An alternative to lumbar fusion. Rather than joining two vertebrae into one solid segment, the worn disc is removed and replaced with a device that lets the level keep moving. The selection criteria are very narrow — most patients considering it are better served by another option, and candidacy is decided on imaging rather than on preference.
A fusion treats a painful lumbar level by stopping it moving. That works, and it is the right operation for a great many people — but it also transfers load to the levels above and below, which is the reasoning behind wanting to preserve motion where the anatomy genuinely allows it.
Disc arthroplasty removes the disc through an anterior approach and puts an articulating implant in its place, so the segment continues to flex and extend. The decompression achieved is the same; what differs is what is left behind.
Lumbar disc arthroplasty construct. Anterior view of the implant seated in the prepared disc space, with the vertebral endplates above and below, contrasted against a fused level.
Discogenic low back pain from a single degenerated level, in a patient whose anatomy is otherwise sound. The pain has to be coming from the disc itself rather than from the facet joints, the sacroiliac joint, or a nerve root — which is why the workup matters more here than the operation does.
An artificial disc only makes sense if the rest of the segment can do its job. The implant restores the disc; it cannot restore facet joints that are already arthritic, it cannot correct instability, and it depends on bone that will hold it. Each of those rules people out, and together they rule out most.
This is the honest position: most patients who come in asking about a lumbar disc replacement are not candidates for one. That is not a hedge — it is what the imaging usually shows, and saying so early is better than working through a consultation toward a disappointment.
Any one of these generally rules it out. They are assessed on imaging, not on symptoms.
This list is not exhaustive and none of it substitutes for a consultation — the point is that candidacy turns on findings a patient cannot assess from symptoms alone.
Neither column is the better operation in the abstract. A fusion does things an artificial disc cannot, which is exactly why the candidacy for arthroplasty is narrow — see how the approach is chosen.
Through an anterior approach — the disc is reached from the front, through the abdomen, rather than through the back muscles. That gives direct access to the disc space without disturbing the posterior elements the implant depends on.
Anterior lumbar exposure. The retroperitoneal corridor to the anterior disc space, with the great vessels mobilised and the disc space prepared for implant seating.
Lumbar disc arthroplasty. Discectomy through the anterior corridor, endplate preparation, and the implant seated with the level still articulating through flexion and extension.
Recovery from an anterior approach differs from the posterior operations described elsewhere on this site, and the specifics depend on the level treated and on the individual patient. Dr. Zaidi will set out what to expect during consultation.
Recovery figures elsewhere on this site are general ranges from the surgical literature, not guarantees for any individual case. This page deliberately gives none rather than quote a range that has not been reviewed for this procedure.
It is decided on imaging. Bring any MRI or CT you already have — most of the question is answered before the conversation starts.