The Scientific Evidence for Lumbar Total Disk Replacement Surgery

Abstract

Lumbar total disk replacement (TDR) has been in use since the 1980s, yet its adoption has not paralleled that of hip or knee arthroplasty or cervical TDR, which was introduced years after lumbar arthroplasty. If the lack of adoption is related to concerns about the safety and/or effectiveness of these implants, these issues have been extensively addressed in the literature. This narrative review aims to concisely report on the evidence published in the peer-reviewed literature related to lumbar TDR. Literature was identified from online databases such as PubMed, Scopus, and ScienceDirect, supplemented by the authors’ institution’s comprehensive database of TDR articles. By the end of 2023, there were at least 816 articles published on lumbar TDR covering all aspects of this technology, including biomechanics, clinical outcome, radiographic outcome, safety as assessed by re-operations and complications, and the cost related to this treatment intervention. Consistently, the evidence indicates that TDR yields outcomes similar or superior to fusion for treating painful disk degeneration unresponsive to non-operative care in appropriately selected patients.