Lumbar Disc Replacement

ABSTRACT

Lumbar disc replacement is a developing primary surgical treatment for patients with degenerative disc disease. The goals of disc arthroplasty are to remove the native nucleus pulposus and to preserve motion at that disc level. Devices being developed include artificial replacement of the nucleus pulposus and artificial replacement of the entire disc. With the recent approval by the Food and Drug Administration of the Charite artificial disc, this procedure will be used with increasing frequency. This article reviews pertinent anatomy and pathology of the functional spinal unit as well as the types of devices being developed and the factors related to development of a successful implant. Clinical outcomes and complications are also discussed.

KEYWORDS

Disc arthroplasty - disc replacement - artificial disc - disc degeneration - low back pain

REFERENCES

• 1 Bao Q B, McCullen G M, Higham P A, Dumbleton J H, Yuan H A. The artificial disc: theory, design and materials.  Biomaterials. 1996;  17 1157-1167
• 2 Lee C K. Accelerated degeneration of the segment adjacent to a lumbar fusion.  Spine. 1988;  13 375-377
• 3 Lehmann T R, Spratt K F, Tozzi J E et al.. Long term follow up of lower lumbar fusion patients.  Spine. 1987;  12 97-104
• 4 Schlegel J D, Smith J A, Schleusener R L. Lumbar motion segment pathology adjacent to thoracolumbar, lumbar and lumbosacral fusions.  Spine. 1996;  21 970-981
• 5 Blumenthal S L, Ohnmeiss D D, Guyer R et al.. Artificial intervertebral discs and beyond: a North American Spine Society Annual Meeting symposium.  Spine J. 2002;  2 460-463
• 6 Bono C M, Garfin S R. History and evolution of disc replacement.  Spine J. 2004;  4(6 Suppl) 145S-150S
• 7 Szpalski M, Gunzburg R, Mayer M. Spine arthroplasty: a historical review.  Eur Spine J. 2002;  11 S65-S84
• 8 Dooris A P, Goel V K, Grosland N M, Gilbertson L G, Wilder D G. Load-sharing between anterior and posterior elements in a lumbar motion segment implanted with an artificial disc.  Spine. 2001;  26 E122-E129 Available at: http://gateway1.ovid.com/ovidweb.cgi Accessed February 12, 2004; 
• 9 Link H. History, design and biomechanis of the LINK SB Charite artificial disc.  Eur Spine J. 2002;  (11 suppl 2) S98-S105
• 10 Pearcy M J, Bogduk N. Instantaneous axes of rotation of the lumbar intervertebral joints.  Spine. 1988;  13 1033-1041
• 11 Lemaire J P, Skalli W, Lavaste F et al.. Intervertebral disc prosthesis. Results and prospects for the year 2000.  Clin Orthop Relat Res. 1997;  337 64-76
• 12 Bertagnoli R, Kumar S. Indications for full prosthetic disc arthroplasty: a correlation of clinical outcome against a variety of indications.  Eur Spine J. 2002;  11(Suppl 2) S131-S136
• 13 Enker P, Steffee A, McMillin C, Kepplrt L, Biscup R, Miller S. Artificial disc replacement: preliminary report with a 3 year minimum follow-up.  Spine. 1993;  18 1061-1070
• 14 Griffith S L, Shelokov A P, Buttner-Janz K, Lemaire J P, Zeegers W S. A multicenter retrospective study of the clinical results of the link intervertebral prosthesis. The initial European experience.  Spine. 1994;  19 1842-1849
• 15 McAfee P C. The indications for lumbar and cervical disc replacement.  Spine J. 2004;  4 177S-181S
• 16 Hochschuler S H, Ohnmeiss D D, Guyer R D, Blumenthal S L. Artificial disc: preliminary results in a prospective study in the United States.  Eur Spine J. 2002;  11 S106-S110
• 17 McAfee P C, Fedder I L, Saiedy S, Shucosky E M, Cunningham B W. Experimental design of total disk replacement-experience with a prospective randomized study of the SB Charite.  Spine. 2003;  28 S153-S162
• 18 Hedman T P, Kostuik J P, Fernie G R et al.. Design of an intervertebral disc prosthesis.  Spine. 1991;  16 S256-S260
• 19 Cinotti G, David T, Postacchini F. Results of the disc prosthesis after a minimum follow up period of 2 years.  Spine. 1996;  21 995-1000
• 20 Zeegers W S, Bohnen LMI, Laaper M, Verhaegen MJA. Artificial disc replacement with the modular type SC Charite III: 2-year results in 50 prospectively studied patients.  Eur Spine J. 1999;  8 210-217
• 21 Lee CK, Goel VK. Artificial disc prosthesis: design concepts and criteria.  Spine J. 2004;  4 209S-218S
• 22 Carl A, Ledet E, Yuan H, Sharan A. New developments in nucleus pulposus replacement technology.  Spine J. 2004;  4 325S-329S
• 23 Sieber A N, Kostiuk J P. Concepts in nuclear replacement.  Spine J. 2004;  4 322S-324S
• 24 Eijkelkamp M F, van Donkelaar C C, Veldhuizen A G, van Horn J R, Huyghe J M. Requirements for an artificial intervertebral disc.  Int J Artif Organs. 2001;  24 311-321
• 25 Eijkelkamp M F, Hyen J, Veldhuizen A G, van Horn J R, Verkerke G J. Improving the fixation of an artificial intervertebral disc.  Int J Artif Organs. 2002;  25 327-333
• 26 Van Ooij A, Oner F C, Verbout A J. Complications of artificial disc replacement a report of 27 patients with the SB Charite disc.  J Spinal Disord. 2003;  16 369-383
• 27 FDA approves artificial disc; another alternative to treat low back pain. Available at: http://www.fda.gov/bbs/topics/ANSWERS/2004/ANS01320.html Accessed January 4, 2005
• 28 Errico T J. Why a mechanical disc?.  Spine J. 2004;  4 151S-157S
• 29 Zigler J E. Lumbar spine arthroplasty using the ProDisc II.  Spine J. 2004;  4 260S-267S
• 30 Mathews H H, LeHuec J C, Friesem T, Zdeblick T, Eisermann L. Design rationale and biomechanics of Maverick Total Disc arthroplasty with early clinical results.  Spine J. 2004;  4 268S-275S
• 31 Valdevit A, Errico T J. Design and evaluation of the FlexiCore metal-on-metal intervertebral disc prosthesis.  Spine J. 2004;  4 276S-288S
• 32 Guyer R D, McAfee P C, Hochschuler S H et al.. Prospective randomized study of the Charite artificial disc: data from two investigational centers.  Spine J. 2004;  4 252S-259S
• 33 McAfee P C, Cunningham B W, Devine J, Williams E, Yu-Yahiro J. Classification of heterotopic ossification (HO) in artificial disk replacement.  J Spinal Disord Tech. 2003;  16 384-389