What are the caveats associated with the effectiveness of artificial intervertebral disc replacement?

From the Guidelines

Artificial intervertebral disc replacement is associated with several caveats, including variable effectiveness compared to lumbar spine fusion, reduced reoperation rate and operation time, and decreased post-surgical complications in the short and long term, as shown in recent reviews 1. The effectiveness of artificial intervertebral disc replacement is a complex issue, with recent studies indicating that it can significantly improve pain and patient satisfaction, reduce reoperation rate and operation time, and decrease post-surgical complications compared to lumbar spine fusion in both the short term and the long term 1. Some key points to consider include:

• Recent reviews have shown that total disc replacement can improve outcomes compared to lumbar spine fusion, including reduced pain and improved patient satisfaction 1.
• The comparison between lumbar spine fusion and total disc replacement has shown variable results in earlier reviews, but more recent studies have consistently shown the benefits of total disc replacement 1.
• The minimally invasive approach has been associated with less blood loss, shorter hospital stay, and slightly less disability compared to open transforaminal lumbar interbody fusion for single level degenerative disease 1. However, it is essential to consider the limitations of the current evidence, including the lack of long-term data and the focus on single-level disk disease, which may not be representative of all patients requiring spinal surgery 1. Overall, the decision to use artificial intervertebral disc replacement should be made on a case-by-case basis, taking into account the individual patient's needs and the potential benefits and risks of the procedure, as supported by the best available evidence 1.

From the Research

Caveats Associated with Artificial Intervertebral Disc Replacement

The effectiveness of artificial intervertebral disc replacement is associated with several caveats, including:

• The quality of evidence for cervical artificial disc replacement (C-ADR) is moderate for effectiveness and very low for long-term durability 2, 3
• The rate of major complications after lumbar artificial disc replacement (ADR) ranges from 0% to 13% per device implanted, and the rate of adjacent segment degeneration (ASD) is not well reported 2, 4
• The effectiveness of C-ADR compared to spinal fusion cannot be determined due to sparse data 2, 3
• The cost-effectiveness of ADR compared to spinal fusion is uncertain, with estimated costs ranging from $11,607 to $16,782 per quality-adjusted life-year (QALY) 3
• The long-term outcomes of ADR are not well established, with limited data available beyond 2-year follow-up 2, 4, 5

Complications and Risks

Some of the complications and risks associated with artificial intervertebral disc replacement include:

• Device failure and reoperation 2, 4
• Neurological complications, such as numbness and weakness 2, 4
• Infection and wound complications 4
• Adjacent segment degeneration (ASD) 2, 4
• Heterotopic ossification (HO) 6

Limitations of Current Evidence

The current evidence for artificial intervertebral disc replacement has several limitations, including:

• Limited long-term follow-up data 2, 4, 5
• Sparse data for cervical ADR 2, 3
• High risk of bias in some studies 4
• Limited generalizability to different patient populations and settings 2, 4, 3