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#15-03 Mt. Elizabeth Medical Centre
3 Mt. Elizabeth, Singapore 228510

30+ YEARS OF SPECIALIST EXPERIENCE -
USA, CANADA, UK, SINGAPORE

AWARD WINNING SPECIALIST

BACK PAIN DIAGNOSIS AND BACK PAIN RELIEF EXPERT
LESS INVASIVE AND NO SURGERY SPINE SPECIALIST


Lumbar Spine Disc Replacement: A Comprehensive Overview

Dr Prem Pillay,
Spine Disc Replacement Expert,
Senior Spine Specialist and Neurosurgeon,
Singapore

Advantages Over Fusion

Lumbar spine disc replacement (TDR) is increasingly recognized as a viable and excellent alternative to spinal fusion for treating degenerative disc disease (DDD). One of the primary advantages of TDR over fusion is the preservation of spinal motion, which can reduce the risk of adjacent segment degeneration—a common issue with fusion procedures. TDR has been shown to result in higher patient satisfaction and lower reoperation rates compared to fusion. Additionally, TDR patients often experience greater improvements in disability indices and back pain scores.

Indications and Contraindications

TDR is typically indicated for patients with single-level lumbar DDD who have not responded to conservative treatments. It is most suitable for patients without significant facet joint arthritis or spinal deformities. Contraindications include severe osteoporosis, spinal infections, and significant spondylolisthesis (grade 2 or higher). Patients with multi-level DDD or severe facet joint degeneration may not be ideal candidates for TDR.

Types of Implants

Several types of artificial discs are used in TDR, including the Charité, ProDisc, and Flexicore discs. Each has unique design features aimed at mimicking the natural motion of the spine discs. The Charité disc has been shown to be non-inferior to traditional fusion methods in terms of clinical success. The ProDisc has demonstrated statistically significant effectiveness compared to lumbar circumferential fusion. The choice of implant often depends on the specific anatomical and clinical needs of the patient. Implants are made from several different types of materials including high grade titanium, Cobalt Chromium alloys, Ceramics, Polyethylene, PVA-BC composites.

Success Rates

The success rates of TDR are generally favorable, with many studies reporting outcomes comparable to or better than those of fusion. For instance, TDR has been associated with higher rates of clinical success and patient satisfaction at both 2-year and 5-year follow-ups. However, the overall success rates can vary depending on the specific implant used and the surgical technique.

Future Innovations

Future innovations in TDR may focus on improving implant materials and designs to enhance durability and mimic natural disc biomechanics more closely. There is ongoing research into posterior-based motion-preserving options that address both disc and facet joint pathology, potentially expanding the indications for TDR. Additionally, advancements in surgical techniques and imaging technologies may improve the precision and outcomes of TDR procedures.

Conclusion

Lumbar spine disc replacement offers several advantages over traditional fusion, including motion preservation and reduced risk of adjacent segment degeneration. While TDR is not suitable for all patients, it provides a promising alternative for those with specific indications. Continued research and innovation are likely to expand the applicability and success of TDR in the future.

References

Comparison of Lumbar Total Disc Replacement With Surgical Spinal Fusion for the Treatment of Single-Level Degenerative Disc Disease: A Meta-Analysis of 5-Year Outcomes From Randomized Controlled Trials
Total disc replacement (TDR) offers several clinical advantages over fusion for lumbar degenerative disc disease, such as greater likelihood of success, patient satisfaction, and lower risk of reoperation.
2017·69Citations·J. Zigler et al. · Global Spine Journal

Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature
Total disc replacement surgery has no clinical relevant differences with lumbar fusion techniques, and overall success rates in both treatment groups were small.
2010·221Citations·K. D. van den Eerenbeemt et al. · European Spine Journal

Lumbar disc replacement surgery—successes and obstacles to widespread adoption
Lumbar disc replacement surgery has shown satisfactory long-term results.
2017·62Citations·S. Salzmann et al. · Current Reviews in Musculoskeletal Medicine

Advanced meta-analyses comparing the three surgical techniques total disc replacement, anterior stand-alone fusion and circumferential fusion regarding pain, function and complications up to 3 years to treat lumbar degenerative disc disease
Total disc replacement (TDR) is considered the most appropriate surgical technique for treating lumbar degenerative disc disease, followed by anterior lumbar interbody fusion (ALIF).
2021·9Citations·Susanne A.J. Lang et al. · European Spine Journal

Total disc replacement compared to lumbar fusion: a randomised controlled trial with 2-year follow-up
Total disc replacement (TDR) was superior to spinal fusion in clinical outcome one year after surgery.
2009·169Citations·S. Berg et al. · European Spine Journal

A Novel Lumbar Total Joint Replacement May be an Improvement Over Fusion for Degenerative Lumbar Conditions: A Comparative Analysis of Patient-Reported Outcomes at One Year.
A novel, posterior-based lumbar total joint replacement (LTJR) showed significant improvement in back and leg pain at one year compared to TLIF for degenerative lumbar conditions.
2020·12Citations·J. Alex Sielatycki et al. · The spine journal : official journal of the North American Spine Society

A meta-analysis of artificial total disc replacement versus fusion for lumbar degenerative disc disease
TDR does not show inferiority for the treatment of lumbar DDD compared with fusion.
2010·88Citations·Wu Yajun et al. – European Spine Journal

Lumbar Disc Replacement Versus Interbody Fusion: Meta-analysis of Complications and Clinical Outcomes.
Both lumbar disc replacement (LDR) and interbody fusion (IBF) procedures offer similar results in managing lumbar disc disease, with LDR showing slightly superior back pain improvement.
2024·1Citations·Mohammad Daher et al. · Orthopedic reviews

Artificial total disc replacement versus fusion for lumbar degenerative disc disease: an update systematic review and meta-analysis.
TDR is superior in improved clinical success, reduced pain, shortened hospital stay, and operating time compared to fusion, but does not benefit from blood loss.
2018·38Citations·Yu-Zhe Li et al. · Turkish neurosurgery

Comparison of Total Disc Replacement with lumbar fusion: a meta-analysis of randomized controlled trials.
Total Disc Replacement (TDR) shows significant superiority for the treatment of lumbar Degenerative Disc Disease (DDD) compared to lumbar fusion at 2 years.
2015·31Citations·Hong-fei Nie et al. · Journal of the College of Physicians and Surgeons–Pakistan : JCPSP