Lumbar Total Disc Arthroplasty: State of the Data

The objective of this study is to evaluate the effectiveness and safety of total disc replacement surgery compared with spinal fusion in patients with symptomatic lumbar disc degeneration. Low back pain (LBP), a major health problem in Western countries, can be caused by a variety of pathologies, one of which is degenerative disc disease (DDD). When conservative treatment fails, surgery might be considered. For a long time, lumbar fusion has been the “gold standard” of surgical treatment for DDD. Total disc replacement (TDR) has increased in popularity as an alternative for lumbar fusion. A comprehensive systematic literature search was performed up to October 2008. Two reviewers independently checked all retrieved titles and abstracts, and relevant full text articles for inclusion. Two reviewers independently assessed the risk of bias of included studies and extracted relevant data and outcomes. Three randomized controlled trials and 16 prospective cohort studies were identified. In all three trials, the total disc replacement was compared with lumbar fusion techniques. The Charité trial (designed as a non-inferiority trail) was considered to have a low risk of bias for the 2-year follow up, but a high risk of bias for the 5-year follow up. The Charité artificial disc was non-inferior to the BAK® Interbody Fusion System on a composite outcome of “clinical success” (57.1 vs. 46.5%, for the 2-year follow up; 57.8 vs. 51.2% for the 5-year follow up). There were no statistically significant differences in mean pain and physical function scores. The Prodisc artificial disc (also designed as a non-inferiority trail) was found to be statistically significant more effective when compared with the lumbar circumferential fusion on the composite outcome of “clinical success” (53.4 vs. 40.8%), but the risk of bias of this study was high. Moreover, there were no statistically significant differences in mean pain and physical function scores. The Flexicore trial, with a high risk of bias, found no clinical relevant differences on pain and physical function when compared with circumferential spinal fusion at 2-year follow up. Because these are preliminary results, in addition to the high risk of bias, no conclusions can be drawn based on this study. In general, these results suggest that no clinical relevant differences between the total disc replacement and fusion techniques. The overall success rates in both treatment groups were small. Complications related to the surgical approach ranged from 2.1 to 18.7%, prosthesis related complications from 2.0 to 39.3%, treatment related complications from 1.9 to 62.0% and general complications from 1.0 to 14.0%. Reoperation at the index level was reported in 1.0 to 28.6% of the patients. In the three trials published, overall complication rates ranged from 7.3 to 29.1% in the TDR group and from 6.3 to 50.2% in the fusion group. The overall reoperation rate at index-level ranged from 3.7 to 11.4% in the TDR group and from 5.4 to 26.1% in the fusion group. In conclusion, there is low qu...

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“…major vascular injury, major nerve root damage and device failure. However, these complication rates are low [ 9 , 17 , 79 , 80 ].…”

Section: Discussionmentioning

confidence: 99%

“…Since that time, multiple disc replacement prostheses have been designed for use in the lumbar spine. A large majority would never be implanted in humans [ 4 , 10 , 17 ]. The first prosthesis designed to be commercially distributed as an artificial disc was initiated in 1982 by Schellnack and Buttner-Janz.…”

Section: Introductionmentioning

confidence: 99%

Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature

et al. 2010

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“…Current research in tissue engineering is investigating biomimetic approaches to replicate the lamellar struc ture and induce regeneration [28]; however, the avascular nature of this region and the low technology readiness level of existing research strategies mean that these approaches Spinal fusion aims to reduce pain by restricting the motion of the affected vertebral segment(s), but postoperative biomechanical alterations can result in loss of normal range of motion, reduced shock absorption, instability, and spinal misalignment [15][16][17]. These changes in turn cause abnormal stress/strain and increased intradiscal pressure in the adjacent segments [16,18]. Ultimately this can lead to degeneration in IVDs adjacent to the fused segment(s).…”

Section: The Importance Of Annular Closurementioning

confidence: 99%

“…Spinal fusion aims to reduce pain by restricting the motion of the affected vertebral segment(s), but postoperative biomechanical alterations can result in loss of normal range of motion, reduced shock absorption, instability, and spinal misalignment [ 15 , 16 , 17 ]. These changes in turn cause abnormal stress/strain and increased intradiscal pressure in the adjacent segments [ 16 , 18 ]. Ultimately this can lead to degeneration in IVDs adjacent to the fused segment(s).…”

Section: Introductionmentioning

confidence: 99%

Lumbar Intervertebral Disc Herniation: Annular Closure Devices and Key Design Requirements

et al. 2022

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Lumbar disc herniation is one of the most common degenerative spinal conditions resulting in lower back pain and sciatica. Surgical treatment options include microdiscectomy, lumbar fusion, total disc replacement, and other minimally invasive approaches. At present, microdiscectomy procedures are the most used technique; however, the annulus fibrosus is left with a defect that without treatment may contribute to high reherniation rates and changes in the biomechanics of the lumbar spine. This paper aims to review current commercially available products that mechanically close the annulus including the AnchorKnot® suture-passing device and the Barricaid® annular closure device. Previous studies and reviews have focused mainly on a biomimetic biomaterials approach and have described some mechanical and biological requirements for an active annular repair/regeneration strategy but are still far away from clinical implementation. Therefore, in this paper we aim to create a design specification for a mechanical annular closure strategy by identifying the most important mechanical and biological design parameters, including consideration of material selection, preclinical testing requirements, and requirements for clinical implementation.

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Total disc replacement for chronic back pain in the presence of disc degeneration

Jacobs

Gaag

Tuschel

et al. 2012

Cochrane Database of Systematic Reviews

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Lumbar Total Disc Arthroplasty: State of the Data

Cited by 4 publications

References 49 publications

Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature

Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature

Lumbar Intervertebral Disc Herniation: Annular Closure Devices and Key Design Requirements

Total disc replacement for chronic back pain in the presence of disc degeneration

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