Clinical Improvement and Motion Preservation After Lumbar Total Disc Replacement with ProDisc-L: A Single-Center Cohort Study

Abstract

Lumbar total disc replacement (LTDR) is a motion-preserving alternative to fusion for selected patients with symptomatic degenerative disc disease. Although favorable outcomes have been reported in clinical trials, data from standardized real-world cohorts remain limited. This study evaluated clinical, radiographic, and perioperative outcomes following LTDR in a consecutive single-center cohort. Adults undergoing LTDR between March 2023 and March 2025 were retrospectively identified. Patients with osteoporosis, lumbar instability, previous retroperitoneal surgery, or disc collapse greater than 50% were excluded. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS). Segmental motion was evaluated on standing flexion-extension radiographs using Surgimap®. All patients completed six months of follow-up. Sixty patients were included. Mean ODI improved from 43.8 ± 2.5 preoperatively to 12.8 ± 2.2 at six months (mean reduction, 31.0 points; p < 0.001), while VAS improved from 6.7 ± 0.8 to 1.3 ± 0.5 (mean reduction, 5.42 points; p < 0.001). Mean range of motion at the operated and adjacent segments was 5.5 ± 1.1° and 6.0 ± 2.1°, respectively. Clinically meaningful improvement according to predefined ODI and VAS thresholds was observed in all patients. Five intraoperative complications occurred (8.3%), all managed without postoperative sequelae; no postoperative complications or reoperations were observed. LTDR was associated with significant improvements in pain and disability while preserving segmental motion and demonstrating a favorable perioperative safety profile. Longer follow-up is required to evaluate implant durability and adjacent segment degeneration.