Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Jun;8(4):413-423.
doi: 10.1177/2192568217737317. Epub 2017 Nov 16.

Comparison of Lumbar Total Disc Replacement With Surgical Spinal Fusion for the Treatment of Single-Level Degenerative Disc Disease: A Meta-Analysis of 5-Year Outcomes From Randomized Controlled Trials

Jack Zigler  1 , Matthew F Gornet  2 , Nicole Ferko  3 , Chris Cameron  3 , Francine W Schranck  4 , Leena Patel  3
Affiliations
Review

Comparison of Lumbar Total Disc Replacement With Surgical Spinal Fusion for the Treatment of Single-Level Degenerative Disc Disease: A Meta-Analysis of 5-Year Outcomes From Randomized Controlled Trials

Jack Zigler et al. Global Spine J. 2018 Jun.

Abstract

Study design: Meta-analysis.

Objectives: To evaluate the long-term efficacy and safety of total disc replacement (TDR) compared with fusion in patients with functionally disabling chronic low back pain due to single-level lumbar degenerative disc disease (DDD) at 5 years.

Methods: PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials reporting outcomes at 5 years for TDR compared with fusion in patients with single-level lumbar DDD. Outcomes included Oswestry Disability Index (ODI) success, back pain scores, reoperations, and patient satisfaction. All analyses were conducted using a random-effects model; analyses were reported as relative risk (RR) ratios and mean differences (MDs). Sensitivity analyses were conducted for different outcome definitions, high loss to follow-up, and high heterogeneity.

Results: The meta-analysis included 4 studies. TDR patients had a significantly greater likelihood of ODI success (RR 1.0912; 95% CI 1.0004, 1.1903) and patient satisfaction (RR 1.13; 95% CI 1.03, 1.24) and a significantly lower risk of reoperation (RR 0.52; 95% CI 0.35, 0.77) than fusion patients. There was no association with improvement in back pain scores whether patients received TDR or fusion (MD -2.79; 95% CI -8.09, 2.51). Most results were robust to sensitivity analyses. Results for ODI success and patient satisfaction were sensitive to different outcome definitions but remained in favor of TDR.

Conclusions: TDR is an effective alternative to fusion for lumbar DDD. It offers several clinical advantages over the longer term that can benefit the patient and reduce health care burden, without additional safety consequences.

Keywords: degenerative disc disease; long-term outcomes; lumbar arthrodesis; lumbar arthroplasty; lumbar fusion; meta-analysis; total disc replacement.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LP, NF, and CC are employees of Cornerstone Research Group Inc, a consultancy that received fees from Aesculap during the conduct of the study. JZ reports personal fees from Aesculap and DePuy Synthes outside the submitted work. MFG reports other funding from Medtronic, K2M, Bonovo, International Spine & Orthopedic Institute, LLC, Nocimed, OuroBoros, and Viscogliosi Bros Venture Partners, LLC outside the submitted work. FWS reports personal fees from Aesculap during the conduct of the study; personal fees from Medtronic, Zimmer/Biomet, and Nocimed and other from Nocimed outside the submitted work.

Figures

Figure 1.
Figure 1.
PRISMA flowchart for the comprehensive literature search.
Figure 2.
Figure 2.
Risk of bias assessment for included trials.
Figure 3.
Figure 3.
Forest plot of pooled results comparing TDR with fusion for ODI success.
Figure 4.
Figure 4.
Forest plot of pooled results comparing TDR with fusion for back pain score.
Figure 5.
Figure 5.
Forest plot of pooled results comparing TDR with fusion for reoperations.
Figure 6.
Figure 6.
Forest plot of pooled results comparing TDR with fusion for patient satisfaction.
See this image and copyright information in PMC

References

    1. Walker BF, Muller R, Grant WD. Low back pain in Australian adults: prevalence and associated disability. J Manipulative Physiol Ther. 2004;27:238–244. doi:10.1016/j.jmpt.2004.02.002. - PubMed
    1. Fujii T, Matsudaira K. Prevalence of low back pain and factors associated with chronic disabling back pain in Japan. Eur Spine J. 2013;22:432–438. doi:10.1007/s00586-012-2439-0. - PMC - PubMed
    1. Capkin E, Karkucak M, Cakirbay H, et al. The prevalence and risk factors of low back pain in the eastern Black Sea region of Turkey. J Back Musculoskelet Rehabil. 2015;28:783–787. doi:10.3233/bmr-150584. - PubMed
    1. Cassidy JD, Carroll LJ, Côté P. The Saskatchewan health and back pain survey. The prevalence of low back pain and related disability in Saskatchewan adults. Spine (Phila Pa 1976). 1998;23:1860–1866. - PubMed
    1. Gibson JN, Waddell G. Surgery for degenerative lumbar spondylosis. Cochrane Database Syst Rev. 2005;(4):CD001352 doi:10.1002/14651858.CD001352.pub3. - PMC - PubMed