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Total Disk Arthroplasty

Dr. Lin is Fellow, Spine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL. Dr. Wang is Chief, Orthopaedic Spine Service and Associate Professor of Orthopaedic and Neurosurgery, UCLA Comprehensive Spine Center, UCLA School of Medicine, Santa Monica, CA.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Lin and Dr. Wang.

Reprint Requests: Dr. Wang, UCLA Comprehensive Spine Center, UCLA School of Medicine, 1250 16th Street, 7th Floor, Santa Monica, CA 90404.

Spinal fusion remains the gold standard for surgical management of instability and mechanical low back or neck pain. However, even in carefully selected patients, successful clinical results can be difficult to achieve. Reasons for failure include pseudarthrosis and adjacent spine segment disease. The theoretic advantages of removing the painful disk while preserving motion have led to increasing interest in total disk arthroplasty. Although disk replacements have been implanted in Europe for decades, the procedure is relatively new in the United States. Recently, two artificial disks for symptomatic lumbar degenerative disk disease have been approved by the US Food and Drug Administration; several others are undergoing clinical trials. Short-term studies demonstrate similar clinical improvements for both disk replacements and fusion procedures at up to 2-year follow-up. Issues requiring further research include optimal design specifications, potential complications, and appropriate patient selection. Consequently, the long-term benefit of total disk arthroplasty over fusion for the treatment of axial low back or neck pain remains to be determined.