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Spine Postprocedural Imaging
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Lumbar Artificial Disc
Lumbar Artificial Disc
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Total lumbar disc replacement (TLDR), arthroplasty

        • Definitions

          • Treatment of degenerative disc disease (DDD) by restoring normal mobility of diseased segments and decreasing risk of adjacent-level disc degeneration
          • Removal of diseased disc and insertion of disc prosthesis 
            • Main goals: Restoration and maintenance of normal or near-normal disc space motion during flexion and extension, right and left lateral bending, and axial rotation

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • Staging, Grading, & Classification

                      CLINICAL ISSUES

                      • Presentation

                        • Natural History & Prognosis

                          • Treatment

                            DIAGNOSTIC CHECKLIST

                            • Image Interpretation Pearls

                              Selected References

                              1. Othman YA et al: Artificial disc replacement in spine surgery. Ann Transl Med. 7(Suppl 5):S170, 2019
                              2. Cui XD et al: Mid- to long-term results of total disc replacement for lumbar degenerative disc disease: a systematic review. J Orthop Surg Res. 13(1):326, 2018
                              3. Formica M et al: Lumbar total disc arthroplasty: outdated surgery or here to stay procedure? A systematic review of current literature. J Orthop Traumatol. 18(3):197-215, 2017
                              4. Janssen M et al: Challenges and solutions for lumbar total disc replacement implantation. Spine (Phila Pa 1976). 42 Suppl 24:S108-11, 2017
                              5. Nunley PD et al: Factors affecting the incidence of symptomatic adjacent level disease in cervical spine after total disc arthroplasty: 2-4 years follow-up of 3 prospective randomized trials. Spine (Phila Pa 1976). 37(6):445-51, 2012
                              6. Uschold TD et al: Cervical and lumbar spinal arthroplasty: clinical review. AJNR Am J Neuroradiol. 33(9):1631-41, 2012
                              7. Cepoiu-Martin M et al: Artificial cervical disc arthroplasty: a systematic review. Spine (Phila Pa 1976). 36(25):E1623-33, 2011
                              8. Murtagh RD et al: New techniques in lumbar spinal instrumentation: what the radiologist needs to know. Radiology. 260(2):317-30, 2011
                              9. Di Silvestre M et al: Two-level total lumbar disc replacement. Eur Spine J. 18 Suppl 1:64-70, 2009
                              10. Erkan S et al: Biomechanical comparison of a two-level Maverick disc replacement with a hybrid one-level disc replacement and one-level anterior lumbar interbody fusion. Spine J. 9(10):830-5, 2009
                              11. Ingalhalikar AV et al: Effect of lumbar total disc arthroplasty on the segmental motion and intradiscal pressure at the adjacent level: an in vitro biomechanical study: presented at the 2008 Joint Spine Section Meeting Laboratory investigation. J Neurosurg Spine. 11(6):715-23, 2009
                              12. Murtagh RD et al: Normal and abnormal imaging findings in lumbar total disk replacement: devices and complications. Radiographics. 29(1):105-18, 2009
                              13. Center for Devices and Radiological Health, U.S. Food and Drug Administration. New device approval: CHARITÉ Artificial Disc—P040006. Published October 26, 2004. Updated November 17, 2004. Accessed August 21, 2008
                              14. Dmitriev AE et al: Effect of multilevel lumbar disc arthroplasty on the operative- and adjacent-level kinematics and intradiscal pressures: an in vitro human cadaveric assessment. Spine J. 8(6):918-25, 2008
                              15. Galbusera F et al: Design concepts in lumbar total disc arthroplasty. Eur Spine J. 17(12):1635-50, 2008
                              16. Park CK et al: Degenerative changes of discs and facet joints in lumbar total disc replacement using ProDisc II: minimum two-year follow-up. Spine (Phila Pa 1976). 33(16):1755-61, 2008
                              17. Marshman LA et al: The accuracy and validity of "routine" X-rays in estimating lumbar disc arthroplasty placement. Spine (Phila Pa 1976). 32(23):E661-6, 2007
                              18. Resnick DK et al: Lumbar disc arthroplasty: a critical review. Clin Neurosurg. 54:83-7, 2007
                              19. Shim CS et al: CHARITE versus ProDisc: a comparative study of a minimum 3-year follow-up. Spine (Phila Pa 1976). 32(9):1012-8, 2007
                              20. Lemaire JP et al: Clinical and radiological outcomes with the Charité artificial disc: a 10-year minimum follow-up. J Spinal Disord Tech. 2005 Aug;18(4):353-9. Erratum in: J Spinal Disord Tech. 19(1):76, 2006
                              21. Gamradt SC et al: Lumbar disc arthroplasty. Spine J. 5(1):95-103, 2005
                              22. Neal CJ et al: Magnetic resonance imaging evaluation of adjacent segments after disc arthroplasty. J Neurosurg Spine. 3(5):342-7, 2005
                              23. Anderson PA et al: Intervertebral disc arthroplasty. Spine (Phila Pa 1976). 29(23):2779-86, 2004
                              24. Errico TJ: Why a mechanical disc? Spine J. 4(6 Suppl):151S-157S, 2004
                              25. Geisler FH et al: Neurological complications of lumbar artificial disc replacement and comparison of clinical results with those related to lumbar arthrodesis in the literature: results of a multicenter, prospective, randomized investigational device exemption study of Charité intervertebral disc. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 1(2):143-54, 2004
                              26. Hallab N et al: Biomaterial optimization in total disc arthroplasty. Spine (Phila Pa 1976). 28(20):S139-52, 2003
                              27. McAfee PC et al: Cervical disc replacement-porous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine (Phila Pa 1976). 28(20):S176-85, 2003
                              28. van Ooij A et al: Complications of artificial disc replacement: a report of 27 patients with the SB Charité disc. J Spinal Disord Tech. 16(4):369-83, 2003
                              29. Bertagnoli R et al: Indications for full prosthetic disc arthroplasty: a correlation of clinical outcome against a variety of indications. Eur Spine J. 11 Suppl 2:S131-6, 2002
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Clinical Issues

                                    TERMINOLOGY

                                    • Synonyms

                                      • Total lumbar disc replacement (TLDR), arthroplasty

                                    • Definitions

                                      • Treatment of degenerative disc disease (DDD) by restoring normal mobility of diseased segments and decreasing risk of adjacent-level disc degeneration
                                      • Removal of diseased disc and insertion of disc prosthesis 
                                        • Main goals: Restoration and maintenance of normal or near-normal disc space motion during flexion and extension, right and left lateral bending, and axial rotation

                                    IMAGING

                                    • General Features

                                      • Radiographic Findings

                                        • CT Findings

                                          • MR Findings

                                            • Imaging Recommendations

                                              DIFFERENTIAL DIAGNOSIS

                                                PATHOLOGY

                                                • Staging, Grading, & Classification

                                                  CLINICAL ISSUES

                                                  • Presentation

                                                    • Natural History & Prognosis

                                                      • Treatment

                                                        DIAGNOSTIC CHECKLIST

                                                        • Image Interpretation Pearls

                                                          Selected References

                                                          1. Othman YA et al: Artificial disc replacement in spine surgery. Ann Transl Med. 7(Suppl 5):S170, 2019
                                                          2. Cui XD et al: Mid- to long-term results of total disc replacement for lumbar degenerative disc disease: a systematic review. J Orthop Surg Res. 13(1):326, 2018
                                                          3. Formica M et al: Lumbar total disc arthroplasty: outdated surgery or here to stay procedure? A systematic review of current literature. J Orthop Traumatol. 18(3):197-215, 2017
                                                          4. Janssen M et al: Challenges and solutions for lumbar total disc replacement implantation. Spine (Phila Pa 1976). 42 Suppl 24:S108-11, 2017
                                                          5. Nunley PD et al: Factors affecting the incidence of symptomatic adjacent level disease in cervical spine after total disc arthroplasty: 2-4 years follow-up of 3 prospective randomized trials. Spine (Phila Pa 1976). 37(6):445-51, 2012
                                                          6. Uschold TD et al: Cervical and lumbar spinal arthroplasty: clinical review. AJNR Am J Neuroradiol. 33(9):1631-41, 2012
                                                          7. Cepoiu-Martin M et al: Artificial cervical disc arthroplasty: a systematic review. Spine (Phila Pa 1976). 36(25):E1623-33, 2011
                                                          8. Murtagh RD et al: New techniques in lumbar spinal instrumentation: what the radiologist needs to know. Radiology. 260(2):317-30, 2011
                                                          9. Di Silvestre M et al: Two-level total lumbar disc replacement. Eur Spine J. 18 Suppl 1:64-70, 2009
                                                          10. Erkan S et al: Biomechanical comparison of a two-level Maverick disc replacement with a hybrid one-level disc replacement and one-level anterior lumbar interbody fusion. Spine J. 9(10):830-5, 2009
                                                          11. Ingalhalikar AV et al: Effect of lumbar total disc arthroplasty on the segmental motion and intradiscal pressure at the adjacent level: an in vitro biomechanical study: presented at the 2008 Joint Spine Section Meeting Laboratory investigation. J Neurosurg Spine. 11(6):715-23, 2009
                                                          12. Murtagh RD et al: Normal and abnormal imaging findings in lumbar total disk replacement: devices and complications. Radiographics. 29(1):105-18, 2009
                                                          13. Center for Devices and Radiological Health, U.S. Food and Drug Administration. New device approval: CHARITÉ Artificial Disc—P040006. Published October 26, 2004. Updated November 17, 2004. Accessed August 21, 2008
                                                          14. Dmitriev AE et al: Effect of multilevel lumbar disc arthroplasty on the operative- and adjacent-level kinematics and intradiscal pressures: an in vitro human cadaveric assessment. Spine J. 8(6):918-25, 2008
                                                          15. Galbusera F et al: Design concepts in lumbar total disc arthroplasty. Eur Spine J. 17(12):1635-50, 2008
                                                          16. Park CK et al: Degenerative changes of discs and facet joints in lumbar total disc replacement using ProDisc II: minimum two-year follow-up. Spine (Phila Pa 1976). 33(16):1755-61, 2008
                                                          17. Marshman LA et al: The accuracy and validity of "routine" X-rays in estimating lumbar disc arthroplasty placement. Spine (Phila Pa 1976). 32(23):E661-6, 2007
                                                          18. Resnick DK et al: Lumbar disc arthroplasty: a critical review. Clin Neurosurg. 54:83-7, 2007
                                                          19. Shim CS et al: CHARITE versus ProDisc: a comparative study of a minimum 3-year follow-up. Spine (Phila Pa 1976). 32(9):1012-8, 2007
                                                          20. Lemaire JP et al: Clinical and radiological outcomes with the Charité artificial disc: a 10-year minimum follow-up. J Spinal Disord Tech. 2005 Aug;18(4):353-9. Erratum in: J Spinal Disord Tech. 19(1):76, 2006
                                                          21. Gamradt SC et al: Lumbar disc arthroplasty. Spine J. 5(1):95-103, 2005
                                                          22. Neal CJ et al: Magnetic resonance imaging evaluation of adjacent segments after disc arthroplasty. J Neurosurg Spine. 3(5):342-7, 2005
                                                          23. Anderson PA et al: Intervertebral disc arthroplasty. Spine (Phila Pa 1976). 29(23):2779-86, 2004
                                                          24. Errico TJ: Why a mechanical disc? Spine J. 4(6 Suppl):151S-157S, 2004
                                                          25. Geisler FH et al: Neurological complications of lumbar artificial disc replacement and comparison of clinical results with those related to lumbar arthrodesis in the literature: results of a multicenter, prospective, randomized investigational device exemption study of Charité intervertebral disc. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 1(2):143-54, 2004
                                                          26. Hallab N et al: Biomaterial optimization in total disc arthroplasty. Spine (Phila Pa 1976). 28(20):S139-52, 2003
                                                          27. McAfee PC et al: Cervical disc replacement-porous coated motion prosthesis: a comparative biomechanical analysis showing the key role of the posterior longitudinal ligament. Spine (Phila Pa 1976). 28(20):S176-85, 2003
                                                          28. van Ooij A et al: Complications of artificial disc replacement: a report of 27 patients with the SB Charité disc. J Spinal Disord Tech. 16(4):369-83, 2003
                                                          29. Bertagnoli R et al: Indications for full prosthetic disc arthroplasty: a correlation of clinical outcome against a variety of indications. Eur Spine J. 11 Suppl 2:S131-6, 2002