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Lumbar total disc replacement compared with spinal fusion: treatment choice and evaluation of outcome

Nature Clinical Practice Neurology volume 1, pages 4–5 (2005)Cite this article

Degenerative disc disease affects up to 40% of all patients with low back pain. It can lead to spinal instability; that is, the inability of the spine to limit excessive or abnormal spinal displacement. The conventional treatment for a severely degenerated disc that has not responded to conservative treatment is spinal fusion. The various techniques that are used aim to stop the pathological (abnormal) motion between two vertebrae, but this can decrease the spine's overall range of motion, thereby increasing the stress applied to the adjacent discs. The goal of artificial disc replacement is to retain motion at the operative level once the damaged disc has been removed. This theoretically protects the discs at adjacent levels from additional stress and, ultimately, from degeneration.

Spinal fusion was first described by Albee1 for the treatment of spinal tuberculosis, and by Hibbs2 for the management of deformity. Over the past 40 years, lumbar spinal fusion has become the standard of care in the management of several pathologic conditions, including spondylolisthesis, facet joint problems, spinal trauma, and spinal deformities such as scoliosis. In 1947, Barr3 postulated that persistent low back pain after disc excision resulted from structural weakness, and lumbar spinal fusion became a popular treatment for chronic low back pain.

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Authors and Affiliations

  1. fellow of the Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada

    Daniel Shedid

  2. resident in the Department of Neurosurgery at the Cleveland Clinic Foundation, Cleveland, OH, USA

    Kene T Ugokwe

  3. the Chairman of the Cleveland Clinic Spine Institute and Vice-Chairman of the Department of Neurosurgery at The Cleveland Clinic Foundation, Cleveland, OH, USA

    Edward C Benzel

Authors
  1. Daniel Shedid
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  2. Kene T Ugokwe
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  3. Edward C Benzel
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Corresponding author

Correspondence to Edward C Benzel.

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Competing interests

Edward Benzel is a shareholder and advisor/developer for AxioMed Spine Corporation and OrthoMEMS, and a consultant and developer for DePuy and Abbott.

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Shedid, D., Ugokwe, K. & Benzel, E. Lumbar total disc replacement compared with spinal fusion: treatment choice and evaluation of outcome. Nat Rev Neurol 1, 4–5 (2005). https://doi.org/10.1038/ncpneuro0018

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