The present invention provides an intervertebral prosthesis generally defining a first wall, a second wall, sidewalls extending from the first wall to the second wall, and an upper surface and a lower surface. One or more passages may be included providing for an affixation element, to be inserted therethrough. The passages may each include a first portion for receiving a head or tip of an affixation element, and a second portion of a smaller diameter, where a substantial amount of the second portion of the passage located above or below a midline of the prosthesis. One or more openings may also be provided on the spinal prosthesis for coupling the prosthesis to a surgical tool, and the upper and lower surfaces of the prosthesis may include a depression or portion void of any teeth for the insertion of the prosthesis where a distraction tool is situated about the surgical site.