Operation

Minimally Invasive Surgery Performed by Highly Qualified Surgeons

Minimally invasive artificial disc replacement surgery is performed at the hospital under general anesthesia during a one-week stay at the Sana Dreifaltigkeits-Hospital in Cologne. As a rule, artificial disc replacement surgery takes between 90 and 120 minutes, depending on the location of the affected disc and the degree of degeneration.

During the surgery, the patient lies supine, and the artificial disc implantation is performed via a small incision, about six to eight centimeters (about two to three inches) in length, at the level of the disc about to be replaced. In the next step, the diseased disc is carefully exposed so that the surgeon has a clear view of the front of the spinal segment to be operated on. The anterior longitudinal ligament is opened up in such a way so that it can be closed again after the disc has been replaced.

During surgery on the cervical spine, the cervical muscles, the artery, and the veins are gently moved to the side, and the airway and esophagus are moved gently toward the center. In a lumbar spinal surgery, the spine is exposed through the lower abdomen while working around the abdominal organs.

After successful localization and exposure of the affected spinal segment, the surgeon begins to carefully remove the diseased disc using a special surgical microscope. Care is taken not to injure the spinal cord or nerve fibers that are located immediately behind the disc. The space between the vertebrae that was created by the removal of the disc is carefully enlarged with a spreader. The upper and lower parts of the vertebral end plates, which abut the natural discs, are prepared with a special instrument. This ensures that the disc implant is anchored in the correct position in the vertebrae and positioned for optimal bone ingrowth. Then a sample prosthesis is inserted to determine size and midline alignment.

In the final step, the artificial disc is inserted between the vertebral plates (intervertebral) under visual guidance from the front and radiological guidance from the side. The implant is anchored with two titanium plates. This is followed by measures to prevent excessive scar formation (adhesion prophylaxis). Thereafter, drainages are placed to remove wound exudate, and the wound is sutured. Already the day after surgery, the patient should be able to carefully get up out of bed. The patient is issued a custom-made back brace designed to limit movement during the first six weeks.

Rehabilitation

Rehabilitation After Successful Artificial Disc Replacement Surgery

After the successful implantation of a state-of-the-art artificial disc, our patients can usually get up the day after surgery, eat light meals, and carefully start walking. We use artificial discs that are manufactured and implanted according to the latest scientific findings. This provides the necessary stability and freedom from pain.

After surgery, of course, the spine must not be exposed to extreme stress. For that reason, patients stay in the hospital for another five to seven days. During that time, our highly trained nursing staff takes great care to familiarize our patients with the most important gentle exercise sequences. Patients also learn and practice the proper way to get out of bed and use the toilet.

Proper rehabilitation after artificial disc replacement surgery is crucial for successful recovery. Upon request, rehabilitation can be customized and tailored to the individual patient. Strengthening exercises, stretching exercises, and exercises for general mobility are performed under the guidance of highly qualified physical therapists in our hospital’s own rehabilitation center. During the first day of rehab, patients also receive specific treatments for pain relief, using cold, heat, or electricity.

After leaving the hospital (about one week after surgery), our patients have to be seen every day by one of our specialists, in order to check on the implant and the patient’s general health. During this timeframe, patients can continue individual rehab in our modern rehabilitation center.

For about six weeks it is necessary to wear a back brace. At about six weeks after surgery, patients should be able to go swimming or cycling. After nine to twelve weeks after surgery, patients can resume sports training but need to take care to slowly increase intensity. Patients can drive a car or ride a bicycle as soon as the abdominal scar has healed.

About two to three weeks after surgery, patients can resume office work and light physical work. Heavy physical activities should be avoided during the first twelve weeks. On average, the spine can be fully stressed after a period of three months.

Risks

Success Rates, Complications, and the Risks of Surgery

With our highly skilled, experienced surgeons and specialists, the likelihood of complications after surgery is very low. This is due to the fact that we use state-of-the-art artificial disc prostheses and the latest techniques for implantation, supported by specific rehabilitation measures tailored to the individual patient.

After any type of surgery, it is possible that pain remains. The greatest risk of artificial disc replacement surgery (10 to 15 percent) is insufficient pain relief or remaining radiating pain (5 percent). However, the likelihood that an additional surgery would become necessary is 50% less with artificial disc replacement surgery compared to spinal fusion surgery.

In about one in a hundred cases, venous thrombosis may occur. Facet joint deterioration is also possible in the long term. Inadequate bone density may cause the implant to sink in, especially in women over the age of 45 years.

Common complications that may occur after any type of surgery include infection, wound healing issues, thrombosis, or pulmonary embolism.