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What is Total Disc Replacement

Total Disc replacement (TDR) also referred to as artificial disc replacement (ADR) is a type of surgery where a painful damaged disc is replaced with an artificial disc. Artificial disc surgery may be performed on the lower back (lumbar spine) or the neck (cervical spine). Artificial discs are designed with the goal of providing motion preservation of the spine with the most natural possible form and function of the spine's disc.

Understanding the problem

Lumbar Total Disc Replacement has been proposed as a newer alternative to fusion procedures for the treatment of pain and instability associated with degenerative disc disease.

Patients should be aware that not all disc pathologies are suitable for a disc replacement as it can only treat certain types of disc pathology.

Indications favourable to TDR include:

  • Chronic pain unresponsive for at least six months of conservative (nonsurgical) treatment finds no relief, especially when the pain and potential symptoms make it hard to live a normal life and complete everyday activities
  • Degenerative Disc Disease which is symptomatic identified by clinical examination and correlating diagnostic examination such as MRI
  • Patients with pain following a previous surgery including for example laminectomy/discectomy with posterior elements still intact
  • Patients with degenerative Spondylolysis and Spondylolisthesis
  • In patient with significant disc space collapse, provided there is no significant facet joint disease
  • Patients with degenerative scoliosis

Indications not normally favourable to TDR include:

  • Patients with Osteoporosis, Osteopenia of osteoporotic and other fractures
  • Patients with extreme obesity
  • Pre-existing instability resulting from direct surgical and/or medical intervention affecting the posterior elements,
  • Patients with Anterolisthesis or retrolisthesis dependent on the scale of slippage
  • Patient with high degree of Spondylolysis and Spondylolisthesis
  • Patients with higher degrees of scoliosis
Understanding who suffers

Lumbar Spine Degenerative Disc Disease or “lower back” refers to a syndrome in which a compromised disc causes low back pain. Although research indicates that there may be some genetic component to individuals who suffer from degenerative disc disease, the true cause is likely due to a multiple of reasons including simple wear and tear, trauma, likely from everyday impact injuries over time.

Degenerative disc disease (DDD) is fairly common, and it is estimated that at least 30% of people aged 30-50 years old will have some degree of disc space degeneration, although many without symptoms or ever needing diagnosis. In patient over 60 some level of disc degeneration is a normal progression in aging and can be seen on an MRI scan.

Potential Signs and Symptoms

Lumbar Spine Degenerative Disc Disease symptoms can vary, but the general characteristics usually include:

  • Low-grade aching pain that will occasionally flare up for a few days or more.
  • Pain that is centre of the lower back, potentially radiating to the hips and legs, also known as Sciatica Pain
  • Pain that is frequently worse when sitting, pressure on disc from sitting, than when standing, walking or laying down.
  • Prolonged standing may also aggravate the pain
  • Pain that is exacerbated by certain movements, particularly bending, twisting or lifting
  • Severe symptoms can include numbness and tingling in the legs, as well as difficulty walking
  • In more developed cases where the disc space collapses, a pinched nerve root at the particular level can result causing foraminal narrowing or stenosis and leg pain from the known as radiculopathy
Examinations Usually Required

Examinations required for diagnosis for lumbar degenerative disc disease would include:

  • Patients' history
  • Physical exam, to review physical signs of a disease including testing range of motion, muscle strength, local pain on touch and review of lower back and legs.
  • An MRI scan
Proposing Treatment and Why AIMIS

AIMIS technologies for Total Disc Replacement include the Nuvasive XL TDR artificial disc.

  • XL TDR® - Introducing a new surgical solution providing Minimally Disruptive Motion Preservation For The Lumbar Spine through Lateral Approach


  • Minimizes the risk of vascular and visceral injury
  • Avoids mobilizing the great vessels
  • Preserves the ALL and PLL, resulting in less stress on the facets
  • Permits a more forgiving device placement, because the midline is easy to identify on intraoperative fluoroscopy
  • Leaves safer surgical approach options if removal and revision become necessary
  • Allows hybrid constructs of TDR at L4-5 and fusion at L5-S1 for two-level L4-S1 pathology
  • Facilitates more rapid patient recovery because of less invasive surgical access
  • Unlike other total disc replacement devices, that require an anterior abdominal approach that can be technically demanding with “access general surgeons” to support the procedure and disruptive to the abdominal section of the body and all the organs, especially at the L4–5 level, because the major vessels must be mobilized to achieve optimal exposure to the surgical site for the device placement.
  • NuVasive, who developed this TDR technologically is best known for developing the XLIF procedure, a minimally disruptive procedure that allows spine surgeons to have direct access to the intervertebral disc space (the “joint” of the spine) from the side of the body, as opposed to the front or back which has redefined spine surgery and opened doors to treat pathologies not previously treated with minimal disruption.
  • XL TDR® is as described above, a total disc replacement that is implanted from the patient's side, an approach which radically improves the patient experience. XL TDR is building on the success of XLIF, ® the lateral approach spine fusion procedure introduced by has been successful in treating thousands of patients suffering from a variety of spinal disorders.
  • XL TDR seeks to relieve the painful symptoms associated with lumbar degenerative disc disease. However, instead of achieving pain relief through fusion (immobilization of the spinal segment), XL TDR seeks to relieve pain while restoring height and maintaining motion at the spinal segment. Through thoughtful and careful scientific study, we seek to demonstrate the safety and efficacy of this device, compared to other fusion procedures.
  • Patient are expected to have better outcome with a total disc replacement (TDR) rather than with fusion as the need for additional surgery after a fusion at 10 years is as high as 20% whereas with a TDR the risk is only 5%. Moreover, evidence based literature and recent data are showing a better outcome in younger patients when undergoing a total disc replacement when compared to fusion.
  • Long-term results of a laterally placed TDR device demonstrate maintenance of pain relief and functional improvement. The benefits of this technique—minimal morbidity, avoiding mobilization of the great vessels, preserving the ALL, biomechanically stable orientation, and broader revision options—suggest a promising new direction for TDR procedures.
  • The clinical and imaging results of a laterally placed total disc replacement have shown maintenance of pain relief and functional improvement over a long-term follow-up period.

In brief some of the benefits of the lateral access XL TDR are multiple and can include:

  • Minimal risk of complications
  • Minimal potential disruption and avoidance of mobilization of the great vessels,
  • Preservation of the anterior longitudinal ligament,
  • biomechanically stable orientation,
  • Provides broader revision options— for motion-preservation procedures.


The lateral approach is also used for revising primary anteriorly placed TDR devices. Anterior retrieval of a TDR device and revision to an ALIF is difficult, especially after the first 2 weeks postoperatively, because of scar formation and elevated risk of vascular injury, particularly at the level of the vascular bifurcation at L4-5.14-16 The Charité U.S. IDE data showed that while the primary TDR procedure resulted in a rate of vascular complication of 3.4%, vascular injury occurred in 16.7% of the revision cases.8 Although experience to date is limited, case reports describing the successful use of the lateral approach (which does not require anterior mobilization of the major vessels) to revise anteriorly placed TDR devices have been encouraging.

Should removal and revision become necessary after primary placement of a lumbar TDR device from a lateral approach, several safer surgical approach options are available. The contralateral retroperitoneal approach can easily be performed, or an anterior (transperitoneal or retroperitoneal) approach can be more safely performed, because the primary procedure does not produce scars in or around the anterior vasculature.


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Reputable and Prestigious Surgeons

AIMIS' skilled team of neurosurgeons, orthopaedic surgeons and ancillary professionals has one of the leading experiences in the world for minimally invasive spine surgery and total disc replacement with use of these technologies. Our full team are consulted with each case to find the most suitable experienced doctor for the patient’s exact issue, to increase potential of superior surgical outcome.

Wondering if you're a candidate for total disc replacement?

Contact us to get a full review and surgical options available for your specific condition from our leading American Surgeons.

Getting More Information Before Moving Forward
You may have questions like:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
What AIMIS Can do:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide. AIMIS’s mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.


AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

Why AIMIS for this Surgery

AIMIS strives for excellence in delivering the best surgical outcomes, via the extensive expertise of its prestige surgeons, its technologies, its highly trained staff and superior facilities to provide an individualized and compassionate experience in a comfortable environment. All patients are treated with the individual care they deserve in an effort to provide the best chance of successful treatment.

Other Services Provided by AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.