Total lumbar disc replacement.

©2005 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.87B8. 16151 $2.00 J Bone Joint Surg [Br] 2005;87-B:1029-37. Rationale for total lumbar disc replacement In the early 20th century, surgical fusion of one or more ‘functional spinal units’ (FSU) was developed and primarily performed for the treatment of spinal infection. 1-4 In the second half of the century, the indication was broadened and soon included the treatment of deformities, fractures, and tumours. 5-10 The main goal of this type of operation was to preserve or re-establish segmental stability in situ or after reduction manoeuvres aiming at the restoration of physiological curvature. The fact that a functional and mobile spinal unit was turned into a stiff non-functional part of the spine was accepted as unavoidable. With the development of spinal instrumentation in the late 1970s and early 1980s, spinal fusion became more popular because these implants facilitated intra-operative manipulation of the spine to restore disc height, foraminal height, and curvature. 11-13 Moreover, the instrumented spine was often given immediate postoperative stability so that patients could be mobilised quickly and post-operative complications because of long-term hospitalisation and periods of immobilisation could be decreased. Spinal fusion had become a standard surgical procedure which was now more predictable and reproducible. Soon it was used for the treatment of degenerative or post-operative changes of the spine. 14-20 Although there is still controversy about its benefit, 21-27 lumbar spinal fusion became accepted worldwide as a treatment option for symptomatic degenerative disease, degenerative spondylolisthesis, degenerative lumbar scoliosis, post-discectomysyndromes or segmental instability adjacent to a previous fusion. 28-32