Disc arthroplasty in the management of the painful lumbar motion segment.

STUDY DESIGN: A review of the published literature regarding lumbar arthroplasty.

OBJECTIVE: To describe the current state of lumbar total disc replacement and, in particular, the recent clinical results of the Charité and ProDisc trials.

SUMMARY OF BACKGROUND DATA: Lumbar fusion remains the surgical procedure of choice for patients with chronic low back pain unresponsive to nonsurgical management. Lumbar fusion is a strictly palliative procedure with suboptimal clinical results obtained by a significant proportion of patients. Adjacent segment disease is thought to limit the long-term clinical results with up to 20% of patients requiring secondary surgical interventions within the decade following a "successful" lumbar fusion. Total disc replacement has been developed as a potential means to improve the long-term outcome of these patients.

METHODS: Literature review of total lumbar disc replacement.

RESULTS: The surgical decision-making process, a description of current lumbar disc arthroplasty devices, and early clinical results are described.

CONCLUSION: In appropriately chosen patients, lumbar disc arthroplasty provided clinical results similar to those obtained with interbody fusion at 2 years. The long-term results with respect to the effect of these devices on adjacent segment degeneration are not known, as the incidence of adjacent segment degeneration is not an endpoint of the current trials.