Disc arthroplasty: lessons learned from total joint arthroplasty

Abstract

Background context With the rapid emergence of new disc arthroplasty designs and ongoing clinical trials, there is great anticipation among clinicians. Inevitably there will be challenges associated with adoption of this new technology. Potential lessons learned from the extensive experience with extremity arthroplasty may predict some of the perils and pitfalls associated with motion-preserving devices in spinal applications. Purpose To review the extremity total joint literature for lessons that may be transferable to disc arthroplasty and anticipate predictable problems that will occur. Study design/setting A literature review and conjectural analysis of key lessons learned from the experience of extremity total joint arthroplasty and anterior lumbar interbody fusion devices with subsequent application of these lessons to disc arthroplasty in the lumbar spine. Methods Limited data are available on disc arthroplasty. Results Particular areas of controversy and uncertainty exist. The ongoing US Food and Drug Administration Investigational Device Exemption clinical trials may provide additional insight into these questions. Conclusions Complications will occur. These will be approach related, device related and patient-selection related. Studying the experience of extremity joint arthroplasty may accelerate the learning curve for lumbar disc arthroplasty.