Lumbar disc replacement surgery—successes and obstacles to widespread adoption
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Purpose of review
Lumbar disc replacement has been a surgical alternative to fusion surgery for the treatment of lumbar degenerative disc disease (DDD) for many years. Despite enthusiasm after the approval of the first devices, implantation rates have remained low, especially in the USA. The goal of this review is to provide a general overview of lumbar disc replacement in order to comprehend the successes and obstacles to widespread adoption.
Although a large amount of evidence-based data including satisfactory long-term results is available, implantation rates in the USA have not increased in the last decade. Possible explanations for this include strict indications for use, challenging surgical techniques, lack of device selection, fear of late complications or revision surgeries, and reimbursement issues.
Recent publications can address some of the past concerns, but there still remain obstacles to widespread adoption. Upcoming data on long-term outcome, implant durability and possible very late complications will determine the future of lumbar disc replacement surgery.
KeywordsDegenerative disc disease Lumbar spine Fusion Total disc replacement Widespread adoption
Compliance with ethical standards
Conflict of interest
Stephan N. Salzmann, Nicolas Plais and Jennifer Shue declare that they have no conflict of interest. Federico P. Girardi reports grants from MiMedx, personal fees from Paradigm Spine, LLC, personal fees from HealthPoint Capital, LP, personal fees from Spineart USA, personal fees and other from Centinel Spine, grants from Spinal Kinetics, personal fees from Scient'x USA, personal fees from Pharmawrite, LLC, personal fees from DePuy Spine, personal fees from OrthoDevelopment Corp, personal fees from Gerson Lehrman Group, Inc., personal fees from Lanx, Inc., grants from Aesculap Implant Systems, other from Paradigm Spine, other from LifeSpine, other from Pioneer Surgical Technology, Inc., and other from Small Bone Innovations, outside the submitted work.
Human and animal rights and informed consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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