Degenerative disc disease
Degeneration of one or several lumbar disc leads to the failure of the intervertebral disc to achieve its main functions: shock absorption and stability.
This can be responsible for low back pain.
Several grades of degeneration are described. The Pfirmann classification is most commonly used.
Sometimes, inflammation may also be present around the degenerative disc. It is referred to as a Modic I sign.
When the medical treatment with painkillers, rehabilitation, and infiltrations fails to provide effective pain control, the surgical treatment can be discussed.
The surgical treatment consist of performing a spinal fusion at the index level or performing an arthroplasty (motion preservation device).
Lumbar disc replacement
The lumbar disc replacement preserves the mobility between two vertebra, unlike a fusion.
The prosthesis is an implant that is inserted in between two vertebra, filling in for the degenerative disc that is removed. Lumbar disc replacement are done through an anterior lumbar approach.
Several types of prosthesis are available and used:
- Mechanical disc prosthesis (Mobidisc, Prodisc): two metallic endplates with a polyethylene space in between.
- Viscoelastic disc prosthesis (ESP): two metallic endplates bound together by a viso elastic structure, offering a vertical load absorption capacity, like a cushion.
By keeping the motion at the operated level, it reduces the stress on the adjacent discs.
Total disc replacement must not be performed when the facet joints are degenerative. Mobility on arthritic joints would lead to pain.
Fusion through anterior approach (ALIF: Anterior lumbar interbody fusion)
Arthrodesis is the fusion between two or more vertebra.
When performed through an anterior approach, the intervertebral disc is removed from the front.
An intervertebral body device called a “cage” is placed between the two vertebra along with a bone graft.
The anterior approach spares the posterior spinal muscles, allows for a greater bone graft, and a better lordosis restoration.
Preoperative
Postoperative
Fusion through posterior approach (TLIF: Transforaminal Lumbar Interbody Fusion)
Arthrodesis is the fusion between two or more vertebra.
When performed through a posterior approach, screws are placed in the vertebra and are linked with a rod to stabilize the spine segment.
A bone grafting is performed to allow bone healing.
Fusion through posterior approach (TLIF: Transforaminal Lumbar Interbody Fusion)
Arthrodesis is the fusion between two or more vertebra.
When performed through a posterior approach, screws are placed in the vertebra and are linked with a rod to stabilize the spine segment.
A bone grafting is performed to allow bone healing.
Fusion through lateral approach (OLIF: Oblique Lumbar Interbody Fusion)
Arthrodesis is the fusion between two or more vertebra.
When performed through a lateral approach, the intervertebral disc is removed from the side.
An intervertebral body device called a “cage” is placed between the two vertebra along with a bone graft.
The lateral allows for a greater bone graft, and spares the posterior spinal muscles.
