Revision Strategies Involving Lumbar Artificial Disc Replacement

Lumbar disc arthroplasty can be an effective treatment for the properly selected patient with recalcitrant pain from isolated degenerative disc disease when all conservative modalities have been exhausted. Artificial disc replacement represents an ongoing effort to preserve segmental spinal motion, thereby avoiding excessive adjacent level stresses which may lead to accelerated degeneration. In the absence of facet arthropathy, results are optimized when a well-engineered implant is used, soft tissues are balanced, and the prosthesis is well positioned in appropriate alignment. Although current lumbar arthroplasty designs have resulted in a relatively low incidence of failure, there are various complications which may still occur. We describe our revision arthroplasty experience based on 20 cases performed over a 4-year period. This summarizes our approach, guidelines, and philosophies toward addressing a range of complications associated with lumbar disc arthroplasty.