Novel 360° lumbar arthroplasty: Surgical technique and procedural details

To describe the operative technique, dedicated intraoperative calibration workflow, and perioperative management protocol for 360° lumbar arthroplasty, a dual-approach, motion-preserving alternative to fusion addressing concurrent disc and facet pathology at a single lumbar level.

Conventional fusion restricts segmental motion, potentially increasing stress on adjacent levels. The combination of the Prodisc L, artificial disc replacement, and the Total Posterior System from enables circumferential reconstruction of the lumbar motion segment while preserving physiologic kinematics. A novel intraoperative calibration device allows precise alignment of the Total Posterior System to the artificial disc replacement, optimizing segmental center of rotation and motion preservation.

Patient selection, preoperative imaging, sequential anterior-posterior surgical technique, dedicated intraoperative center of rotation calibration protocol, device sizing, and postoperative rehabilitation protocols are detailed. Biomechanical validation of the calibration device is incorporated to support its clinical application.

Early results of 24 patients over 2 years are encouraging. Total VAS and ODI scores decreased by 9 (89%) and 50 (88%) points, respectively. The SF36 PCS/MCS scores increased by 63/49 (114%/100%). A total of 9 patients were discharged the same day, while 14 were sent to a post-op rehab center for 1 to 3 days. Average return to light physical activity (swimming, golfing, fencing, hiking, gym) was 4 weeks (SD2.2).

This 360° motion-preserving construct integrates validated anterior and posterior arthroplasty systems with a novel intraoperative calibration to restore both disc and facet function, representing an evolution in lumbar spine surgery.