Prosthetic disc replacement: the future?

Since it first was introduced more than 90 years ago, disc arthrodesis remains the main surgical method for the treatment of degenerative disc disease. Although this procedure does relatively well in stabilizing the anterior column and relieving low back pain by eliminating motion, it is not physiologic and it alters the stress distribution on the adjacent segments. Although the issue of whether this stress alteration leads to symptomatic degeneration remains debatable, it probably is agreed that disc arthrodesis is not the best choice for correcting or preventing anterior column instability caused by degenerative disc disease. The ultimate solution for reestablishing anterior column stability is to restore not only the anatomy but also the normal mechanical function by using a more functional device, prosthetic disc replacement. During the past 401 years, many different designs have been attempted for prosthetic disc replacement. Many biomechanical studies have shown that normal mechanical functions of a disc can be restored by a disc prosthesis. Some early clinical studies have shown promising results. Although it might take more effort to optimize the design and reduce costs and risks, prosthetic disc replacement will be the future of spine care.