Professor MD Thomas Gösling
Vertebral joints prosthetic is comparatively new area of development of spinal surgery. Quite long it was rather questionable: can vertebrae be replaced? Experiments with some metal devices supporting the spine were known as early as beginning of 20th century but first principally new approach was implemented – though in horses – in 1977 by George Bagby, a creator of so called “Bagby Basket”, a perforated steel cylinder that was used for horse spine stabilization. It could be regarded as success but the death rate was about 20%.
Nevertheless, in 1996 improved “Bagby Basket” made of titanium was approved for use in humans. Then, one year later, first expandable case was presented. Today, vertebral prosthesis are still rare but in some complex cases involving severe injuries of the spine and other heavy vertebral body damages, vertebra replacement can be beneficial.
The conditions when vertebra replacement may be considered are bad spine fractures, tumors of the spine and some degenerative diseases.
When a vertebra is completely malfunctioning, replacement surgery can be an option. The most severe fracture of the vertebra is a burst fracture when vertebra is literally bursting into pieces that are often sharp and pierce to surrounding tissues. It could happen in traffic accident or at fall from the height. Those who have the burst fracture of vertebra are the first candidates for replacement surgery, especially, when neurological issues are involved. The surgeons of Trauma and Orthopedics Surgery Clinic and Neurosurgery Department work together to give emergency service for those who are in urgent need of surgery.
Another more common kind of the spinal injuries is a compression fracture which happens of vertical loads. As a rule, the back side of the vertebral body stays intact but the front part can be collapsed. Thereat, when surgery for compression fracture is needed, it is performed from anterior approach. Thoracic region is more likely location for compression fracture and access for surgery is done via incision in the rib cage.
Sometimes tumor can destroy vertebral body and, then, after removal of the tumor, surgery of vertebral replacement may be considered.
The vertebra replacement surgery is a complex procedure that required more than 6 hours. It is normally divided for the two main parts:
As it was mentioned before, anterior approach is the most convenient for replacement surgery as it gives better access and more space. After the fractured or diseased vertebra is removed together with intervertebral disks and all the pieces of fractured bones are cleaned, the screws are inserted into the healthy vertebras on the both side. After that, an implant filled with bone graft material is accurately placed in the space in the spine.
The anatomy and shape of vertebras along the spine column differ and, accordingly, there is a variety of vertebral implants. Normally, artificial vertebras are made of titanium. The common form is a vertebral body replacement cage. The cage can be non-expandable, with fixed sizes tailored for the patient and expandable that has a room for adjustment. The both show good results and additional studies are needed which is more beneficial. Currently, it is preference of a surgeon what to use.
The bone graft is used to provide natural bone growing around the implant placed. It takes from 3 months to a half of year to finish the process.
Based on spinal region, the following vertebra replacement procedures are recognized
The main risk of the vertebra replacement is that artificial vertebra may collapse. The surgery does not have long statistics and it is still not enough material for detailed research. Some patients had vertebra replacement claimed that it has tendency to collapse.
The other risks are common for different types of surgery including
Please contact our spine surgeons to learn more on progressive method of vertebra replacement. If you are deciding on treatment for your spine, ask our doctors what is better treatment for you. Our trauma surgeon MD Ernst Rzesacz has extended experience both of emergency and planned surgery on the spice, while our neurosurgeons are ready to care the patients with related neurological problems. We have individual decision for every patient.