Artificial lumbar intervertebral disc replacement: accepted practice or experimental surgery?

Abstract

A review of the literature suggests that implanting current artificial discs for degenerative disc disease at one level of the lumbar spine is as safe and effective as fusion, but is not a substantially better procedure. There are no controlled trials of multilevel implantation, and the literature suggests that this should, therefore, be considered experimental surgery. There is evidence that adjacent levels are not protected from degeneration, and degeneration of the zygapophysial joints at the operated level may occur. The concept of motion preservation is unproven and needs to be reviewed.

Keywords::

• artificial disc
• artificial lumbar intervertebral disc replacement
• clinical outcome
• consensus opinion
• fusion
• literature review
• lumbar spine

Acknowledgements

Thanks to Professor John Evans for discussions over the years, together with Associate Professor Clayton Adam and Dr Paige Little, which led to the writing of this article.

Financial & competing interests disclosure

Thanks to Queensland University of Technology for supporting and funding my Professional Development Leave with Professor J Norberto Pires at the University of Coimbra, Portugal, where this article was written. No other financial support was received. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.