[Keel-implants: Activ-L].

UNLABELLED

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.

OBJECTIVE

Aim of the surgery is lasting pain relief and complete restauration of segmental mobility without affection of adjacent motion segments.

INDICATIONS

Mono- or multisegmental lumbar disc degeneration leading to low-back pain, refractory to conservative treatment.

CONTRAINDICATIONS

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.

SURGICAL TECHNIQUE

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.

POSTOPERATIVE MANAGEMENT

Bed-rest for 6 hours, stabilizing physiotherapy 3 weeks postoperative.

RESULTS

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.