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

Mark J Pearcy¹

¹Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia. m.pearcy@qut.edu.au

Expert Review of Medical Devices

|November 6, 2010

Summary

Artificial disc replacement for lumbar degenerative disc disease is safe and effective as fusion, but not superior. Multilevel implantation is experimental, and motion preservation remains unproven.

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Area of Science:

Spine surgery
Biomaterials
Orthopedics

Background:

Degenerative disc disease (DDD) is a common cause of low back pain.
Artificial disc replacement (ADR) aims to preserve motion compared to spinal fusion.
Current literature provides limited data on multilevel ADR.

Purpose of the Study:

To review the current literature on the safety and efficacy of artificial disc implantation for lumbar degenerative disc disease.
To evaluate the evidence for single-level versus multilevel ADR.
To assess the long-term outcomes and concept of motion preservation with ADR.

Main Methods:

Literature review of existing studies on lumbar artificial disc replacement.
Analysis of safety and efficacy data for single-level ADR compared to spinal fusion.

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Assessment of evidence regarding multilevel ADR and adjacent segment degeneration.

Main Results:

Single-level ADR is as safe and effective as spinal fusion for lumbar DDD, but not substantially better.
No controlled trials exist for multilevel ADR, suggesting it is experimental.
Adjacent segment degeneration and zygapophysial joint degeneration at the operated level may occur.
The concept of motion preservation with ADR is not yet proven.

Conclusions:

Single-level ADR is a viable alternative to fusion for lumbar DDD.
Multilevel ADR should be considered experimental surgery due to lack of evidence.
Further research is needed to validate the long-term benefits of motion preservation and address potential complications.