die Prothese in Frage.

Schlüsselwörter

Bandscheibenersatz - Wirbelsäulenchirurgie - Lumbalgie - LWS
 

  • Literatur

  • 1 Blue Cross Blue Shield Association. Artificial Intervertebral Disc: Lumbar Spine. https://www.bcbsks.com/CustomerService/Providers/MedicalPolicies/policies/policies/ArtificialIntervertebralDisc_LumbarSpine_2018-05-23.pdf (Zugriff 16.7.18)
    Google Scholar
  • 2 Van Steenbrugghe MH. Perfectionnements aux prothèses articulaires. French Patent 1.122.634. ; May 28, 1956
    Google Scholar
  • 3 Nachemson A. Some mechanical properties of the lumbar intervertebral disc. Bull Hosp Joint Dis 1962; 23: 130-132
    Google Scholar
  • 4 Fernström U. Arthroplasty with intercorporal endoprosthesis in herniated disc and in painful disc. Acta Orthop Scand 1966; 10 : 287-289
    Google Scholar
  • 5 Maryanchik A. Spine arthroplasty. Spine industry analysis series. New York: Viscogliosi; 2001
    Google Scholar
  • 6 Fernström U. Der Bandscheibenersatz mit Erhaltung der Beweglichkeit. In: (Hrsg) Herdman H. Zukunftaufgaben für die Erforschung und Behandlung von Wirbelsäulenleiden. Die Wirbelsäule in Forschung und Praxis. Stuttgart: Hippokrates; 1972
    Google Scholar
  • 7 Weber G. Zwischenwirbel Prothese. Swiss Patent 624573. ; February 1, 1978
    Google Scholar
  • 8 Ray CD, Corbin T. Prosthetic disc and method of implanting. US Patent 4,772,287. ; September 20, 1988
    Google Scholar
  • 9 Ray CD. The Raymedica prosthetic disc nucleus. an update. In: Kaech DL, Jinkins JR. (eds) Spinal restabilization procedures. New York: Elsevier Science B.V; 2002: 273-282
    Google Scholar
  • 10 Klara PM, Ray CD. Artificial nucleus replacement. Clinical experience. Spine 2002; 12: 1374-1377
    Google Scholar
  • 11 Schönmayr R, Busch C, Lotz C. et al. Prosthetic disc nucleus implants: the Wiesbaden feasibility study. 2 years follow-up in ten patients. Riv Neuroradiol 1999; 12: S163-S170
    Google Scholar
  • 12 Shim CS, Lee SH, Park CW. et al. Partial disc replacement with the PDN prosthetic disc nucleus device. J Spinal Disord Tech 2003; 16: 324-330
    CrossrefGoogle Scholar
  • 13 Bertagnoli R, Karg A, Voigt S. Lumbar partial disc replacement. Orthop Clin N Am 2005; 36: 341-347
    CrossrefGoogle Scholar
  • 14 Schnake KJ, Weigert F, Kandziora F. et al. Local vertebral body destruction after migration of a nucleus replacement. Z Orthop Unfallchir 2007; 145: 649-651
    Google Scholar
  • 15 Selviaridis P, Foroglou N, Tsitlakidis A. et al. Long-term outcome after implantation of prosthetic disc nucleus device (PDN) in lumbar disc disease. Hippokratia 2010; 14 : 176-84
    Google Scholar
  • 16 Balsano M, Zachos A, Ruggiu A. et al. Nucleus disc arthroplasty with the NUBAC™ device: 2-year clinical experience. Eur Spine J 2011; 20 (Suppl. 01) S36-40
    CrossrefGoogle Scholar
  • 17 Bertagnoli R, Vazquez RJ. The anterolateral transpsoaticapproach (ALPA): a new technique for implanting prosthetic disc-nucleus devices. J Spinal Disord Tech 2003; 36: 398-404
    Google Scholar
  • 18 Di Martino A, Vaccaro AJ, Lee JY. et al. Nucleus pulposus replacement: basic science and indications for cliinical use. Spine 2005; 30: S16-S22
    CrossrefGoogle Scholar
  • 19 Coric D, Mummaneni PV. Nucleus replacement technologies. J Neurosurg Spine 2008; 8: 115-120
    CrossrefGoogle Scholar
  • 20 Link HD. History, design and biomechanics of the LINK SB Charité artificial disc. Eur Spine J 2002; 11 (Suppl. 02) S98-S105
    Google Scholar
  • 21 Büttner-Janz K, Schnellnack K, Zippel H. Eine alternative Behandlungsstrategie beim lumbalen Bandscheibenschaden mit der Bandscheibenendoprothese Modulartyp SB Charité. Z Orthop 1987; 125: 1-6
    Article in Thieme ConnectGoogle Scholar
  • 22 LeMaire JP, Skalli W, Lavaste F. et al. Intervertebral disc prosthesis. Results and prospects for the year 2000. Clin Orthop Res 1997; 337: 64-76
    CrossrefGoogle Scholar
  • 23 Blumenthal S, McAfee PC, Guyer RD. et al. A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes. Spine 2005; 30: 1565-1575
    CrossrefGoogle Scholar
  • 24 McAfee PC, Cunningham B, Holsapple G. et al. Prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part II: evaluation of radiographic outcomes and correlation of surgical technique accuracy with clinical outcomes. Spine 2005; 30: 1576-1583
    CrossrefGoogle Scholar
  • 25 Petersilge CA. Lumbar disc replacement. Semin Musculoskelet Radiol 2006; 10: 22-29
    Article in Thieme ConnectGoogle Scholar
  • 26 Mayer HM. Total lumbar disc replacement. J Bone Joint Surg Brit 2005; 87: 1029-1037
    Google Scholar
  • 27 Guyer RD, McAfee PC, Banco RJ. et al. Prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: Five-year follow-up. Spine J 2009; 9: 374-386
    CrossrefGoogle Scholar
  • 28 Putzier M, Funk JF, Schneider SV. et al. Charité total disc replacement – clinical and radiographical results after an average follow-up of 17 years. Eur Spine J 2006; 15: 183-195
    CrossrefPubMedGoogle Scholar
  • 29 Marnay T. Prosthesis for intervertebral discs and instruments for implanting it. United States Patent 5314477. ; May 24, 1994
    Google Scholar
  • 30 Marnay T. The Prodisc™: clinical analysis of an intervertebral disc implant. In: Kaech DL, Jinkins JR. (Eds) Spinal Restabilization Procedures. New York: Elsevier Science B.V; 2002: 317-331
    Google Scholar
  • 31 Zigler J, Delamarter R, Spivak JM. et al. Results of the prospective, randomized, multicenter 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 2007; 32: 1155-1162
    CrossrefGoogle Scholar
  • 32 Bertagnoli R, Yue JJ, Shah RV. et al. The treatment of disabling multilevel lumbar discogenic low back pain with total disc arthroplasty utilizing the Prodisc prosthesis: a prospective study with 2-year minimum follow-up. Spine 2005; 30: 2192-2199
    CrossrefPubMedGoogle Scholar
  • 33 Siepe CJ, Heider F, Wiechert K. et al. Mid- to long-term results of total lumbar disc replacement: a prospective analysis with 5- to 10-year follow-up. Spine J 2014; 14: 1417-1431
    CrossrefGoogle Scholar
  • 34 Zigler JE, Delamarter RB. Five-year results of the prospective, randomized, multicenter, Food and Drug Administration investigational device exemption study of the Prodisc-L total disc replacement versus circumferential arthrodesis for the treatment of single-level degenerative disc disease. J Neurosurg Spine 2012; 17: 493-501
    CrossrefGoogle Scholar
  • 35 Park CK, Ryu KS, Lee KY. et al. Clinical outcome of lumbar total disc replacement using Prodisc-L in degenerative disc disease: minimum 5-year follow-up results at a single institute. Spine 2012; 37: 672-677
    CrossrefGoogle Scholar
  • 36 Tropiano P, Huang RC, Girardi FP. et al. Lumbar total disc replacement. Seven to eleven-year follow-up. J Bone Joint Surg Am 2005; 87-A: 490-496
    Google Scholar
  • 37 Wuertinger C, Annes RDÀ, Hitzl W. et al. Motion preservation following total lumbar disc replacement at the lumbosacral junction: a prospective long-term clinical and radiographic investigation. Spine J 2018; 18: 72-80
    CrossrefGoogle Scholar
  • 38 Gornet MF, Burkus JK, Dryer RF. et al. Lumbar disc arthroplasty with MAVERICK disc versus stand-alone interbody fusion: a prospective, randomized, controlled, multicenter investigational device exemption trial. Spine (Phila Pa 1976) 2011; 36: E1600-1611
    CrossrefGoogle Scholar
  • 39 Le Huec JC, Mathews H, Basso Y. et al. Clinical results of Maverick lumbar total disc replacement: two-year prospective follow-up. Orthop Clin North Am 2005; 36: 315-322
    CrossrefGoogle Scholar
  • 40 Van de Kelft E, Verguts L. Clinical outcome of monosegmental total disc replacement for lumbar disc disease with ball-and-socket prosthesis (Maverick): prospective study with four-year follow-up. World Neurosurg 2012; 78: 355-363
    CrossrefGoogle Scholar
  • 41 Plais N, Thevenot X, Cogniet A. et al. Maverick total disc arthroplasty performs well at 10 years follow-up: a prospective study with HRQL and balance analysis. Eur Spine J 2018; 27: 720-727
    CrossrefGoogle Scholar
  • 42 Garcia Jr R, Yue JJ, Blumenthal S. et al. Lumbar Total Disc Replacement for Discogenic Low Back Pain: Two-year Outcomes of the activL Multicenter Randomized Controlled IDE Clinical Trial. Spine (Phila Pa 1976) 2015; 40: 1873-1881
    CrossrefGoogle Scholar
  • 43 Schätz C, Ritter-Lang K, Gössel L. et al. Comparison of Single-Level and Multiple-Level Outcomes of Total Disc Arthroplasty: 24-Month Results. Int J Spine Surg 2015; 9: 14
    CrossrefGoogle Scholar
  • 44 Büttner-Janz K, Guyer RD, Ohnmeiss DD. Indications for lumbar total disc replacement: selecting the right patient with the right indication for the right total disc. Int J Spine Surg 2014; 8 DOI: 10.14444/1012.
    Google Scholar
  • 45 Wong DA, Annesser B, Birney T. et al. Incidence of contraindications to total disc arthroplasty: A retrospective review of 100 consecutive fusion patients with a specific analysis of facet arthrosis. Spine J 2007; 7: 5-11
    CrossrefGoogle Scholar
  • 46 Chin KR. Epidemiology of indications and contraindications to total disc replacement in an academic practice. Spine J 2007; 7: 392-398
    CrossrefGoogle Scholar
  • 47 Aghayev E, Bärlocher C, Sgier F. et al. Five-year results of lumbar disc prostheses in the SWISSspine registry. Eur Spine J 2014; 23: 2114-2126
    CrossrefGoogle Scholar
  • 48 Rao MJ, Cao SS. Artificial total disc replacement versus fusion for lumbar degenerative disc disease: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2014; 134: 149-158
    CrossrefGoogle Scholar
  • 49 Cinotti G, David T, Postacchini F. Results of disc prosthesis after a minimum follow-up period of 2 years. Spine 1996; 21: 995-1000
    CrossrefGoogle Scholar
  • 50 Sköld C, Tropp H, Berg S. Five-year follow-up of total disc replacement compared to fusion: a randomized controlled trial. Eur Spine J 2013; 22: 2288-2295
    CrossrefGoogle Scholar
  • 51 Furunes H, Storheim K, Brox JI. et al. Total disc replacement versus multidisciplinary rehabilitation in patients with chronic low back pain and degenerative discs: 8-year follow-up of a randomized controlled multicenter trial. Spine J 2017; 17: 1480-1488
    CrossrefGoogle Scholar
  • 52 Furunes H, Hellum C, Brox JI. et al. Lumbar total disc replacement: predictors for long-term outcome. Eur Spine J 2018; 27: 709-718
    CrossrefGoogle Scholar
  • 53 Hoff EK, Strube P, Pumberger M. et al. ALIF and total disc replacement versus 2-level circumferential fusion with TLIF: a prospective, randomized, clinical and radiological trial. Eur Spine J 2016; 25: 1558-1566
    CrossrefGoogle Scholar
  • 54 Nie H, Chen G, Wang X. et al. Comparison of Total Disc Replacement with lumbar fusion: a meta-analysis of randomized controlled trials. J Coll Physicians Surg Pak 2015; 25: 60-67
    Google Scholar
  • 55 Ding F, Jia Z, Zhao Z. et al. Total disc replacement versus fusion for lumbar degenerative disc disease: a systematic review of overlapping meta-analyses. Eur Spine J 2017; 26: 806-815
    CrossrefGoogle Scholar
  • 56 Jacobs WC, van der Gaag NA, Kruyt MC. et al. Total disc replacement for chronic discogenic low back pain: a Cochrane review. Spine (Phila Pa 1976) 2013; 38: 24-36
    CrossrefGoogle Scholar
  • 57 Jacobs W, Van der Gaag NA, Tuschel A. et al. Total disc replacement for chronic back pain in the presence of disc degeneration. Cochrane Database Syst Rev 2012; 9: CD008326
    Google Scholar
  • 58 Formica M, Divano S, Cavagnaro L. et al. Lumbar total disc arthroplasty: outdated surgery or here to stay procedure? A systematic review of current literature. J Orthop Traumatol 2017; 18: 197-215
    CrossrefGoogle Scholar