Lumbar total disc replacement part I: rationale, biomechanics, and implant types

Lumbar total disc replacement is an evolving new technology designed to preserve motion and to perhaps supplant fusion as the current "gold standard" surgical treatment for lumbar degenerative disc disease. Given the intense interest in disc replacement as a paradigm shift from fusion, this article describes the anatomy, physiology, and biomechanics of degenerative disc disease. Various treatment options and their outcomes are reviewed. A brief history of disc replacement surgery is outlined, current indications and commonly accepted contraindications for disc replacement surgery are explained, and current implants likely to be available in the United States are described. An overview of the surgical procedure is provided, with technical tips and pitfalls included. Finally, a standard postoperative regime is described.