Preserving spinal motion: lumbar disc arthroplasty in the US

Symptomatic lumbar degenerative disc disease affects millions of patients, is a leading cause of physician visits annually, and significantly impacts healthcare systems globally. The gold standard treatment for this condition is spinal fusion, but its mechanism of eliminating segmental motion and risk of adjacent segment disease resulting in additional surgery has increased interest in alternative treatments. Lumbar disc arthroplasty has emerged as an alternative to fusion due to its comparable patient outcomes coupled with the ability to preserve spinal motion resulting in greater long-term benefit potential. Yet, widespread adoption of the procedure has been dampened by low reimbursement rates and disproportionate insurance denials compared to lumbar fusions, affecting patient access to this technology. Artificial disc procedures have been performed in Europe since the mid-1980's with favorable results, leaving the United States comparatively behind. The aim of this review article is to summarize the current literature regarding lumbar disc arthroplasty as it pertains to implants available in the United States.