Skip to main content
Log in

Two-level total lumbar disc replacement

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript


Total lumbar disc replacement (TDR) has been widely used as a treatment option for 2-level symptomatic degenerative disc disease. However, recent studies have presented conflicting results and some authors concluded that outcome deteriorated when disc replacement was performed bisegmentally, with an increase of complications for bisegmental replacements in comparison with monosegmental disc arthroplasty. The goal of the present retrospective study is to investigate results in a group of patients who have received bisegmental TDR with SB Charitè III artificial disc for degenerative disc disease with a minimum follow-up of 3 years, and to compare the results of 2-level disc replacement versus 1-level patients treated with the same prosthesis. A total of 32 patients had at least 3-years follow-up and were reviewed. The average age of the patients was 38.5 years. There were 11 males and 21 females. About 16 patients received 2-level TDR (SB Charitè III) and 16 received 1-level TDR (SB Charitè III). Both radiographic and functional outcome analysis, including patient’s satisfaction, was performed. There were no signs of degenerative changes of the adjacent segments in any case of the 2- or 1-level TDR. There was no statistically significant difference between 2- and 1-level TDR both at 12 months and at 3-years follow-up on functional outcome scores. There was a statistically insignificant difference concerning the patients satisfaction between 1- and 2-level surgeries at the last follow-up (P = 0.46). In the 2-level TDR patients, there were 5 minor complications (31.25%), whereas major complications occurred in 4 more patients (25%) and required a new surgery in 2 cases (12.5%). In the 1-level cases there were 2 minor complications (12.5%) and 2 major complications (12.5%) and a new revision surgery was required in 1 patient (6.25%). In conclusion, the use of 2-level disc replacement at last follow-up presented a higher incidence of complications than in cases with 1-level replacement. At the same time it was impossible to delineate a clear difference in evaluating the questionnaires between the follow-up results of patients receiving 2- and 1-level TDR: the 2-level group presented slightly lower scores at follow-up, but none was statistically significant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Apolone G, Mosconi P, Ware JE (1997) Questionario sullo stato di salute SF-36. Guerini e Associati, Milano

    Google Scholar 

  2. Bertagnoli R, Kumar S (2002) Indications for full prosthetic disc arthroplasty: a correlation of clinical outcome against a variety of indications. Eur Spine J 11(Suppl 2):131–136

    Google Scholar 

  3. Bertagnoli R, Yue JJ, Shah RV, Nanieva R, Pfeiffer F, Fenk-Mayer A, Kershaw T, Husted DS (2005) The treatment of disabling multilevel lumbar discogenic low back pain with total disc arthroplasty utilizing the ProDisc prosthesis. A prospective study with 2-year minimum follow-up. Spine 30:2192–2199

    Article  PubMed  Google Scholar 

  4. Blumenthal S, McAfee PC, Guyer RD et al (2005) A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITÉ artificial disc versus lumbar fusion: part I: evaluation of clinical outcomes. Spine 30:1565–1575

    Article  PubMed  Google Scholar 

  5. Chung SS, Lee CS, Kang CS (2006) Lumbar total disc replacement using ProDisc II: a prospective study with a 2-year minimum follow-up. J Spinal Disord Tech 19:411–415

    Article  PubMed  Google Scholar 

  6. Cinotti G, David T, Postacchini F (1996) Results of disc prosthesis after a minimum follow-up period of 2 years. Spine 21:995–1000

    Article  PubMed  CAS  Google Scholar 

  7. Cunningham BW, Gordon JD, Dmitriev AE (2003) Biomechanical evaluation of total disc replacement arthroplasty: an in vitro human cadaveric model. Spine 28(Suppl):110–117

    Article  Google Scholar 

  8. David T (1993) Lumbar disc prosthesis: surgical technique, indications and clinical results in 22 patients with a minimum of 12 months follow-up. Eur Spine J 1:254–259

    Article  Google Scholar 

  9. David T (2007) Long-term results of one-level lumbar arthroplasty: minimum 10-year follow-up of the CHARITÉ artificial disc in 106 patients. Spine 32:661–666

    Article  PubMed  Google Scholar 

  10. Enker P, Steffee A, McMillin C, Kepler L, Biscup R, Miller S (1993) Artificial disc replacement: preliminary report with a 3-year minimum follow-up. Spine 18:1061–1670

    Article  PubMed  CAS  Google Scholar 

  11. Fairbank JC, Couper J, Davies JB et al (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273

    PubMed  CAS  Google Scholar 

  12. Griffith SL, Shelokov AP, Buttner-Janz K, LeMaire JP, Zeegers WS (1994) A multicenter retrospective study of the clinical results of the LINK SB Charite intervertebral prosthesis: the initial European experience. Spine 19:1842–1849

    Article  PubMed  CAS  Google Scholar 

  13. Hannibal M, Thomas DJ, Low J, Hsu KY, Zucherman J (2007) ProDisc-L total disc replacement a comparison of 1-level versus 2-level arthroplasty patients with a minimum 2-year follow-up. Spine 32:2322–2326

    Article  PubMed  Google Scholar 

  14. Huang RC, Tropiano P, Marnay T et al (2006) Range of motion and adjacent level degeneration after lumbar total disc replacement. Spine J 6:242–247

    Article  PubMed  Google Scholar 

  15. Le Huec JC, Basso Y, Aunoble S, Friesem T, Brayda-Bruno M (2005) Influence of facet and posterior muscle degeneration on clinical results of lumbar total disc replacement: two-year follow-up. J Spinal Disord Tech 18:219–223

    PubMed  Google Scholar 

  16. Lemaire JP, Carrier H, Ali el-HS et al (2005) Clinical and radiological outcomes with the Charité trade mark artificial disc: a 10-year minimum follow-up. J Spinal Disord Tech 18:353–359

    Article  PubMed  Google Scholar 

  17. McAfee PC, Cunningham B, Holsapple G, Adams K et al (2005) A prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITÉ artificial disc versus lumbar fusion: part II: evaluation of radiographic outcomes and correlation of surgical technique accuracy with clinical outcomes. Spine 30:1576–1583

    Article  PubMed  Google Scholar 

  18. Patel AA, Brodke DS, Pimenta L, Bono CM, Hilibrand AS, Harrop JS, Riew KD, Youssef JA, Vaccaro AR (2008) Revision Strategies in lumbar Total Disc Arthroplasty. Spine 33:1276–1283

    Article  PubMed  Google Scholar 

  19. Putzier M, Funk JF, Schneider SV et al (2006) Charitè total disc replacement–clinical and radiographical results after an average follow-up of 17 years. Eur Spine J 15:183–195

    Article  PubMed  Google Scholar 

  20. Roland M, Fairbank JC (2000) The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine 25:3115–3124

    Article  PubMed  CAS  Google Scholar 

  21. Sachs BL, Vanharanta H, Spivey MA et al (1987) Dallas discogram description: a new classification of CT/discography in low back disorders. Spine 12:287–294

    Article  PubMed  CAS  Google Scholar 

  22. Shim CS, Lee SH, Shin HD et al (2007) Charité versus ProDisc: a comparative study of a minimum 3-year follow-up. Spine 32:1012–1018

    Article  PubMed  Google Scholar 

  23. Siepe CJ, Mayer HM, Heinz-Leisenheimer M, Korge A (2007) Total lumbar disc replacement: different results for different levels. Spine 32:782–790

    Article  PubMed  Google Scholar 

  24. Tropiano P, Huang RC, Federico PG et al (2005) Lumbar total disc replacement: seven to eleven year follow-up. J Bone Joint Surg Am 87:490–496

    Article  PubMed  Google Scholar 

  25. Trouillier H, Kern P, Refior HJ, Muller-Gerbl M (2006) A prospective morphological study of facet joint integrity following intervertebral disc replacement with the Charitè artificial disc. Eur Spine J 15:174–182

    Article  PubMed  Google Scholar 

  26. Van Ooij A, Oner FC, Verbout AJ (2003) Complications of artificial disc replacement a report of 27 patients with SB Charitè disc. J Spinal Disord Tech 16:369–383

    PubMed  Google Scholar 

  27. Zeegers WS, Bohnen LM, Laaper M, Verhaegen MJ (1999) Artificial disc replacement with the modular type SB Charite III: 2-year results in 50 prospectively studied patients. Eur Spine J 8:210–217

    Article  PubMed  CAS  Google Scholar 

  28. Zigler J (2003) Clinical results with ProDisc: European experience and U.S. investigation device exemption study. Spine 28(Suppl):163–166

    Article  Google Scholar 

  29. Zigler JE (2004) Lumbar spine arthroplasty using the ProDisc II. Spine J 4(Suppl):260–267

    Article  Google Scholar 

  30. Zigler JE, Sachs BL, Rashbaum RF et al (2005) Two level total lumbar disc replacement with ProDisc: results and comparison to one level cases. In: Proceedings of the NASS 20th annual meeting. Philadelphia, PA, USA. Spine J 5(suppl 1):4–5

  31. Zindrick MR, Tzermiadianos MN, Voronov LI, Lorenz M, Hadjipavlov A (2008) An evidence-based medicine approach in determining factors that may affect outcome in lumbar total disc replacement. Spine 33(11):1262–1269

    Article  PubMed  Google Scholar 

Download references


No funds were received in support of this study.

Conflict of interest statement

None of the authors has any potential conflict of interest.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Mario Di Silvestre.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Di Silvestre, M., Bakaloudis, G., Lolli, F. et al. Two-level total lumbar disc replacement. Eur Spine J 18 (Suppl 1), 64–70 (2009).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: