Lumbar disc arthroplasty
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Lumbar disc arthroplasty is a procedure involving the replacement of lumbar intervertebral discs with artificial discs to manage lower back pain.
Similar to its cervical counterpart (cervical disc arthroplasty), it is an alternative to fusion procedures as a means of maintaining an increased range of motion as well as avoiding adjacent segment degeneration 1.
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The most common indication for lumbar disc arthroplasty is lower back pain that is secondary to degenerative disc disease and is refractory to conservative therapy. Furthermore, although recommendations on the age range vary, patients should generally be aged between 18-60 years old 2.
Lumbar disc arthroplasty is used in a more limited patient population compared to lumbar fusion. This occurs as a consequence of a greater range of contraindications that are present for this procedure. Contraindications can include osteoporosis or osteopaenia, spinal stenosis or spinal deformities such as scoliosis 2.
The procedure is performed with the patient generally placed in a supine position with limbs abducted 3.
This procedure is most commonly performed with an anterior incision of the abdomen at the level of the target disc. Both retroperitoneal and transperitoneal approaches are feasible though the former is generally preferred, with dissection utilized to access the vertebral column. The diseased intervertebral disc is subsequently resected and the site of implantation is prepared. Trial implants of varying sizes are introduced to identify the appropriate prosthesis size. Following this, an implant of the selected size is introduced 3.
Complications that may arise for this procedure are as follows 1,2 :
- damage to anatomical structures (vascular or neural)
- vertebral fractures
- heterotopic ossification
The procedure is associated with a success rate of 76.9% based on a 10-year follow-up. Though it has been suggested to be associated with superior outcomes compared to lumbar fusion, its more limited patient population contributes to its comparatively more infrequent use 4.
- 1. Sandhu Faheem A, Ehsan Dowlati and Rolando Garica. "Lumbar Arthroplasty: Past, Present, and Future". Neurosurgery 86, no. 2 (2019): 155-169. . doi:10.1093/neuros/nyz439.
- 2. Abi-Hanna David, Jack Kerferd and Kevin Phan et al. "Lumbar Disk Arthroplasty for Degenerative Disk Disease: Literature Review". World Neurosurgery 109 (2018): 188-196. . doi:10.1016/j.wneu.2017.09.153.
- 3. Tropiano Patrick, Russel C. Huang and Federico P. Girardi et al. "Lumbar Total Disc Replacement". Journal of Bone and Joint Surgery 88, no. 1 (2006): 50-64. . doi:10.2106/jbjs.e.01066.
- 4. Saifi Comron, Alejandro Cazzulino and Caroline Park et al. "National Trends for Primary and Revision Lumbar Disc Arthroplasty Throughout the United States". Global Spine Journal 8, no. 2 (2017): 172-177. . doi:10.1177/2192568217726980.