title: Total disc replacement.
abstract: Total disc replacement (TDR) (partial disc replacement will not be described) has been used in the lumbar spine since the 1980s, and more recently in the cervical spine. Although the biomechanical concepts are the same and both are inserted through an anterior approach, lumbar TDR is conventionally indicated for chronic low back pain, whereas cervical TDR is used for soft discal hernia resulting in cervicobrachial neuralgia. The insertion technique must be rigorous, with precise centering in the disc space, taking account of vascular anatomy, which is more complex in the lumbar region, particularly proximally to L5-S1. All of the numerous studies, including prospective randomized comparative trials, have demonstrated non-inferiority to fusion, or even short-term superiority regarding speed of improvement. The main implant-related complication is bridging heterotopic ossification with resulting loss of range of motion and increased rates of adjacent segment degeneration, although with an incidence lower than after arthrodesis. A sufficiently long follow-up, which has not yet been reached, will be necessary to establish definitively an advantage for TDR, particularly in the cervical spine.
authors.affiliation: Unité Rachis 1, hôpital Tripode, CHU de Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France. Electronic address: jean-marc.vital@chu-bordeaux.fr.
authors.forename: J-M
authors.initials: JM
authors.lastname: Vital
authors.affiliation: Unité Rachis 1, hôpital Tripode, CHU de Bordeaux, place Amélie Raba-Léon, 33000 Bordeaux, France.
authors.forename: L
authors.initials: L
authors.lastname: Boissière
mesh_terms: D020968:Brachial Plexus Neuritis / Q000175:diagnosis / Q000601:surgery*; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D010147:Pain Measurement; D011183:Postoperative Complications / Q000175:diagnosis; D011474:Prosthesis Design; D013122:Spinal Diseases / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D059145:Total Disc Replacement / Q000379:methods*
keywords: Cervical herniation; Cervical total disc replacement (CTDR); Cervicobrachial neuralgia; Low back pain; Lumbar total disc replacement (LTDR)