Lumbar Disc Replacements and Motion Preservation Devices
Lumbar Disc Replacements and Motion Preservation Devices
Lumbar disc replacement and motion preservation is a popular concept to treat degenerative disc disease in the lumbar spine. These surgical interventions are thought to maintain mobility at the operated level and subsequently aid in the prevention of adjacent level degeneration. This article reviews the current status of lumbar disc replacement and motion preservation devices. A literature search was performed via PubMed with an emphasis on reviewing articles published within the last 2 years to discuss recent developments and trends on lumbar disc replacement and motion preservation devices. Based on this criterion, we reviewed over 40 articles in detail recently published on lumbar disc replacement and motion preservation devices. More than 20 of these articles discussed lumbar disc replacement specifically. These articles ranged from outcome studies to the biomechanics of the prosthesis to discussion of adjacent segment degeneration. Ten articles discussed various posterior motion preservation devices ranging from pedicle-based systems to one article that discussed facet joint resurfacing. The remaining articles discussed various other modalities of treatment for the lumbar spine from biologics to manipulative therapy. After this thorough review of the literature, approximately 30 articles are highlighted, as they are particularly relevant to the topic of discussion. Compared with some spine topics, there is little recent literature available for review on this important topic. There are motion preservation devices available for use in the US with proven clinical success, but there is no evidence of definitive prevention or dissipation of adjacent level degeneration with the use of these devices. Further clinical research and product development is imperative to allow for the evolution of this intriguing treatment modality to prosper.
Axial low back pain is pain in the lumbar region that is not associated with radicular symptoms. This phenomenon is commonly referred to as degenerative disc disease (DDD). Low back pain is multifactorial, and the etiology of the pain usually is not fully elucidated. There is a lifetime prevalence of low back pain that exceeds 80% in the United States, and it is the second most common reason to visit a physician or miss work. This equals an estimated annual incidence of 15 million Americans who seek a physician every year secondary to back pain. Fortunately, the natural history generally is favorable with acceptable improvement or complete resolution of symptoms within 4–6 weeks.
Back pain permeates American society and has become such an economic burden that companies have begun to research this work place issue independently. In a recent occupational medicine study, 579 prospective employees without low back pain were evaluated to establish baseline lumbar spine motion measurements in the event of a workplace accident, and they found 86% of these applicants had lumbar motion impairment. This is an interesting finding and may offer some insight into the high prevalence of low back pain and further emphasize the importance of treatment alternatives that allow for motion preservation of the spine.
Abstract and Introduction
Abstract
Lumbar disc replacement and motion preservation is a popular concept to treat degenerative disc disease in the lumbar spine. These surgical interventions are thought to maintain mobility at the operated level and subsequently aid in the prevention of adjacent level degeneration. This article reviews the current status of lumbar disc replacement and motion preservation devices. A literature search was performed via PubMed with an emphasis on reviewing articles published within the last 2 years to discuss recent developments and trends on lumbar disc replacement and motion preservation devices. Based on this criterion, we reviewed over 40 articles in detail recently published on lumbar disc replacement and motion preservation devices. More than 20 of these articles discussed lumbar disc replacement specifically. These articles ranged from outcome studies to the biomechanics of the prosthesis to discussion of adjacent segment degeneration. Ten articles discussed various posterior motion preservation devices ranging from pedicle-based systems to one article that discussed facet joint resurfacing. The remaining articles discussed various other modalities of treatment for the lumbar spine from biologics to manipulative therapy. After this thorough review of the literature, approximately 30 articles are highlighted, as they are particularly relevant to the topic of discussion. Compared with some spine topics, there is little recent literature available for review on this important topic. There are motion preservation devices available for use in the US with proven clinical success, but there is no evidence of definitive prevention or dissipation of adjacent level degeneration with the use of these devices. Further clinical research and product development is imperative to allow for the evolution of this intriguing treatment modality to prosper.
Introduction
Axial low back pain is pain in the lumbar region that is not associated with radicular symptoms. This phenomenon is commonly referred to as degenerative disc disease (DDD). Low back pain is multifactorial, and the etiology of the pain usually is not fully elucidated. There is a lifetime prevalence of low back pain that exceeds 80% in the United States, and it is the second most common reason to visit a physician or miss work. This equals an estimated annual incidence of 15 million Americans who seek a physician every year secondary to back pain. Fortunately, the natural history generally is favorable with acceptable improvement or complete resolution of symptoms within 4–6 weeks.
Back pain permeates American society and has become such an economic burden that companies have begun to research this work place issue independently. In a recent occupational medicine study, 579 prospective employees without low back pain were evaluated to establish baseline lumbar spine motion measurements in the event of a workplace accident, and they found 86% of these applicants had lumbar motion impairment. This is an interesting finding and may offer some insight into the high prevalence of low back pain and further emphasize the importance of treatment alternatives that allow for motion preservation of the spine.
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