Advocates of the lumbar artificial disc argue that spinal fusion has two significant drawbacks. The first argument is that stabilization of the spine inherently reduces the functional capacity of the individual because of decreased spinal motion. Secondly, a transfer of forces to the adjacent segments of a spinal fusion accelerates therefore creating the potential for degeneration and the possibility of future reconstructive surgery. According to their theory, motion preservation technologies for spinal disorders would obviate these two negative consequences of spinal fusion.
Current lumber artificial disc replacement at L5-S1 is rarely indicated for the following reasons. Failure of lumbar disc hernation and need for revision can be life threatening. There is no significant functional motion at L5-S1. Adjacent segment degeneration has been shown to be equal between disc replacement and fusion at L5-S1.
Lumber artificial disc replacement will be subjected to a much steeper learning curve, the short and long-term outcomes may be marginal, and the revision for failed implants will be difficult and at times life-threatening. Current literature suggests that lumber artificial disc replacement when compared to spinal fusion does little to improve overall functional spine motion. Moreover, the current studies indicate when lumber artificial disc replacement is observed for a long period of time, the failure rate is high, and there appears to be little benefit to protecting the adjacent segment as with standard fusion. This leads to a situation where the short-term benefit of the theoretical advantages of lumber artificial disc replacement for motion preservation may lead to significant long-term problems.
These findings suggest that the lumbar spine is subjected to significant forces which put high mechanical stress on these implants leading to their failure. From an anatomical standpoint, failure of lumber artificial disc replacement may have serious consequences. The anterior part of the spine lies behind large vessels and intra abdominal structures which make it difficult to reach after the first operation is performed.
The Future: Hopefully in the not-too-distant future gene therapy technologies will be applied so that the patient's own disc can be reconstituted and restored to its natural function. In the meantime, fusion or artificial disc devices will be used in clinical trials to treat these conditions.
Current lumber artificial disc replacement at L5-S1 is rarely indicated for the following reasons. Failure of lumbar disc hernation and need for revision can be life threatening. There is no significant functional motion at L5-S1. Adjacent segment degeneration has been shown to be equal between disc replacement and fusion at L5-S1.
Lumber artificial disc replacement will be subjected to a much steeper learning curve, the short and long-term outcomes may be marginal, and the revision for failed implants will be difficult and at times life-threatening. Current literature suggests that lumber artificial disc replacement when compared to spinal fusion does little to improve overall functional spine motion. Moreover, the current studies indicate when lumber artificial disc replacement is observed for a long period of time, the failure rate is high, and there appears to be little benefit to protecting the adjacent segment as with standard fusion. This leads to a situation where the short-term benefit of the theoretical advantages of lumber artificial disc replacement for motion preservation may lead to significant long-term problems.
These findings suggest that the lumbar spine is subjected to significant forces which put high mechanical stress on these implants leading to their failure. From an anatomical standpoint, failure of lumber artificial disc replacement may have serious consequences. The anterior part of the spine lies behind large vessels and intra abdominal structures which make it difficult to reach after the first operation is performed.
The Future: Hopefully in the not-too-distant future gene therapy technologies will be applied so that the patient's own disc can be reconstituted and restored to its natural function. In the meantime, fusion or artificial disc devices will be used in clinical trials to treat these conditions.
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