Impact of Total Disc Replacement on Spine Surgery in the Community
Total disc replacement (TDR) was approved by the FDA in 2004. Since that time, more surgical centers have started to include this procedure. But how often does the average community-based spinal surgeon have patients who could benefit from this operation?

In this study, the charts of patients seen for lumbar surgery by one private practice surgeon were reviewed. Fusion and nonfusion patients over a period of 15 months were included. The goal was to identify how often patients in a typical spine surgery practice might be a good candidate for TDR.

As it turned out, there were 190 patients who had lumbar spine surgery during that time period. Two-thirds had nonfusion procedures. The remaining one-third had a spinal fusion. The authors used criteria from two well-known studies to determine eligibility for TDR.

None of the patients in the nonfusion group were good candidates for TDR. Everyone had at least one factor that was considered a contraindication (reason not to have the surgery). About 14 per cent of the fusion group would have been potential candidates for TDR surgery. Only half of those patients eligible had private health insurance.

Only five per cent of the entire group (fusion and nonfusion patients) were potential candidates for TDR. The authors point out that this figure is much less than the 70 per cent previously predicted by the companies that manufacture the TDR implants.

These results were consistent with information from other studies. However, not everyone uses the same indications and contraindications when evaluating patients for a TDR. It's likely that as TDR technology improves, more people will qualify for TDR surgery. For now, it appears that patients who qualify for spinal fusion groups are also the most likely candidates for TDR.
Christian I. Fras, MD, and Joshua D. Auerbach, MD. Prevalence of Lumbar Total Disc Replacement Candidates in a Community-Based Spinal Surgery Practice. In Journal of Spinal Disorders & Techniques. april 2008. Vol. 21. No. 2. Pp. 126-129.