The modern Lumbar Artificial Disc Replacement (ADR) was originally developed at the Charite' hospital in Berlin, Germany. The purpose of its development was to replace fusion and its associated problems, as a treatment for degenerated vertebral discs. Artificial Disc Replacement requires no bony fusion to work, nor does it contribute to degeneration of the adjacent segments. Failure of fusions to fuse can cause the patient a great deal of pain. ADR also heals faster and retains the flexible functions of the spine.
Degenerative disc disease, post-total-laminectomy syndrome and spondylosis in the lumbar spine are most common diagnoses, which lead to lumbar artificial disc replacements surgery. Artificial Disc Replacement (ADR) surgery can be performed on the l3/4, l4/5 and l5/s1 disc for most surgeons, as shown in the image,
however highly skilled surgeons can place ADRs in the l1/2 and l2/3 segments. There is no upper limit on age for this surgery in Germany. However, young adults who are still growing should not have this surgery.
Contraindications for the surgery are patients who have ankylosing spondylothesis, pregnant, idiopathic scoliosis, spine infections, severe facet arthrosis, and a spondylothesis greater than a grade 1 are not candidates for this surgery.
Today, there are many different types of lumbar artificial disc replacements available in Europe. The selections are much more limited in the US and the US usually limits ADR surgery to one level, where it is quite common to have multiple-level ADR surgery. Different designs have different strengths and weaknesses and the patient should visit a doctor, who uses many types for the best results.
At the time of this writing, only the Charite and ProDisc are currently FDA approved for use in the USA. This is a consideration when choosing the type of disc for your surgery as follow-up may be easier to find in the US or Canada with an FDA approved lumbar artificial disc replacement device.
For research papers and additional information see Artificial Disc Replacement