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Spine Institute
Glendale Adventist Medical Center
1500 E. Chevy Chase Drive, Suite 401B
Glendale, CA 91206
Ph: (818) 863-4444






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Still Searching for Results of Total Disc Replacement

Posted on: 11/30/1999
Total disc replacement (TDR) continues to be a heated topic. But after 15 years, there's still no evidence that disc replacement is reliable over a long period of time. These authors report that TDR should be considered an experimental operation until proven safe.

There are two parts to the natural disc: the central part called the nucleus and the outer layer, the annulus. Both parts are replaced in TDR. An implant of this type is referred to as an artificial joint or disc arthroplasty.

There are still many questions about the use of these devices. For example:

  • How do the results of TDR compare to fusion?
  • What does a loose implant look like on X-ray?
  • Does the spine keep its motion after TDR?
  • Does the implant prevent wear and tear on the spinal segments above and below it?
  • What happens if it fails? Can it be removed?

    The authors of this report reviewed all studies available on this subject. They found that the short-term results of TDR are similar to spine fusion. Long-term results aren't reported. Loosening of the TDR device hasn't been studied yet.

    After TDR, spine motion is often lost, resulting in fusion between the two vertebral bones after a short time. This defeats the purpose of using an implant instead of just doing a spinal fusion. Wear and tear on nearby spinal levels hasn't been followed up past two years. The implant can be taken out if it fails. When this occurs, a fusion is needed after all.

    According to the authors, research is incomplete on TDR. Even though the devices have been around more than 10 years, the results and possible problems are still not clear. For now, total disc replacement doesn't seem to be better than fusion.

  • References:
    M. de Kleuver, et al. Total Disc Replacement for Chronic Low Back Pain: Background and a Systematic Review of the Literature. In European Spine Journal. April 2003. Vol. 12. No. 2. Pp. 108-116.

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