Outcomes of CHARITE Lumbar Artificial Disk versus Fusion: 5-Year Data

Lumbar total disk replacement (TDR) has been used for the treatment of painful disk degeneration since the 1980s. Not until the Food and Drug Administration (FDA) regulated trials in the United States initiated in 2000 had there been formal prospective randomized trials evaluating the results of this technology compared with fusion, the traditional surgical treatment for disk degeneration. The purpose of this article was to provide a commentary on the results of the 5-year follow-up of CHARITÉ artificial disk (DePuy Spine, Raynham, MA) published by Guyer et al (Spine J 9:374-386, 2009) and to comment on this work in the context of other TDR literature. In the study, results of TDR using the CHARITÉ artificial disk, were compared with those of anterior lumbar interbody fusion (ALIF) with BAK cages and iliac crest autograft, for the treatment of single-level degenerative disk disease from L4 to S1. The results of the 5-year, prospective, randomized multicenter study were consistent with the 2-year outcomes. The TDR group had improved functional outcomes based on visual analog pain scales, Oswestry Disability Index, and the SF-36 Physical component scores. CHARITÉ patients reached a greater rate of part- and full-time employment and a statistically lower rate of long-term disability compared with ALIF patients. Radiographically, the range of motion at the index and adjacent levels was maintained. The incidence of adjacent level degeneration was lower for TDR than in the fusion group. The results of this study indicate that TDR with the CHARITE produced results similar or superior to ALIF at 5-year follow-up.