Total disc replacement in the treatment of lumbar discogenic pain with disc herniation: a prospective clinical study.

BACKGROUND Biomechanical benefits of Total Disc Replacement (TDR) including both the restoration of normal segmental range of motion and the prevention of physiological lumbar lordosis encourage spine surgeons to perform TDR for lumbar disc disease. METHODS A total of twenty patients (mean age: 39.5) who had degenerative disc disease with unilateral disc herniation were operated on between 2003 and 2006. Microscopic anterior lumbar discectomy with TDR placement via a transperitoneal approach were performed. Each patient was evaluated using a VAS and the Oswestry index. RESULTS Mean ODI improved from 73.3 preoperatively to 35.0 and 20.4 at 3 and 12 months of follow-up respectively (P < 0.001). The mean VAS score improved from 8.65 preoperatively to 2.6 and 1.9 at 3 and 12 months respectively (P < 0.001). CONCLUSIONS Results from this series are promising and indicate that placement of TDR for degenerative disc disease with lumbar disc herniation is a valuable alternative to conventional techniques. The main advantages of this application are preservation of spinal stability, early mobilization, restoration of normal segmental range of motion and elimination of problems related to intervertebral disc tissue such as discogenic pain and recurrence of disc herniation.