More than 10 years have passed since total disc replacement (TDR) was introduced for the first time to the world market for the surgical management of degenerative disc disease (DDD). It seems like the right time to sum up the relevant results in order to understand where TDR stands on now, and is heading forward to.
The pathogenesis of DDD has been currently settled, but diagnosis and managements are still controversial. Fusion is recognized as golden standard of surgical managements but has various kinds of shortcomings. Lately, TDR has been expected to replace fusion surgery. A great deal of TDR reports has come out. Among them, more than 5-year follow-up prospective randomised controlled studies including USA IDE trials were expected to elucidate whether for TDR to have therapeutic benefit compared to fusion.
The results of these studies revealed that TDR was not inferior to fusion. Most of clinical studies dealing with TDR revealed that there was no strong evidence for preventive effect of TDR against symptomatic degenerative changes of adjacent segment disease. TDR does not have shortcomings associated with fusion. However, it has a potentiality of the new complications to occur, which surgeons have never experienced in fusion surgeries. Consequently, longer follow-up should be necessary as yet to confirm the maintenance of improved surgical outcome and to observe any very late complications.
TDR still may get a chance to establish itself as a substitute of fusion both nominally and virtually if it eases the concerns listed above.