Degenerative Disc Disease: Disc Replacement

Abstract

Disc replacement is an exciting and relatively new technique in the treatment of patients with discogenic back pain. Its advantages include a less destructive approach than posterior surgery, with the potential to maintain motion and protect the adjacent levels of the spine, by preventing a stress riser at the interface of the fusion. Spinal fusion on the other hand is the gold standard by which new treatments must be measured. Spinal fusion has been used for more than 50 years and the long-term results are well understood and are generally reliable. While disc replacement offers many potential advantages, it has not been shown to be superior to spinal fusion in randomised, controlled trials, although the postoperative recovery is certainly more rapid. The majority of the patients in this group are relatively young, certainly less than 60 years old, with many years to live. We have little idea about the long-term results of disc replacement and the possible complications which might occur in the future. We do know that revision surgery after disc replacement can be hazardous. Surgeons and the public are inevitably enthusiastic about new developments, which have potential advantages, but caution needs to be exercised until long-term results of well-controlled trials are available. James Wilson-MacDonald Nuffield Orthopaedic Centre Headington, Oxford OX14 4LZ, UK; E: ten.nigriv@cam.liw