• Russel C Huang, Moe R Lim, Federico P Girardi, and Frank P Cammisa.
• Hospital for Special Surgery, Spine Surgery Service, New York, NY, USA. russelhuang@yahoo.com
• Spine. 2004 Nov 15;29(22):2538-41.

Study DesignThis is a retrospective review of the epidemiology of contraindications to lumbar total disc replacement (TDR).ObjectiveTo define the prevalence of contraindications to lumbar total disc replacement in a cohort of patients undergoing lumbar surgery in the senior author's (F.P.C.) practice.Summary Of Background DataNo published reports have documented the prevalence of contraindications to lumbar total disc replacement.MethodsWe performed a retrospective review of 100 consecutive patients who had lumbar surgery by one surgeon between September and December 2002. Procedures performed and contraindications to TDR were recorded. Contraindications to TDR included central or lateral recess stenosis, facet arthrosis, spondylolysis or spondylolisthesis, herniated nucleus pulposus with radiculopathy, scoliosis, osteoporosis, and postsurgical pseudarthrosis or deficiency of posterior elements. Patients were divided into fusion and nonfusion groups. The percentage of patients without contraindications to TDR was calculated.ResultsOf 100 patients, 56 had fusions and 44 had nonfusion surgery. In the fusion group, 56 of 56 patients had contraindications to TDR. In the nonfusion group, 11% (5 of 44) were candidates for TDR. Overall, 5% of patients in this series were candidates for TDR. The average number of contraindications to TDR was 2.48 (range, 0-5).ConclusionsPredictions that TDR will replace fusion are premature. A small percentage (5%) of the patients currently indicated for lumbar surgery at our institution have no contraindications to TDR. Future growth in TDR implantation will result from the indication of patients for surgery who would not be indicated today or from the elimination of current contraindications.

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