Lumbar disc replacement is an operation to replace a degenerated lumbar disc with an artificial device that preserves motion at the treated level. It is an alternative to lumbar fusion for selected patients with discogenic back pain.
The procedure is performed through an anterior approach (through the abdomen), similar to ALIF. An access surgeon mobilises the abdominal contents and great vessels. The degenerated disc is completely removed. An artificial disc (typically metal endplates with a polyethylene core) is inserted into the disc space. The device preserves flexion, extension, and rotation at the treated level. The operation takes one and a half to two hours.
Disc replacement is considered for single-level discogenic low back pain in patients under 55–60, with preserved facet joints, no significant deformity, no spondylolisthesis, and no severe osteoporosis. It preserves motion and may reduce the risk of adjacent segment disease compared to fusion.
Physiotherapy, pain management, injections, and activity modification. Lumbar fusion (TLIF, ALIF, XLIF) is the main surgical alternative.
MRI, CT, and discography may be used to confirm the painful level. Vascular imaging for the anterior approach. Strict patient selection criteria.
Pain relief equivalent to fusion, with preservation of motion at the treated level. Potentially reduced risk of adjacent segment disease. Most patients experience significant improvement in back pain.
Temporary bowel slowing from the anterior approach.
From the surgical approach.
Risk in men at L5/S1 level, approximately 1–3%.
Great vessels are adjacent. Rare but serious.
Implant sinking into the vertebral body.
Implant shifting position.
Bone formation around the device limiting motion.
Preserved motion may accelerate facet degeneration.
Device failure or ongoing pain may require conversion to fusion.
General anaesthesia. Supine position. Access surgeon assists.
Hospital stay two to three days. Walking from day one. No brace required. Return to desk work at two to four weeks. Avoid heavy lifting for six to eight weeks. Full recovery three to six months.
X-rays at six weeks, three months, six months, and one year. Flexion-extension X-rays to confirm motion preservation.
For carefully selected patients, outcomes are equivalent to fusion with the added benefit of motion preservation. However, not all patients are suitable candidates — strict selection criteria are important.
Long-term data now extends to 15–20 years with good outcomes. The devices are designed to last a lifetime, though long-term wear data continues to be collected.