Wiechert Karsten
Abteilung für Wirbelsäulenchirurgie, Hessingpark-Clinic, Augsburg, Germany.
Oper Orthop Traumatol. 2010 Nov;22(5-6):608-19. doi: 10.1007/s00064-010-1005-3.
Due to its modular design, the Activ-L total disc replacement (B. Braun/Aesculap, Tuttlingen, Germany) allows for a flexible anchoring concept either with spikes or one or two keels. It has a semiconstraint design which allows for some movement of a UHMWPE inlay. The minimal invasive surgical technique is highly standardized. Early clinical results are comparable to established disc-replacement devices.
Aim of the surgery is lasting pain relief and complete restauration of segmental mobility without affection of adjacent motion segments.
Mono- or multisegmental lumbar disc degeneration leading to low-back pain, refractory to conservative treatment.
Infections of vertebra or disc-space, fractures, prior fusion surgery of the affected motion segments, malignancy, osteoporosis, metabolic bone disease, severe conditions affecting general health, conditions prohibitive for anterior abdominal surgery, unclear or non-discogenic low-back-pain.
Minimal-invasive anterior approach to the lumbar spine, removal of nucleus and cartilagenous endplates, sizing with trial implant, decision about spike or keel anchoring concept, implantation of prosthesis, x ray-control, wound closure.
Bed-rest for 6 hours, stabilizing physiotherapy 3 weeks postoperative.
Level-3 evidence shows early clinical results comparable with published data from previous implants, particle wear of inlay is significantly lower, possibly due to different testing protocols.
由于其模块化设计，Activ-L全椎间盘置换术（德国图特林根市贝朗医疗/蛇牌）允许采用灵活的锚固概念，可使用钉或一或两个龙骨。它采用半限制设计，允许超高分子量聚乙烯衬垫有一定的活动度。微创手术技术高度标准化。早期临床结果与已有的椎间盘置换装置相当。
手术的目的是持久缓解疼痛并完全恢复节段活动度，同时不影响相邻运动节段。
单节段或多节段腰椎间盘退变导致腰痛，经保守治疗无效。
椎体或椎间盘间隙感染、骨折、受累运动节段既往有融合手术史、恶性肿瘤、骨质疏松、代谢性骨病、影响全身健康的严重疾病、无法进行前腹壁手术的情况、不明原因或非椎间盘源性腰痛。
采用微创前路腰椎手术，摘除髓核和软骨终板，用试验植入物进行尺寸测量，决定采用钉或龙骨锚固概念，植入假体，X线检查，关闭伤口。
术后卧床休息6小时，术后3周进行稳定的物理治疗。
3级证据表明早期临床结果与先前植入物的已发表数据相当，衬垫的颗粒磨损明显更低，可能是由于不同的测试方案。
