Harrop JS, Youssef JA, Maltenfort M, Vorwald P, Jabbour P, Bono CM, Goldfarb N, Vaccaro AR, Hilibrand AS. Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine 2008;33:1701-7.
Hypothetically, lumbar disc arthroplasty should serve to preserve motion and thereby ultimately avoid stress and degeneration of the adjacent segment. It is expected that disc replacement would be better than fusion.
Recent research, however, suggests serious shortfalls with disc replacement.
A 3-year follow-up period found that patients who received lumbar disc replacement experienced a high failure rate (33% experienced serious postoperative pain). In another recent study, Shim reported a high progression rate of facet joint osteoarthritis for prosthesis in more than 32% of all patients. This high incidence of facet degeneration after an average follow-up of less than 4 years was too short to be explained by the natural course of degeneration.
In a study examining surgical disc replacement after 17 years, there was a 60% rate of spontaneous ankylosis and a reoperation rate of 11%.
The extremely high rate of spontaneous ankylosis (unintended surgical fusion of sorts) is opposite from the result this surgical scheme is attempting to produce. Moreover, a systematic review by an international medical team suggests that the data on disc replacement argue for caution by patients and surgeons.
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