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The Decline of Lumbar Artificial Disc Replacement
Tony Eskandar1, Zubair Ahmed1, Jeremy Pan1
1Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766, USA.
Journal of Spine Research and Surgery
|September 13, 2024
Summary
Spinal fusion is increasingly common for degenerative disc disease despite risks. Narrow patient selection and poor insurance reimbursement are limiting artificial disc replacement options.
Area of Science:
- Orthopedics
- Neurosurgery
- Spinal Surgery
Background:
- Degenerative disc disease (DDD) commonly causes lower back pain, leading to surgical interventions.
- Current surgical options include discectomy with spinal fusion or artificial disc replacement (ADR).
- Lumbar spinal fusion is becoming more prevalent than ADR, despite potential risks like adjacent segment disease.
Purpose of the Study:
- To investigate factors influencing the declining use of lumbar artificial disc replacement (LADR).
- To assess the impact of selection criteria, clinical outcomes, surgical technique, complications, revision rates, and costs on LADR adoption.
- To understand the reasons behind the increasing preference for spinal fusion over LADR.
Main Methods:
- Literature review and analysis of factors influencing surgical decisions for DDD.
- Assessment of lumbar ADR selection criteria, clinical outcomes, and surgical techniques.
- Evaluation of complication rates, revision burden, and overall economic impact of LADR versus spinal fusion.
Main Results:
- While clinical outcomes and surgical factors play a role, they are not the primary drivers for the decline in LADR.
- Narrow patient selection criteria significantly limit the applicability of LADR.
- Lack of adequate cost reimbursement from insurance providers is a major barrier to LADR utilization.
Conclusions:
- The declining use of lumbar artificial disc replacement is primarily attributed to restrictive patient selection criteria and inadequate insurance coverage.
- These factors outweigh the potential benefits of ADR, such as increased range of motion and reduced adjacent segment disease risk.
- Future trends may depend on expanding indications and improving economic viability for LADR.
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