Lumbar Disc Replacement

What is Lumbar Disc Replacement?

Lumbar disc replacement — also called lumbar disc arthroplasty or total disc replacement (TDR) — is a surgical procedure that replaces a degenerate, painful lumbar intervertebral disc with an artificial disc prosthesis that preserves motion at the treated level. Like anterior lumbar interbody fusion (ALIF), it is performed through an anterior abdominal incision in collaboration with a vascular surgeon, allowing complete disc removal and insertion of the prosthesis. Unlike fusion, the two adjacent vertebrae are not permanently joined — the artificial disc allows continued motion between them.

The primary aim of lumbar disc replacement is to relieve discogenic back pain and leg pain from a degenerate disc while avoiding the consequences of fusion — elimination of motion at the treated level and the associated risk of adjacent segment disease at neighbouring levels.

Lumbar disc replacement is a carefully selected procedure at One Brain and Spine. Patient selection is critical — it is most appropriate for younger, active patients with predominantly single-level discogenic back and leg pain, preserved facet joints, and no significant spinal instability or deformity.

Lumbar Disc Replacement vs ALIF — What is the Difference?

Both use the same anterior surgical approach and allow complete disc removal. The key difference is what is inserted after disc removal:

• ALIF — interbody cage with bone graft to permanently fuse the two vertebrae
• Lumbar disc replacement — motion-preserving artificial disc prosthesis; no fusion; motion preserved

In appropriately selected patients, lumbar disc replacement has been shown to achieve equivalent pain relief and functional outcomes to ALIF while demonstrating lower rates of adjacent segment disease in long-term follow-up studies.

Preoperative Assessment

Extensive preoperative evaluation is essential for lumbar disc replacement. MRI of the lumbar spine confirms disc degeneration at the target level(s). CT assesses bone quality and facet joint health — significant facet joint arthritis at the target level is a contraindication. Discography may be performed to confirm the disc as the primary pain source. A vascular surgery consultation is arranged.

What Happens During Lumbar Disc Replacement?

The patient is positioned supine. The vascular surgeon performs the anterior abdominal approach, retracting the great vessels to expose the front of the lumbar spine. The neurosurgeon removes the entire intervertebral disc and prepares the endplates precisely. Trial implants determine the correct prosthesis size, and the artificial disc is carefully seated and impacted into the disc space. The design of most lumbar disc prostheses (e.g. Prodisc-L, Activite) incorporates metal endplates with keel fins for primary fixation and a mobile polyethylene core allowing flexion-extension and rotation.

Fluoroscopic imaging confirms correct positioning. Posterior pedicle screw fixation is not required as no fusion is performed. The procedure takes approximately 90 to 150 minutes for a single level. Hospital stay is 3 to 5 days.

Long-term studies (5–17 years) demonstrate that lumbar disc replacement achieves equivalent or superior pain relief and functional outcomes compared to ALIF fusion for carefully selected patients with single-level degenerative disc disease. Adjacent segment degeneration rates are lower than with fusion. Motion at the replaced level is preserved on follow-up imaging in the majority of patients.

Risks and Complications

Shared with ALIF

• Vascular injury during anterior approach — rare; managed by vascular surgeon
• Retrograde ejaculation — approximately 1–3% at L5-S1
• Wound infection, ileus, ureteric injury — rare

Disc Replacement-Specific

• Implant malposition — rare with careful fluoroscopic guidance
• Heterotopic ossification — new bone forming around the prosthesis restricting motion; occurs in a minority
• Subsidence — settling of implant into the vertebral endplate; usually clinically insignificant
• Device failure — rare with modern materials
• Conversion to fusion — required in a small proportion with persistent pain or implant-related complications