Total disc replacement for lumbar degenerative disc disease: single centre 20 years experience

  • Carlo Formica
  • Andrea Zanirato
  • Stefano Divano
  • Marco Basso
  • Luca Cavagnaro
  • Mattia Alessio Mazzola
  • Valerio Gaetano Vellone
  • Maddalena Mastrogiacomo
  • Pedro Berjano
  • Lamberto Felli
  • Matteo FormicaEmail author
Original Article



To report clinical and radiographic outcomes, rate of complications and influence on spinal alignment on long-term follow-up (FU) of patients who underwent lumbar total disc arthroplasty (TDR), bringing some evidence to determine the profile of the most well-suited patients for TDR.


A retrospective review of patients underwent TDR for low back pain from degenerative disc disease (DDD) resistant to conservative treatment was performed. Demographic features, surgical data, clinical and radiographic outcomes, complications and spinopelvic parameters were evaluated.


Thirty patients (32 TDR) were included with a mean FU of 164 ± 36.5 months. The clinical outcomes measured by visual analogue scale and Oswestry Disability Index showed a significant improvement between preoperative and 1-year FU (p < 0.01). No significant temporal variance has been identified between 1-year and long-term follow-up (p > 0.05). The surgical revision rate was 10%. The overall rate of complications was 20%. At final follow-up, the mobility of the prosthesis was preserved in 68.75% of the cases, and 73.3% of the patients were globally well aligned.


The optimal surgical indication is crucial to achieve excellent clinical and radiological outcomes. According to the literature and to our experience, we underline the importance of a coronal deformity < 15° Cobb angle and a Roussouly type 1 or 2 as the profile of the most well-suited patient for TDR. Our long-term results confirm the existing evidence about efficacy and safety of TDR as a reliable option, in optimal surgery indication, to treat DDD.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Degenerative disc disease Total disc replacement Long-term results Sagittal alignment Total disc arthroplasty 



There is no funding source for this article.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6100_MOESM1_ESM.pptx (187 kb)
Supplementary file1 (PPTX 186 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Carlo Formica
    • 1
  • Andrea Zanirato
    • 2
  • Stefano Divano
    • 2
  • Marco Basso
    • 2
  • Luca Cavagnaro
    • 2
  • Mattia Alessio Mazzola
    • 2
  • Valerio Gaetano Vellone
    • 3
  • Maddalena Mastrogiacomo
    • 4
    • 5
  • Pedro Berjano
    • 1
  • Lamberto Felli
    • 2
  • Matteo Formica
    • 2
    Email author
  1. 1.IRCCS Istituto Ortopedico GaleazziMilanItaly
  2. 2.Clinica OrtopedicaOspedale Policlinico San MartinoGenoaItaly
  3. 3.Anatomic Pathology, Department of Integrated Surgical and Diagnostic SciencesUniversity of Genoa - Ospedale Policlinico San MartinoGenoaItaly
  4. 4.Department of Internal MedicineUniversity of GenoaGenoaItaly
  5. 5.Biotherapy UnitOspedale Policlinico San MartinoGenoaItaly

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