Lumbar Disc Replacement: Where Are We in 2007?

A number of options exist for patients with intractable back pain and degenerative disc disease (DDD). Total lumbar disc replacement procedures confer advantages of motion preservation with potentially lower adjacent segment degeneration rates. While lumbar total disc replacement systems have been employed for decades abroad, they have been widely available in North America for the last 5 years or so. Disc replacement procedures have failed to achieve the popularity initially predicted. Insurers claim reluctance to pay for expensive new technologies with outcomes data demonstrating only equivalency with existing techniques. Additionally, a significant portion of patients appropriate for surgery carry one or more contraindications to the current generation of disc replacement implants. This paper examines the role of disc replacement in DDD including outcomes and complications.