Artificial Disc Replacement / 대한척추외과학회지

ABSTRACT

The current two most popular spine surgeries, discectomy and fusion, at best address the pathology of low back pain, but significantly change the normal structure and function of the disc and lead to further degeneration of the adjacent segments. Artificial disc replacement (ADR) is considered an alternative to fusion in treatment of the degenerative disc disease. It can restore the normal kinematic and load-shearing properties of diseased lumbar segments, maintaining stability and mobility with relief of pain. Over the past 40 years, a tremendous effort has been made to develop an artificial disc to replace the degenerated disc. Design criteria of artificial disc include endurance, biocompatibility, galvanic corrosion, geometry, constraints, dynamics, implant stability, and fail-safe. The indications of ADR are still not clear. But the principal indications include mono- and bi-segmental instability, the postnucleotomy syndrome, and spondylolisthesis up to Meyerding I after unsuccessful conservative treatment. The contra-indications are osteoporosis, previous or latent local infection, spondylolisthesis greater than Meyerding I, spinal stenosis, as well as degenerative spondylosis, mainly involving facet joints. There have been several reports about clinical results of ADR. The initial results seem to be good, but follow-up is too short for definite conclusions. Accurate patient selection is imperative to obtain good clinical results. Prospective and longer term studies are needed to evaluate the efficacy of ADR. The further development in designs and materials of artificial disc is the most important to duplicate not only the natural form of disc but also its function.