[The disc prosthesis: myths and facts]

The results of surgical treatment of degenerative low-back conditions by means of a fusion (spondylodesis) are in general less predictable than operative treatments for arthrosis of the (large) peripheral joints. Recently, new techniques of disc replacement have been developed as an alternative to traditional fusion operations. The most important theoretical advantage is the prevention of adjacent segment degeneration in the longer term. Because the disc prosthesis replaces the presumably painful intervertebral disc--just as an intercorporal fusion--the short-term results are expected to be comparable to ventral fusion. The results with a short follow-up period described in the literature are comparable to those published for spondylodesis. However, disc prosthesis requires a more extensive approach and therefore more serious complications are to be expected. In the longer term, prosthesis-related complications can be expected because these prostheses are used in young and active patients. Despite 15 years of small-scale experience in some European countries, there is a lack of reliable information about the middle and long-term performance of these prostheses in the peer-reviewed literature. Therefore, these implantations should be regarded as experimental procedures and should be confined to clinical trials in centres with sufficient experience in the operative treatment of degenerative low-back conditions as well as the necessary infrastructure to follow up these usually young patients in a scientifically responsible manner over a period of decades. These centres should also have the expertise necessary to adequately deal with the possible complications.