Lumbar disc replacement

By how it behaves. Disc-related pain increases with postures that raise the pressure inside the disc, and the most characteristic is sitting, because it involves lumbar flexion: this is the patient who is worse in the car or in a chair than walking. And there is a negative finding that helps just as much: it does not usually respond to treatments aimed at the posterior joint complex, such as facet rhizolysis. If the pain settles with a rhizolysis, it was not discogenic.

Because outside its profile it offers no advantage. It requires disc-related pain at one or two levels, healthy facet joints, good bone quality and no deformity or instability. When those are not met, I would rather say so before operating than implant something that will not help.

No, from the front: it is implanted through the same anterior approach used for ALIF fusion. The back muscles are not touched.

Both restore disc height, but fusion locks the segment and the prosthesis keeps it moving. The choice is not a matter of preference: it depends on whether the facet joints, the bone and the stability allow that movement to be preserved.