Nubac disc arthroplasty via the posterior approach. Technical note

The author describes the details of Nubac disc arthroplasty via the posterior approach and discusses indications, limitations and benefits of this procedure. This surgical technique provides the following main steps: 1) patient positioning in a prone-kneeling position; 2) subperiosteal exposure of the index interlaminar space; 3) limited laminotomy (involving both the inferior edge of the hemilamina above and the superior edge of the hemilamina below), resection up to the medial one third of the facet joint, and partial flavectomy; 4) minimum nerve root retraction; 5) removal of eventual free disc fragments and annular cutting to obtain a small window (4 mm x 6 mm) through the annulus; 6) total nucleus pulposus evacuation; 7) annular window dilatation; 8) trial spacer implant sizing; 9) implant insertion into the disc cavity. Nubac disc arthroplasty via the posterior approach can be recommended for patients suffering from degenerative disc disease with disc herniation at L4-L5 and/or L5-S1 in order to relieve the back pain and to delay or to prevent disc degeneration progression status postdiscectomy. A middle height of the index disc of at least 5 mm is prerequisite for performing nucleus replacement.