삼성서울병원 정형외과, 성균관대학교 의과대학
Discectomy or fusion have been a gold standard of the treatment for discogenic back pain. Since mid 1950s, spine surgeons have introduced the concept of arthroplasty for the management of low back pain. The current technologies are total disc replacement (TDR), posterior dynamic stabilization (PDS), interspinous process. Although many studies have reported their efficacy and safety, there are still lacking high-quality evidence. It is also not proven that these technologies are superior to spinal fusion in preventing the adjacent segment disease. Second generation TDR is newly developed technology. The current TDR could allow the motion of flexionextension and lateral bending, but it did not have the capacity to bear the axial compressive force. Second generation TDR placed the shock-absorption materials that can endure the compressive force. The current TDR was performed through the anterior approach, which is invasive and necessitates the removal of anterior longitudinal ligament. To overcome these disadvantages, TDR through lateral approach was developed. Various type of nucleus replacement technologies have been introduced with theoretical advantages over TDR such as less invasiveness, stable segmental motion and preservation of disc height. However, some of them had critical problems such as the migration and subsidence of implanted prosthesis. Total facet replacement arthroplasty was developed to overcome both the adjacent segment disease after fusion and the instability after posterior decompression. Because most of reports about total facet replacement arthroplasty are based on the results from the animal or cadaveric study, the long-term human trial is required. New technologies regarding motion preservation spinal surgery have been introduced, shifting paradigm in spinal care. Even though various attempts have been made in the field of spine surgery, the fact is that all of these attempts do not succeed due to paucity of better clinical outcomes. Thus, well designed long-term studies are required to prove their safety and efficacy, showing “superiority”, not just “no inferiority” to the traditional treatments.
