The Fate of Facet Joint and Disc Degeneration

"Lumbar degenerative disc disease (DDD) is a major cause of axial low back pain (LBP) in industrialized countries.1,2 Over the past decades, fusion of lumbar motion segments has been established as a “gold- standard” for the treatment of DDD with true deformi- ties and instabilities that have proved unresponsive to conservative treatment. Due to perceived disadvantages such as accelerated adjacent level degeneration (ALD), symptomatic facet/iliosacral joint complaints and hyper- trophy of the facet joints with consecutive narrowing of the spinal canal, the role of lumbar fusion procedures remains controversially debated.

In an attempt to avoid these fusion-related negative side affects, motion preserving technologies including to- tal lumbar disc replacement procedures (TDR) have been pursued over the last decades. Their clinical efficacy has been demonstrated by a variety of class I to class IV studies.15–28 Whether or not disc replacement technolo- gies can, however, live up to their global expectation of adjacent level preservation still lacks evidence.

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