Lumbar disc arthroplasty

Last revised by Yahya Baba on 23 Aug 2021

Citation, DOI, disclosures and article data

Citation:

Rahman F, Baba Y, Lumbar disc arthroplasty. Reference article, Radiopaedia.org (Accessed on 24 Apr 2024) https://doi.org/10.53347/rID-91760

DOI:

https://doi.org/10.53347/rID-91760

Permalink:

https://radiopaedia.org/articles/91760

rID:

91760

Article created:

1 Aug 2021, Faiyaz Rahman

Disclosures:

At the time the article was created Faiyaz Rahman had no recorded disclosures.

View Faiyaz Rahman's current disclosures

Last revised:

23 Aug 2021, Yahya Baba ◉

Disclosures:

At the time the article was last revised Yahya Baba had no recorded disclosures.

View Yahya Baba's current disclosures

Revisions:

2 times, by 2 contributors - see full revision history and disclosures

Systems:

Musculoskeletal, Spine

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.

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.

Procedure

Positioning

The procedure is performed with the patient generally placed in a supine position with limbs abducted ³.

Technique

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

Complications that may arise for this procedure are as follows ^1,2:

intraoperative:
- damage to anatomical structures (vascular or neural)
- vertebral fractures
postoperative:
- heterotopic ossification
- pseudoarthrosis

Outcomes

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.