Technical factors for inserting a « Charité » type lumbar disc prosthesis

The implantation of a « Charite » prosthesis has to be solved through a biomechanical compromise between the size of the implants and it’s positioning in the intervertebral space. A retroperitoneal approach allows one to minimise complications and especially to see and protect the hypogastric nerve. Generally, the anatomy of the great vessels offers a wide approach on the anterior aspect of the disc, except in the case of a high bifurcation of the vena cava with a left iliac vena outside and over the iliac artery and having a straight downwards direction. This situation is infrequent, 1 for 1,000 anterior approaches in our experience.