The Future of Motion Preservation and Arthroplasty in the Degenerative Lumbar Spine.

The lumbar degenerative cascade is a pathological process that affects most of the aging adult population and has significant negative economic consequences. Lumbar fusion surgery remains a mainstay of treatment for refractory degenerative disease but carries significant long-term consequences. More recently, lumbar arthroplasty and motion-sparing technology has become an increasingly popular alternative surgical option in carefully indicated patients. Arthroplasty technology carries the theoretical benefits of spinal segment motion preservation and decreased degeneration of adjacent segments as compared to traditional fusion procedures. This article will review the lumbar degenerative cascade and its related anatomic considerations, current management strategies and the challenges surrounding lumbar spinal fusion, including adjacent segment disease. This article will also review the theoretical benefits of lumbar arthroplasty and motion preservation. Furthermore, this paper will highlight the current state of lumbar arthroplasty, including current concepts of implant design, limitations, outcomes and ongoing development. It will review the development and current state of artificial disk arthroplasty, total joint arthroplasty and posterior column motion-preserving implants, including flexible rods and facet joint replacement.