Related Experiment Video
Updated: Jun 2, 2026
11:30
Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
Published on: July 25, 2025
On total disc replacement.
1Stockholm Spine Center, Löwenströmska Hospital, SE-194 89 Upplands Väsby, Sweden. svante.berg@spinecenter.se
Acta Orthopaedica. Supplementum
|May 6, 2011
Summary
Total Disc Replacement (TDR) offers comparable or better outcomes than spinal fusion for chronic low back pain. TDR patients reported less pain and quicker recovery, justifying its use in selected cases.
Area of Science:
- Spine surgery outcomes
- Degenerative disc disease treatment
- Biomechanical engineering in orthopedics
Background:
- Chronic low back pain (CLBP) from degenerative disc disease (DDD) significantly impacts quality of life and healthcare resources.
- Spinal fusion is a common treatment for severe DDD, but adjacent segment disease (ASD) remains a concern.
- Total Disc Replacement (TDR) has emerged as an alternative aiming to preserve spinal mobility and reduce ASD risk.
Purpose of the Study:
- To compare the clinical outcomes, complications, sexual function, spinal mobility, and health economics of Total Disc Replacement (TDR) versus posterior spinal fusion.
- To evaluate the efficacy and safety of TDR as a treatment for degenerative disc disease causing chronic low back pain.
Main Methods:
- Randomized controlled trial involving 152 patients (aged 20-55) with DDD treated with either posterior fusion or TDR.
- Four sub-studies assessed clinical outcomes, complications, sexual function, lumbar spine mobility (X-ray analysis), and health economics.
- Follow-up was conducted at one and two years post-surgery.
Main Results:
- Both TDR and fusion improved patient outcomes, with TDR showing superior results in most scores at one year and significantly more patients being totally pain-free at two years (30% TDR vs. 15% fusion).
- TDR surgery and hospital stays were shorter; no significant difference in complications or reoperations, except for fusion implant removal in 17 patients.
- TDR showed no retrograde ejaculation complications; fusion group reported decreased orgasm ability. Both groups experienced improved sexual function correlating with pain reduction. TDR maintained mobility while fusion achieved non-mobility goal. TDR was more cost-effective with shorter sick leave.
Conclusions:
- Total Disc Replacement (TDR) provides comparable or superior short-term results to spinal fusion for degenerative disc disease, with a higher rate of complete pain relief.
- TDR is associated with reduced surgical time, hospital stay, and sick leave, and avoids specific complications like retrograde ejaculation seen with anterior approaches.
- The findings support the use of TDR in selected patients with DDD, though long-term follow-up data is still pending.
Related Concept Videos
01:27Degenerative Disc Disease I: Introduction
Degenerative disc disease is a chronic condition in which intervertebral discs gradually lose structure and function. It is not infectious or autoimmune; rather, it results from age-related biochemical and mechanical changes, influenced by genetic, metabolic, and environmental factors.Structure and Function of DiscsThe spine contains 23 intervertebral discs that absorb load, distribute forces, maintain spacing, and allow flexibility. Each disc consists of a nucleus pulposus, a gel-like core...
01:23Degenerative Disc Disease ll: Pathophysiology
The symptoms of degenerative disc disease arise from a combination of mechanical compression, vascular compromise, and biochemical inflammation, which together disrupt nerve function and produce pain.Mechanical CompressionDisc degeneration reduces height and elasticity, predisposing to herniation of the nucleus pulposus, a major cause of radicular pain. Herniations may be protrusion (bulging with intact annulus), extrusion (nucleus extends beyond disc but remains connected), or sequestration...
01:29Herniated Intervertebral Disc l: Introduction
Intervertebral disc herniation refers to the displacement of the nucleus pulposus (the gel-like inner core of the disc) through a tear or weakened area in the annulus fibrosus (the outer fibrous ring). The displaced disc material extends beyond the normal boundaries of the disc space and may compress or irritate nearby spinal nerve roots or, less commonly, the spinal cord.Etiology and Risk FactorsHerniation commonly results from degeneration, in which aging reduces disc hydration and...