J Korean Neurosurg Soc.  2015 Nov;58(5):401-411. 10.3340/jkns.2015.58.5.401.

Total Disc Replacement in Lumbar Degenerative Disc Diseases

• Park CK

• KMID: 2191404
• DOI: http://doi.org/10.3340/jkns.2015.58.5.401

Abstract

More than 10 years have passed since lumbar total disc replacement (LTDR) was introduced for the first time to the world market for the surgical management of lumbar degenerative disc disease (DDD). It seems like the right time to sum up the relevant results in order to understand where LTDR stands on now, and is heading forward to. The pathogenesis of DDD has been currently settled, but diagnosis and managements are still controversial. Fusion is recognized as golden standard of surgical managements but has various kinds of shortcomings. Lately, LTDR has been expected to replace fusion surgery. A great deal of LTDR reports has come out. Among them, more than 5-year follow-up prospective randomized controlled studies including USA IDE trials were expected to elucidate whether for LTDR to have therapeutic benefit compared to fusion. The results of these studies revealed that LTDR was not inferior to fusion. Most of clinical studies dealing with LTDR revealed that there was no strong evidence for preventive effect of LTDR against symptomatic degenerative changes of adjacent segment disease. LTDR does not have shortcomings associated with fusion. However, it has a potentiality of the new complications to occur, which surgeons have never experienced in fusion surgeries. Consequently, longer follow-up should be necessary as yet to confirm the maintenance of improved surgical outcome and to observe any very late complications. LTDR still may get a chance to establish itself as a substitute of fusion both nominally and virtually if it eases the concerns listed above.

Keyword

Degenerative disc disease; Total disc displacement; Lumbar spine; Outcome; Complications

MeSH Terms

Diagnosis
Dichlorodiphenyldichloroethane
Follow-Up Studies
Head
Prospective Studies
Total Disc Replacement*
Dichlorodiphenyldichloroethane

Figure

• 

  Fig. 1 Photograph showing a representative lumbar artificial disc of semi-constrained design with translation, Charite.

• 

  Fig. 2 Photograph showing a representative lumbar artificial disc of semi-constrained design without translation, ProDisc-L, and general composition of artificial disc. A : upper plate, made up with metal and alloys, B : core, made up with UHMWPE or ceramics, C : lower plate, D : keel for anchorage. UHMWPE : ultra-high molecular weight polyethylene.

• 

  Fig. 3 Diagram showing an approach for TDR. In TDR for L5-S1 : Anterior approach via right retroperitoneal route is preferred, while in anterior approach for TDR levels above L5-S1, left retroperitoneal route is preferred.

• 

  Fig. 4 Diagram showing hypogastric plexus which is usually located in the left anterior part of the promontory and one of the reasons why right retroperitoneal route is preferred in anterior approach for L5-S1 TDR. A : superior hypogastric plexus, B : left iliac artery and vein, C : pre-sacral artery. TDR : total disc replacement.

• 

  Fig. 5 Image of CT angiography showing vascular structures in the anterior part of lumbar spine, and the access (open arrow) between the large vessels and psoas muscle in anterolateral (oblique) approach for L4-5 TDR. TDR : total disc replacement.

Reference

1. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999; 354:581–585. PMID: 10470716.

2. Baldwin NG. Lumbar disc disease : the natural history. Neurosurg Focus. 2002; 13:E2. PMID: 15916399.

3. 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. PMID: 12384734.

4. Bertagnoli R, Yue JJ, Kershaw T, Shah RV, Pfeiffer F, Fenk-Mayer A, et al. Lumbar total disc arthroplasty utilizing the ProDisc prosthesis in smokers versus nonsmokers : a prospective study with 2-year minimum follow-up. Spine (Phila Pa 1976). 2006; 31:992–997. PMID: 16641775.

5. Bertagnoli R, Yue JJ, Shah RV, Nanieva R, Pfeiffer F, Fenk-Mayer A, et al. The treatment of disabling single-level lumbar discogenic low back pain with total disc arthroplasty utilizing the Prodisc prosthesis : a prospective study with 2-year minimum follow-up. Spine (Phila Pa 1976). 2005; 30:2230–2236. PMID: 16205353.

6. Bisseling P, Zeilstra DJ, Hol AM, van Susante JL. Metal ion levels in patients with a lumbar metal-on-metal total disc replacement : should we be concerned? J Bone Joint Surg Br. 2011; 93:949–954. PMID: 21705569.

7. Block AR, Vanharanta H, Ohnmeiss DD, Guyer RD. Discographic pain report. Influence of psychological factors. Spine (Phila Pa 1976). 1996; 21:334–338. PMID: 8742210.

8. Blondel B, Tropiano P, Gaudart J, Huang RC, Marnay T. Clinical results of lumbar total disc arthroplasty in accordance with Modic signs, with a 2-year-minimum follow-up. Spine (Phila Pa 1976). 2011; 36:2309–2315. PMID: 21252824.

9. Blumenthal S, McAfee PC, Guyer RD, Hochschuler SH, Geisler FH, Holt RT, et al. A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion : part I : evaluation of clinical outcomes. Spine (Phila Pa 1976). 2005; 30:1565–1575. discussion E387-E391PMID: 16025024.

10. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990; 72:403–408. PMID: 2312537.

11. Bogduk N. The innervation of the lumbar spine. Spine (Phila Pa 1976). 1983; 8:286–293. PMID: 6226119.

12. Borenstein DG, O'Mara JW Jr, Boden SD, Lauerman WC, Jacobson A, Platenberg C, et al. The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study. J Bone Joint Surg Am. 2001; 83-A:1306–1311. PMID: 11568190.

13. Braithwaite I, White J, Saifuddin A, Renton P, Taylor BA. Vertebral end-plate (Modic) changes on lumbar spine MRI : correlation with pain reproduction at lumbar discography. Eur Spine J. 1998; 7:363–368. PMID: 9840468.

14. Brau SA, Delamarter RB, Kropf MA, Watkins RG 3rd, Williams LA, Schiffman ML, et al. Access strategies for revision in anterior lumbar surgery. Spine (Phila Pa 1976). 2008; 33:1662–1667. PMID: 18594459.

15. Carragee EJ, Lincoln T, Parmar VS, Alamin T. A gold standard evaluation of the "discogenic pain" diagnosis as determined by provocative discography. Spine (Phila Pa 1976). 2006; 31:2115–2123. PMID: 16915099.

16. Carragee EJ, Tanner CM, Khurana S, Hayward C, Welsh J, Date E, et al. The rates of false-positive lumbar discography in select patients without low back symptoms. Spine (Phila Pa 1976). 2000; 25:1373–1380. discussion 1381PMID: 10828919.

17. Choma TJ, Miranda J, Siskey R, Baxter R, Steinbeck MJ, Kurtz SM. Retrieval analysis of a ProDisc-L total disc replacement. J Spinal Disord Tech. 2009; 22:290–296. PMID: 19494750.

18. Cohen SP, Larkin TM, Barna SA, Palmer WE, Hecht AC, Stojanovic MP. Lumbar discography : a comprehensive review of outcome studies, diagnostic accuracy, and principles. Reg Anesth Pain Med. 2005; 30:163–183. PMID: 15765459.

19. Cook DJ, Yeager MS, Cheng BC. Range of motion of the intact lumbar segment : a multivariate study of 42 lumbar spines. Int J Spine Surg. 2015; 9:5. PMID: 25785241.

20. Daftari TK, Chinthakunta SR, Ingalhalikar A, Gudipally M, Hussain M, Khalil S. Kinematics of a selectively constrained radiolucent anterior lumbar disc : comparisons to hybrid and circumferential fusion. Clin Biomech (Bristol, Avon). 2012; 27:759–765.

21. Delamarter RB, Bae HW, Pradhan BB. Clinical results of ProDisc-II lumbar total disc replacement : report from the United States clinical trial. Orthop Clin North Am. 2005; 36:301–313. PMID: 15950690.

22. DePalma MJ, Ketchum JM, Saullo T. What is the source of chronic low back pain and does age play a role? Pain Med. 2011; 12:224–233. PMID: 21266006.

23. Dmitriev AE, Cunningham BW, Hu N, Sell G, Vigna F, McAfee PC. Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty : an in vitro human cadaveric model. Spine (Phila Pa 1976). 2005; 30:1165–1172. PMID: 15897831.

24. Dmitriev AE, Gill NW, Kuklo TR, Rosner MK. Effect of multilevel lumbar disc arthroplasty on the operative- and adjacent-level kinematics and intradiscal pressures : an in vitro human cadaveric assessment. Spine J. 2008; 8:918–925. PMID: 18178528.

25. Eck JC, Humphreys SC, Lim TH, Jeong ST, Kim JG, Hodges SD, et al. Biomechanical study on the effect of cervical spine fusion on adjacent-level intradiscal pressure and segmental motion. Spine (Phila Pa 1976). 2002; 27:2431–2434. PMID: 12435970.

26. Edgar MA. The nerve supply of the lumbar intervertebral disc. J Bone Joint Surg Br. 2007; 89:1135–1139. PMID: 17905946.

27. Erkan S, Rivera Y, Wu C, Mehbod AA, Transfeldt EE. Biomechanical comparison of a two-level Maverick disc replacement with a hybrid one-level disc replacement and one-level anterior lumbar interbody fusion. Spine J. 2009; 9:830–835. PMID: 19477692.

28. Fernström U. Arthroplasty with intercorporal endoprothesis in herniated disc and in painful disc. Acta Chir Scand Suppl. 1966; 357:154–159. PMID: 5227072.

29. Freemont AJ, Watkins A, Le Maitre C, Baird P, Jeziorska M, Knight MT, et al. Nerve growth factor expression and innervation of the painful intervertebral disc. J Pathol. 2002; 197:286–292. PMID: 12115873.

30. Frelinghuysen P, Huang RC, Girardi FP, Cammisa FP Jr. Lumbar total disc replacement part I : rationale, biomechanics, and implant types. Orthop Clin North Am. 2005; 36:293–299. PMID: 15950689.

31. García-Cosamalón J, del Valle ME, Calavia MG, García-Suárez O, López-Muñiz A, Otero J, et al. Intervertebral disc, sensory nerves and neurotrophins : who is who in discogenic pain? J Anat. 2010; 217:1–15. PMID: 20456524.

32. Gillette RG, Kramis RC, Roberts WJ. Sympathetic activation of cat spinal neurons responsive to noxious stimulation of deep tissues in the low back. Pain. 1994; 56:31–42. PMID: 8159439.

33. Gornet MF, Schranck F, Wharton ND, Beall DP, Jones E, Myers ME, et al. Optimizing success with lumbar disc arthroplasty. Eur Spine J. 2014; 23:2127–2135. PMID: 24770556.

34. Groen GJ, Baljet B, Drukker J. Nerves and nerve plexuses of the human vertebral column. Am J Anat. 1990; 188:282–296. PMID: 2371968.

35. Guyer RD. Re : "prospective, randomized multicenter Food and Drug Administration investigational device exemption study of lumbar tool disc replacement with the CHARITE artificial disc versus lumbar fusion : five-year follow-up". Spine J. 2010; 10:360. author reply 361-363. PMID: 20362255.

36. Guyer RD, McAfee PC, Banco RJ, Bitan FD, Cappuccino A, Geisler FH, et al. Prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion : five-year follow-up. Spine J. 2009; 9:374–386. PMID: 18805066.

37. Guyer RD, Shellock J, MacLennan B, Hanscom D, Knight RQ, McCombe P, et al. Early failure of metal-on-metal artificial disc prostheses associated with lymphocytic reaction : diagnosis and treatment experience in four cases. Spine (Phila Pa 1976). 2011; 36:E492–E497. PMID: 21252827.

38. Helgeson MD, Bevevino AJ, Hilibrand AS. Update on the evidence for adjacent segment degeneration and disease. Spine J. 2013; 13:342–351. PMID: 23420004.

39. Hoff EK, Strube P, Pumberger M, Zahn RK, Putzier M. ALIF and total disc replacement versus 2-level circumferential fusion with TLIF : a prospective, randomized, clinical and radiological trial. Eur Spine J. 2015; [Epub ahead of print]. DOI: 10.1007/s00586-015-3852-y.

40. Huang RC, Sandhu HS. The current status of lumbar total disc replacement. Orthop Clin North Am. 2004; 35:33–42. PMID: 15062716.

41. Ishihara H, Osada R, Kanamori M, Kawaguchi Y, Ohmori K, Kimura T, et al. Minimum 10-year follow-up study of anterior lumbar interbody fusion for isthmic spondylolisthesis. J Spinal Disord. 2001; 14:91–99. PMID: 11285419.

42. Jacobs WC, van der Gaag NA, Kruyt MC, Tuschel A, de Kleuver M, Peul WC, et al. Total disc replacement for chronic discogenic low back pain : a Cochrane review. Spine (Phila Pa 1976). 2013; 38:24–36. PMID: 22996268.

43. Kaner T, Ozer AF. Dynamic stabilization for challenging lumbar degenerative diseases of the spine : a review of the literature. Adv Orthop. 2013; 2013:753470. PMID: 23662211.

44. Kurtz SM, MacDonald D, Ianuzzi A, van Ooij A, Isaza J, Ross ER, et al. The natural history of polyethylene oxidation in total disc replacement. Spine (Phila Pa 1976). 2009; 34:2369–2377. PMID: 19789469.

45. Kurtz SM, van Ooij A, Ross R, de Waal Malefijt J, Peloza J, Ciccarelli L, et al. Polyethylene wear and rim fracture in total disc arthroplasty. Spine J. 2007; 7:12–21. PMID: 17197327.

46. Lemaire JP, Skalli W, Lavaste F, Templier A, Mendes F, Diop A, et al. Intervertebral disc prosthesis. Results and prospects for the year 2000. Clin Orthop Relat Res. 1998; (337):64–76.

47. Levin DA, Hale JJ, Bendo JA. Adjacent segment degeneration following spinal fusion for degenerative disc disease. Bull NYU Hosp Jt Dis. 2007; 65:29–36. PMID: 17539759.

48. Liu C, Cai HX, Zhang JF, Ma JJ, Lu YJ, Fan SW. Quantitative estimation of the high-intensity zone in the lumbar spine : comparison between the symptomatic and asymptomatic population. Spine J. 2014; 14:391–396. PMID: 24139862.

49. Mannion AF, Elfering A. Predictors of surgical outcome and their assessment. Eur Spine J. 2006; 15(Suppl 1):S93–S108. PMID: 16320033.

50. Marshman LA, Friesem T, Rampersaud YR, Le Huec JC, Krishna M. Subsidence and malplacement with the Oblique Maverick Lumbar Disc Arthroplasty : technical note. Spine J. 2008; 8:650–655. PMID: 17602886.

51. Maus TP, Aprill CN. Lumbar diskogenic pain, provocation diskography, and imaging correlates. Radiol Clin North Am. 2012; 50:681–704. PMID: 22643391.

52. McMahon SB. Mechanisms of sympathetic pain. Br Med Bull. 1991; 47:584–600. PMID: 1794073.

53. Min JH, Jang JS, Lee SH. Comparison of anterior- and posterior-approach instrumented lumbar interbody fusion for spondylolisthesis. J Neurosurg Spine. 2007; 7:21–26. PMID: 17633483.

54. Morinaga T, Takahashi K, Yamagata M, Chiba T, Tanaka K, Takahashi Y, et al. Sensory innervation to the anterior portion of lumbar intervertebral disc. Spine (Phila Pa 1976). 1996; 21:1848–1851. PMID: 8875714.

55. Murtagh R, Castellvi AE. Motion preservation surgery in the spine. Neuroimaging Clin N Am. 2014; 24:287–294. PMID: 24792608.

56. Nakamura S, Takahashi K, Takahashi Y, Morinaga T, Shimada Y, Moriya H. Origin of nerves supplying the posterior portion of lumbar intervertebral discs in rats. Spine (Phila Pa 1976). 1996; 21:917–924. PMID: 8726193.

57. Nayak AN, Doarn MC, Gaskins RB 3rd, James CR, Cabezas AF, Castellvi AE, et al. : Postero-lateral disc prosthesis combined with a unilateral facet replacement device maintains quantity and quality of motion at a single lumbar level. Int J Spine Surg. 2014; 8:[Epub ahead of print]. DOI: 10.14444/1031.

58. Ness TJ, Gebhart GF. Visceral pain : a review of experimental studies. Pain. 1990; 41:167–234. PMID: 2195438.

59. Park CK, Ryu KS, Jee WH. Degenerative changes of discs and facet joints in lumbar total disc replacement using ProDisc II : minimum two-year follow-up. Spine (Phila Pa 1976). 2008; 33:1755–1761. PMID: 18580548.

60. Park CK, Ryu KS, Lee KY, Lee HJ. Clinical outcome of lumbar total disc replacement using ProDisc-L in degenerative disc disease : minimum 5-year follow-up results at a single institute. Spine (Phila Pa 1976). 2012; 37:672–677. PMID: 21857395.

61. Peng B, Fu X, Pang X, Li D, Liu W, Gao C, et al. Prospective clinical study on natural history of discogenic low back pain at 4 years of follow-up. Pain Physician. 2012; 15:525–532. PMID: 23159971.

62. Peng B, Wu W, Hou S, Li P, Zhang C, Yang Y. The pathogenesis of discogenic low back pain. J Bone Joint Surg Br. 2005; 87:62–67. PMID: 15686239.

63. Peng BG. Pathophysiology, diagnosis, and treatment of discogenic low back pain. World J Orthop. 2013; 4:42–52. PMID: 23610750.

64. Pimenta L, Oliveira L, Schaffa T, Coutinho E, Marchi L. Lumbar total disc replacement from an extreme lateral approach : clinical experience with a minimum of 2 years' follow-up. J Neurosurg Spine. 2011; 14:38–45. PMID: 21166491.

65. Prescher A. Anatomy and pathology of the aging spine. Eur J Radiol. 1998; 27:181–195. PMID: 9717634.

66. Punt IM, Visser VM, van Rhijn LW, Kurtz SM, Antonis J, Schurink GW, et al. Complications and reoperations of the SB Charité lumbar disc prosthesis : experience in 75 patients. Eur Spine J. 2008; 17:36–43. PMID: 17929065.

67. Rosen C, Kiester PD, Lee TQ. Lumbar disk replacement failures : review of 29 patients and rationale for revision. Orthopedics. 2009; 32:[Epub ahead of print]. DOI: 10.3928/01477447-20090624-08.

68. Ryu KS, Park CK. Intradiscal electrothermotherapy (IDET) in patients with chronic discogenic low back pain; preliminary report. J Korean Neurosurg Soc. 2001; 30:749–754.

69. Saavedra-Pozo FM, Deusdara RA, Benzel EC. Adjacent segment disease perspective and review of the literature. Ochsner J. 2014; 14:78–83. PMID: 24688337.

70. Sachs BL, Vanharanta H, Spivey MA, Guyer RD, Videman T, Rashbaum RF, et al. Dallas discogram description. A new classification of CT/discography in low-back disorders. Spine (Phila Pa 1976). 1987; 12:287–294. PMID: 2954226.

71. Sekhon LH. Cervical arthroplasty in the management of spondylotic myelopathy : 18-month results. Neurosurg Focus. 2004; 17:E8. PMID: 15636564.

72. Siepe CJ, Heider F, Wiechert K, Hitzl W, Ishak B, Mayer MH. Mid- to long-term results of total lumbar disc replacement : a prospective analysis with 5- to 10-year follow-up. Spine J. 2014; 14:1417–1431. PMID: 24448028.

73. Soh J, Lee JC, Shin BJ. Analysis of risk factors for adjacent segment degeneration occurring more than 5 years after fusion with pedicle screw fixation for degenerative lumbar spine. Asian Spine J. 2013; 7:273–281. PMID: 24353843.

74. Sowa G, Vadalà G, Studer R, Kompel J, Iucu C, Georgescu H, et al. Characterization of intervertebral disc aging : longitudinal analysis of a rabbit model by magnetic resonance imaging, histology, and gene expression. Spine (Phila Pa 1976). 2008; 33:1821–1828. PMID: 18670334.

75. Suseki K, Takahashi Y, Takahashi K, Chiba T, Tanaka K, Moriya H. CGRP-immunoreactive nerve fibers projecting to lumbar facet joints through the paravertebral sympathetic trunk in rats. Neurosci Lett. 1996; 221:41–44. PMID: 9014176.

76. Suseki K, Takahashi Y, Takahashi K, Chiba T, Yamagata M, Moriya H. Sensory nerve fibres from lumbar intervertebral discs pass through rami communicantes. A possible pathway for discogenic low back pain. J Bone Joint Surg Br. 1998; 80:737–742. PMID: 9699846.

77. Taher F, Essig D, Lebl DR, Hughes AP, Sama AA, Cammisa FP, et al. Lumbar degenerative disc disease : current and future concepts of diagnosis and management. Adv Orthop. 2012; 2012:970752. PMID: 22567411.

78. Tropiano P, Huang RC, Girardi FP, Cammisa FP Jr, Marnay T. Lumbar total disc replacement. Seven to eleven-year follow-up. J Bone Joint Surg Am. 2005; 87:490–496. PMID: 15741612.

79. van den Eerenbeemt KD, Ostelo RW, van Royen BJ, Peul WC, van Tulder MW. Total disc replacement surgery for symptomatic degenerative lumbar disc disease : a systematic review of the literature. Eur Spine J. 2010; 19:1262–1280. PMID: 20508954.

80. Veruva SY, Lanman TH, Hanzlik JA, Kurtz SM, Steinbeck MJ. Rare complications of osteolysis and periprosthetic tissue reactions after hybrid and non-hybrid total disc replacement. Eur Spine J. 2015; 24(Suppl 4):S494–S501. PMID: 25163549.

81. Veruva SY, Lanman TH, Isaza JE, MacDonald DW, Kurtz SM, Steinbeck MJ. UHMWPE wear debris and tissue reactions are reduced for contemporary designs of lumbar total disc replacements. Clin Orthop Relat Res. 2015; 473:987–998. PMID: 25367112.

82. Veruva SY, Steinbeck MJ, Toth J, Alexander DD, Kurtz SM. Which design and biomaterial factors affect clinical wear performance of total disc replacements? A systematic review. Clin Orthop Relat Res. 2014; 472:3759–3769. PMID: 25002211.

83. Vital JM, Boissière L. Total disc replacement. Orthop Traumatol Surg Res. 2014; 100:S1–S14. PMID: 24412045.

84. Wai EK, Santos ER, Morcom RA, Fraser RD. Magnetic resonance imaging 20 years after anterior lumbar interbody fusion. Spine (Phila Pa 1976). 2006; 31:1952–1956. PMID: 16924212.

85. Zhou Y, Abdi S. Diagnosis and minimally invasive treatment of lumbar discogenic pain--a review of the literature. Clin J Pain. 2006; 22:468–481. PMID: 16772802.

86. Zigler JE, Delamarter RB. Five-year results of the prospective, randomized, multicenter, Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential arthrodesis for the treatment of single-level degenerative disc disease. J Neurosurg Spine. 2012; 17:493–501. PMID: 23082846.

87. Zigler JE, Glenn J, Delamarter RB. Five-year adjacent-level degenerative changes in patients with single-level disease treated using lumbar total disc replacement with ProDisc-L versus circumferential fusion. J Neurosurg Spine. 2012; 17:504–511. PMID: 23082849.