Comparative Effectiveness of Artificial Disc Replacement and Spinal Fusion in Lumbar Degenerative Disc Disease: A Systematic Review and Meta-Analysis
Main Article Content
Lumbar Degenerative Disc Disease (LDDD) is a leading cause of chronic low back pain and disability. While surgery is considered when conservative treatments fail, traditional spinal fusion can lead to adjacent segment degeneration. Artificial Disc Replacement (ADR) was developed to preserve motion and reduce biomechanical stress, but evidence comparing ADR to spinal fusion is inconsistent. This systematic review and meta-analysis aimed to assess functional recovery, pain reduction, and reoperation rates between ADR and fusion. A comprehensive search of the literature up to 2025 was conducted across PubMed, ScienceDirect, Cochrane Library, and Google Scholar. Twelve studies involving 2,928 patients were analyzed. Results indicated that ADR provided superior outcomes in functional disability (ODI: MD = -2.59), pain reduction (VAS: MD = -2.15), and lower reoperation risk (RR = 0.60) compared to fusion, with minimal heterogeneity and low publication bias. No significant differences in overall complication rates were found, although patient satisfaction was generally higher with ADR. The findings suggest that ADR offers modest but meaningful benefits, particularly in function and reoperation risk, but long-term durability and cost-effectiveness remain uncertain. Further studies with longer follow-up are needed to confirm these results.
Keywords:
Artificial disc replacement, Spinal fusion, Lumbar degenerative disc disease, Meta-Analysis
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Wu, A., March, L., Zheng, X., Huang, J., Wang, X., Zhao, J., Blyth, F. M., Smith, E., Buchbinder, R., & Hoy, D. (2020). Global low back pain prevalence and years lived with disability from 1990 to 2017: Estimates from the Global Burden of Disease Study 2017. Annals of Translational Medicine, 8(6), 299. https://doi.org/10.21037/atm.2020.02.175
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Zigler, J. E., Delamarter, R., Murrey, D., Spivak, J., & Janssen, M. (2018). ProDisc-L compared with posterior lumbar interbody fusion: Five-year results of a prospective, randomized, multicenter FDA IDE study. Journal of Neurosurgery: Spine, 28(3), 317–329. https://doi.org/10.3171/2017.7.SPINE161040
Zigler, J. E., Gornet, M. F., Delamarter, R. B., et al. (2021). Five-year results of the prospective, randomized, multicenter FDA investigational device exemption study of the ProDisc-L total disc replacement versus circumferential arthrodesis for the treatment of single-level degenerative disc disease. International Journal of Spine Surgery, 15(4), 612–632. https://doi.org/10.14444/8124
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Brinjikji, W., Diehn, F. E., Jarvik, J. G., Carr, C. M., Kallmes, D. F., Murad, M. H., & Luetmer, P. H. (2015). MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: A systematic review and meta-analysis. American Journal of Neuroradiology, 36(12), 2394–2399. https://doi.org/10.3174/ajnr.A4498
Buttermann, G. R. (2018). Prospective nonrandomized comparison of an artificial disc and spinal fusion for treatment of symptomatic single-level degenerative disc disease. Journal of Neurosurgery: Spine, 28(6), 585–593. https://doi.org/10.3171/2017.11.SPINE17879
Chen, S., Chen, M., Wu, X., Lin, S., Tao, C., Cao, H., Shao, Z., & Xiao, G. (2024). Global, regional and national burden of low back pain 1990–2019: A systematic analysis of the Global Burden of Disease Study 2019. Journal of Orthopaedic Translation, 32, 49–58. https://doi.org/10.1016/j.jot.2021.07.005
Daher, M., Nassar, J., Balmaceno-Criss, M., Diebo, B. G., & Daniels, A. H. (2024). Lumbar disc replacement versus interbody fusion: A meta-analysis of complications and clinical outcomes. Orthopedic Reviews, 16(1). https://doi.org/10.52965/001c.116018
Delamarter, R. B., Guyer, R. D., Blumenthal, S., et al. (2011). Prospective, randomized, multicenter FDA investigational device exemption study of the ProDisc-L total disc replacement compared with circumferential arthrodesis for the treatment of two-level lumbar degenerative disc disease. Spine, 36(24), E1558–E1566. https://doi.org/10.1097/BRS.0b013e318219ce7c
Ding, F., Jia, Z., Zhao, Z., Xie, L., Gao, X., Ma, D., & Liu, M. (2017). Total disc replacement versus fusion for lumbar degenerative disc disease: A systematic review of overlapping meta-analyses. European Spine Journal, 26(3), 806–815. https://doi.org/10.1007/s00586-016-4714-y
Gornet, M. F., Zigler, J. E., Delamarter, R. B., et al. (2011). Lumbar disc arthroplasty with MAVERICK disc versus stand-alone interbody fusion. Global Spine Journal, 7(5), 435–442. https://doi.org/10.1055/s-0037-1602228
Guyer, R. D., Blumenthal, S., McAfee, P. C., et al. (2011). Outcomes of CHARITÉ lumbar artificial disk versus fusion: Five-year data. Spine, 36(24), E1550–E1557. https://doi.org/10.1097/BRS.0b013e318219ce7b
Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., & Underwood, M. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356–2367. https://doi.org/10.1016/S0140-6736(18)30480-X
Jordá-Gómez, P., et al. (2025). Long-term outcomes of total lumbar disc prosthesis: Durable pain relief, functional improvement, and occupational reintegration. Spine Arthroplasty Literature.
Kadow, T., Sowa, G., Vo, N., & Kang, J. D. (2015). Molecular basis of intervertebral disc degeneration and herniations: What are the important translational questions? Clinical Orthopaedics and Related Research, 473(6), 1903–1912. https://doi.org/10.1007/s11999-014-3774-8
Kitzen, J., et al. (2020). Long-term clinical outcome of lumbar disc replacement: 19.9% revision spinal fusion rate after a mean follow-up of 19.4 years. [Journal name unavailable].
Knezevic, N. N., Candido, K. D., Vlaeyen, J. W., Van Zundert, J., & Cohen, S. P. (2021). Low back pain. The Lancet, 398(10294), 78–92. https://doi.org/10.1016/S0140-6736(21)00733-9
Li, Y. Z., Sun, P., Chen, D., Tang, L., Chen, C. H., & Wu, A. M. (2020). Artificial total disc replacement versus fusion for lumbar degenerative disc disease: An updated systematic review and meta-analysis. Turkish Neurosurgery. https://doi.org/10.5137/1019-5149.JTN.28143-19.2
Mobbs, R. J., Phan, K., Malham, G., Seex, K., & Rao, P. J. (2015). Lumbar interbody fusion: Techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. Journal of Spine Surgery, 1(1), 2–18. https://doi.org/10.3978/j.issn.2414-469X.2015.10.05
Phillips, F. M., Geisler, F. H., Gilder, K. M., Reah, C., Howell, K. M., & McAfee, P. C. (2015). Long-term outcomes of the US FDA IDE prospective, randomized controlled clinical trial comparing PCM cervical disc arthroplasty with anterior cervical discectomy and fusion. Spine, 40(10), 674–683. https://doi.org/10.1097/BRS.0000000000000869
Salzmann, S. N., Plais, N., Shue, J., & Girardi, F. P. (2017). Lumbar disc replacement surgery—successes and obstacles to widespread adoption. Current Reviews in Musculoskeletal Medicine, 10(2), 153–159. https://doi.org/10.1007/s12178-017-9397-4
Skinner, P., Fournier, D. E., & Delaney, H. (2020). Lumbar disc arthroplasty: A systematic review. European Journal of Orthopaedic Surgery & Traumatology, 30(4), 697–715. https://doi.org/10.1007/s00590-019-02614-x
Teraguchi, M., Yoshimura, N., Hashizume, H., Muraki, S., Yamada, H., Minamide, A., Oka, H., Akune, T. (2014). Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: The Wakayama Spine Study. Osteoarthritis and Cartilage, 22(1), 104–110. https://doi.org/10.1016/j.joca.2013.10.019
Wei, J., Song, Y., Sun, L., & Lv, C. (2021). Comparison of artificial total disc replacement versus fusion for lumbar degenerative disc disease: A meta-analysis of randomized controlled trials. International Orthopaedics, 45(2), 257–269. https://doi.org/10.1007/s00264-020-04786-y
World Health Organization. (2023). Low back pain. https://www.who.int/news-room/fact-sheets/detail/low-back-pain
Wu, A., March, L., Zheng, X., Huang, J., Wang, X., Zhao, J., Blyth, F. M., Smith, E., Buchbinder, R., & Hoy, D. (2020). Global low back pain prevalence and years lived with disability from 1990 to 2017: Estimates from the Global Burden of Disease Study 2017. Annals of Translational Medicine, 8(6), 299. https://doi.org/10.21037/atm.2020.02.175
Yang, N., Di, J., Wang, W., & Feng, H. (2025). Global burden of low back pain from 1990 to 2021: A comprehensive analysis of risk factors and trends using the Global Burden of Disease Study 2021. BMC Public Health, 25(1), Article 1886. https://doi.org/10.1186/s12889-025-1886-x
Zigler, J. E., Delamarter, R., Murrey, D., Spivak, J., & Janssen, M. (2018). ProDisc-L compared with posterior lumbar interbody fusion: Five-year results of a prospective, randomized, multicenter FDA IDE study. Journal of Neurosurgery: Spine, 28(3), 317–329. https://doi.org/10.3171/2017.7.SPINE161040
Zigler, J. E., Gornet, M. F., Delamarter, R. B., et al. (2021). Five-year results of the prospective, randomized, multicenter FDA investigational device exemption study of the ProDisc-L total disc replacement versus circumferential arthrodesis for the treatment of single-level degenerative disc disease. International Journal of Spine Surgery, 15(4), 612–632. https://doi.org/10.14444/8124
Ziino, C., Konopka, J. A., Ajiboye, R. M., & Leary, O. P. (2020). Single level lumbar total disc replacement for degenerative disc disease. Journal of Clinical Neuroscience, 71, 14–19. https://doi.org/10.1016/j.jocn.2019.11.015
