Lumbar Arthroplasty in Degenerative Disc Disease: A Systematic Review of Diagnostic Criteria, Surgical Techniques, Postoperative Management, and Functional Outcomes
Bibliographic record
Abstract
Introduction: Lumbar degenerative disc disease (DDD) is a major cause of chronic low back pain and functional limitation among adults. While spinal fusion has been the traditional surgical approach for advanced DDD, lumbar arthroplasty including total disc replacement (TDR) and facet joint replacement has emerged as a motion-preserving alternative aimed at restoring segmental mobility and reducing adjacent segment degeneration. Objective: This systematic review aims to evaluate the current evidence on the diagnostic criteria, surgical management, postoperative care, and functional outcomes associated with lumbar arthroplasty procedures in patients with symptomatic DDD. Methods: The review followed PRISMA guidelines. A structured search was conducted in PubMed, Scopus, Embase, and Web of Science to identify studies published between January 2000 and July 2025. Inclusion criteria comprised randomized controlled trials, cohort studies, and systematic reviews involving adult patients undergoing TDR, facet arthroplasty, or hybrid procedures. Two independent reviewers conducted data extraction and quality appraisal using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. Data were synthesized narratively due to heterogeneity among studies. Results: Thirty-seven high-quality studies were included. Diagnostic confirmation relied on clinical and radiological indicators such as axial low back pain, Modic changes, disc height loss, and MRI or CT findings. Surgical interventions using prostheses like ProDisc-L, Charité, and TOPS demonstrated efficacy in maintaining motion, reducing pain (VAS), and improving functional indices (ODI). Postoperative strategies prioritized early mobilization, physiotherapy, and radiographic monitoring. Complication rates were comparable or lower than fusion, and outcomes were favorable up to 10 years postoperatively. Conclusion: Lumbar arthroplasty is a safe and effective surgical option for selected patients with DDD. When guided by appropriate diagnostic protocols and applied within evidence-based indications, motion-preserving surgery offers significant improvements in pain, function, and quality of life. Future longitudinal studies and refinement of patient selection criteria are essential to optimize long-term success.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.042 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.008 |
| Bibliometrics | 0.010 | 0.012 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".