Prosthetic lumbar intervertebral disc replacement

The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Prosthetic intervertebral disc replacement in Nocember 2004. This Guidance is currently under review.

The Interventional Procedures Advisory Committee (IPAC) will consider it and NICE will issue an Interventional Procedures Consultation Document about its safety and efficacy for 4 weeks public consultation. IPAC will then review the consultation document in the light of comments received and produce a Final Interventional Procedures Document, which will be considered by NICE before guidance is issued to the NHS in England, Wales, Scotland and Northern Ireland.

In the meantime, the NHS should continue to follow the recommendations in the guidance below.

If you wish to be alerted to developments regarding this procedure, including the release of the consultation document, please express your interest at the top of the page.

This procedure is used to treat:

• Herniated lumbar intervertebral disc
• Degenerative disc disease in lumbar region (typically L4-L5 or L5-S1)
• Post-laminectomy syndrome at either L4-L5 or L5-S1
• Patients with low back pain refractory to conservative treatment for more than six months 
• Patients currently considered suitable for spinal fusion surgery

Artificial  intervertebral discs have been developed to act as a functional prosthetic replacement unit for intervertebral units in much the same way as prostheses have been developed for a variety of joints such as the hip or knee. The design of most prosthetic discs is similar, with two metallic endplates separated by a more pliable inner core designed to emulate the biomechanical properties of the nucleus pulposus. The implantation of the prosthetic discs involves a small incision below the umbilicus. The diseased disc is partially or fully excised (depending on the prosthesis used). The vertebral endplates and surrounding spinal ligaments are preserved and help maintain implant stability. Single discs can be replaced, or alternatively, several levels can be replaced during the same surgery. 

The standard intervention for patients with these indications would be discectomy and spinal fusion.

Other (see guidance)

Musculoskeletal
Surgical procedures

Trauma and orthopaedic surgery

• British Association of Spinal Surgeons
• British Orthopaedic Association
• British Society of Neurological Surgeons

Interventional Procedures Programme
National Institute for Health and Clinical Excellence
MidCity Place
71 High Holborn
London
WC1V 6NA