What is the rationale for lumbar total disc arthroplasty

Lumbar fusion for axial pain is an option for treatment of symptomatic degenerative disease refractory to nonsurgical treatments. Results following fusion surgery may be unsatisfactory due to persistent pain despite achievement of a radiographically healed fusion or as a result of procedure-related complications. The rationale for development of lumbar total disc replacement (TDR) as an alternative surgical procedure was based on the following principles:

• Avoid the negative effects associated with lumbar fusion (e.g. pseudarthrosis, need for additional procedures for implant removal, bone graft donor site problems, adjacent segment problems)

• Protect adjacent levels from iatrogenically accelerated degeneration

• Provide improved treatment outcomes with respect to relief of low back pain

• Enhance postoperative recovery (earlier return to work and activity, avoid use of spinal orthoses)

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