Lumbar Disc Arthroplasty (Artificial Disc)
Lumbar disc arthroplasty is a spinal surgery in which a degenerated intervertebral disc in the lower back is removed and replaced with a motion-preserving artificial disc. The aim is to address the source of discogenic low back pain while maintaining motion at the treated level, offering an alternative to lumbar fusion.
Last updated: 2026-06-09
Definition
Lumbar disc arthroplasty is the removal of a severely degenerated disc in the lower back through an anterior approach and its replacement with an artificial disc implant that permits joint motion. It shares the same goal as lumbar fusion (treating the painful segment); however, instead of fusing the segment, it aims to preserve motion at the treated level. As a motion-preserving technique, it is considered within a narrow range of indications as an option to fusion in selected patients.
Indications
Lumbar disc arthroplasty is considered, usually at a single level, in selected patients with discogenic low back pain from disc degeneration demonstrated on imaging (MRI), concordant with clinical findings, who have not responded to an adequate trial of conservative treatment. Candidates are typically patients without marked facet arthrosis, spondylolisthesis, instability, signs of nerve compression, severe osteoporosis, or extensive multilevel pathology. Because the indication is relatively narrow, patient selection is meticulous; the symptoms must match the pathology of the level and the spinal anatomy must be suited to motion preservation.
Procedure
The procedure is usually performed under general anesthesia with the patient supine, through an anterior retroperitoneal approach to the abdomen; this approach often requires the assistance of a vascular or general surgeon to protect the great vessels. After the target level is confirmed with fluoroscopy, the degenerated disc is removed and the disc space is prepared. An appropriately sized artificial disc is placed between the endplates, and its position and alignment are checked with imaging. After hemostasis is achieved, the layers are closed.
Advantages and Limitations
The theoretical advantage of lumbar disc arthroplasty is that, by preserving motion at the treated level, it aims to reduce the load transferred to adjacent levels and to avoid some problems associated with fusion. However, the range of indications is narrower than for cervical arthroplasty and the proportion of suitable patients is limited; it is not preferred in facet arthrosis, instability, spondylolisthesis, or multilevel degeneration. The risks of the anterior approach due to the proximity of the great vessels, and uncertainty about the long-term durability of the implant and the difficulty of revision surgery when needed, are important limitations. The technique requires experience and very careful patient selection.
Recovery and Risks
Recovery time varies by patient; many patients return gradually to daily activities, while return to heavy activity takes time. Possible risks include infection, bleeding, great-vessel or surrounding-organ injury related to the anterior approach, nerve injury, implant migration or subsidence, heterotopic ossification, and adjacent-level problems. Pain may not resolve completely, or additional intervention may become necessary over time. No outcome is guaranteed; the decision is individualized by considering the patient's clinical status, imaging findings, and expectations together.
References
- Steinmetz MP, Berven SH, Benzel EC, eds. Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management. 5th ed. Elsevier; 2022:1088-1093.
- Winn HR, ed. Youmans Neurological Surgery. 6th ed. Saunders; 2011:2711-2718.
- Steinmetz MP, Berven SH, Benzel EC, eds. Benzel's Spine Surgery: Techniques, Complication Avoidance, and Management. 5th ed. Elsevier; 2022:142-148.
- National Institute for Health and Care Excellence (NICE). Prosthetic intervertebral disc replacement in the lumbar spine. Interventional procedures guidance.
This article is for general information and does not replace a medical examination. Diagnosis and treatment decisions are individual.