Lumbar Artificial Disc Replacement

Current Evidence

The current evidence does not support the routine use of artificial disc replacement for multi-level degenerative disc disease, as its role remains uncertain 1

The patient presents with degenerative changes at L4-5 and L5-S1 with severe bilateral foraminal narrowing at L4-5 1
The patient's MRI shows degenerative changes most prominent at L4-5 with severe bilateral foraminal narrowing, which may be better addressed with decompression and possibly fusion rather than artificial disc replacement 2

For patients with degenerative disc disease and chronic low back pain who have failed conservative management, lumbar fusion is more supported by evidence than artificial disc replacement 1, 2
Guidelines indicate that fusion should be considered for patients with documented instability, spondylolisthesis, or when extensive decompression might create instability 2
For patients with recurrent disc herniation with symptoms of back pain or signs of instability, posterior decompression and fusion has shown good results in 92% of patients 2

Decompression with or without fusion would be a more appropriate surgical option for this patient with severe foraminal narrowing 2
If fusion is considered, it should be reserved for cases with documented instability, spondylolisthesis, or when extensive decompression might create instability 1

Based on the patient's clinical presentation with degenerative changes at L4-5 and L5-S1, severe bilateral foraminal narrowing at L4-5, and failure of conservative management, artificial disc replacement at two levels is not medically necessary 1, 2
Current guidelines and evidence support consideration of decompression with possible fusion rather than artificial disc replacement for this clinical scenario 1, 2