Mid- to long-term results of total disc replacement for lumbar degenerative disc disease: a systematic review

BACKGROUND: Lumbar total disc replacement (TDR) has shown satisfactory clinical outcomes with few complications and reoperations at short-term follow-up, but the mid- to long-term results are not clear. PURPOSE: The objective of this study was to evaluate the mid- to long-term clinical outcomes of artificial TDR for lumbar degenerative disc diseases. PATIENTS AND METHODS: A systematic search was conducted using the PubMed database to identify studies of TDR surgery that included at least 3 years of follow-up. The search keywords were as follows: lumbar, total disc replacement, and arthroplasty. The following data were extracted: patient demographics, visual analogue scale (VAS) and Oswestry disability index (ODI) scores, satisfactory rate, clinical success rate, complications, and reoperations. RESULTS: Thirteen studies, including eight prospective studies and five retrospective studies, met the criteria. A total of 946 patients were identified who reported at least 3 years of follow-up results. The artificial prostheses in these studies were ProDisc-L, Charité, AcroFlex, Maverick, and XL TDR. Patients with lumbar TDR demonstrated significant improvements in VAS scores of 51.1 to 70.5% and of − 15.6 to − 44.4 for Oswestry disability index (ODI) scores at the last follow-up. Patient satisfaction rates were reported in eight studies and ranged from 75.5 to 93.3%. Complication rates were reported in 11 studies, ranging from 0 to 34.4%. The overall reoperation rate was 12.1% (119/986), ranging from 0 to 39.3%, with eight of the 13 studies reporting a reoperation rate of less than 10%. CONCLUSIONS: This review shows that lumbar TDR effectively results in pain relief and an improvement in quality of life at mid- to long-term follow-up. Complication and reoperation rates were acceptable. However, this study did not provide sufficient evidence to show that lumbar TDR is superior to fusion surgery. To answer that question, a greater number of high-quality randomized controlled trials (RCTs) are needed.