The Decline of Lumbar Artificial Disc Replacement

Author(s): Tony Eskandar, Zubair Ahmed, Jeremy Pan, Devendra K. Agrawal

Lower back pain associated with degenerative disc disease is a common occurrence, with many surgical treatments targeting the degenerated disc to relieve symptoms. Current surgical options for degenerative disc disease primarily consist of a discectomy followed by either spinal fusion or artificial disc replacement, with the former being increasingly more common in the lumbar region despite the risk of adjacent segment disease. Though artificial disc replacement aims to provide an increase in range of motion and decreases risk of adjacent segment disease, surgeons are increasingly opting for spinal fusion in the lumbar region. This review investigates underlying factors that may be contributing to this trend by assessing lumbar artificial disc replacement selection criteria, clinical outcomes, surgical technique, complications, revision burden, and overall cost. While these factors had some role in the physician’s decision, ultimately the narrow selection criteria and lack of cost reimbursement by insurance has primarily led to the decline in lumbar artificial disc replacement.