Lumbar Artificial Disc Replacement is a technology designed to replace a symptomatic lumbar degenerated disc with a metal and plastic ball and socket prosthesis. A symptomatic disc is defined as causing low back (axial) or leg (radicular) pain with or without a functional or neurologic deficit. Examples of structurally degenerated discs are herniated nucleus pulposes (your classic ‘herniated disc’), mild instability on motion, loss of disc height or hydration of the disc (like a sponge drying out), and vacuum phenomenon (air in the disc).
The L-ADR is inserted through a front side (anterior) approach. It is implanted at the diseased level after the disc has been completely removed (total discectomy). The discectomy and removal of bone spurs will decompress the nerves. The implanted L-ADR will maintain the joint space height and potentially preserve motion at the surgically corrected level. This motion preservation may theoretically prevent or slow the progression of adjacent disc levels from degenerating.
Here we have an example of a patient who suffered from mainly back pain, with some leg pain, for several years. She failed conservative management in the form of physical therapy, spinal injections, oral medications, and activity modification. She underwent an artificial disc replacement at L4-5 and L5-S1. At two and a half year follow-up, her pain decreased from 8/10 pre-op to 0, and she was training for a half marathon.
For a video demonstration, please click here
Here is an example of a patient who underwent a DLIF procedure. In her late eighties, she suffered with back and bilateral leg pain for many years. She was unable to stand for 5 minutes due to pain. She had a spondylolisthesis at L4-L5 that was treated with DLIF, pedicle screws, and decompression. At last follow-up 2 years after the surgery, the patient was able to stand for 20-30 minutes and her pain was reduced to half of the pre-op level.
Figure 1. Post-op lateral flexion x-ray showing artificial discs at L4-5 and L5-S1.
Figure 2. Post-op lateral extension x-ray showing motion of artificial disc opening up in front, especially at L4-5.
For a description of the ALIF, please click here
For a description of the XLIF/DLIF, please click here
For a description of the TLIF, please click here
For a description of the PLIF, please click here.
We prefer a TLIF to a PLIF because we think it requires less nerve root retraction and is safer for the patient. They are very similar procedures, both done from the back.