Abstract
Numerous clinical studies, including prospective, randomized, controlled trials, have demonstrated lumbar total disc replacement (TDR) to be non-inferior and, in some instances, to be superior to lumbar fusion for the treatment of degenerative disc disease (DDD). There have been various artificial disc device designs dating back to the original Charité I Artificial Disc. There are only two TDR devices that have received Food and Drug Administration (FDA) approval that are currently in use in the US. The Prodisc-L TDR received clearance for one-level implantation in 2006, followed by two-level approval in 2020. The activL TDR received one-level approval in 2015.The surgical treatment of lumbar DDD presenting clinically with primarily mechanical low back pain remains somewhat controversial. Lumbar TDR offers a motion-preserving alternative to fusion in select patients with lumbar DDD pathologies refractory to nonsurgical management. There is firm evidence basis, including long-term follow-up, for safety and efficacy in the treatment of one- and two-level lumbar spondylosis from L4-S1 using lumbar TDR. Ongoing innovations in device design and patient selection continue to drive adoption of this motion preserving procedure.
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