Spinal Arthroplasty Versus Fusion in Degenerative Spine Pathologies: A Systematic Evaluation of Clinical and Functional Efficacy

Objective

The primary objective of this systematic review was to evaluate the clinical and functional outcomes of spinal arthroplasty techniques, including total disc arthroplasty (TDA) and facet joint arthroplasty, in comparison to conventional spinal fusion procedures. The review also aimed to characterize the epidemiological profile of patients undergoing motion-preserving surgeries and describe the effectiveness, safety, and biomechanical implications of these surgical approaches.

Methods

This review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive literature search was performed across PubMed, Scopus, Embase, and Web of Science databases to identify randomized controlled trials, observational studies, finite element modeling analyses, and case reports evaluating TDA or facet joint arthroplasty. A total of 22 eligible studies were included after title, abstract, and full-text screening. Data extraction focused on patient demographics, surgical techniques, functional outcomes (VAS, ODI, SF-36), complications, reoperations, and biomechanical results. Risk of bias was assessed using appropriate tools for each study design.

Results

Across the 22 studies reviewed, spinal arthroplasty demonstrated favorable outcomes in comparison to fusion, including improved postoperative pain scores, reduced disability, preserved segmental range of motion, and lower incidence of adjacent segment disease. Total disc arthroplasty showed superior or equivalent functional improvement compared to fusion in most studies. Facet joint arthroplasty (e.g., using the TOPS™ system) was associated with faster recovery and fewer complications than TLIF. Biomechanical models confirmed that motion-preserving implants better replicated physiological load distribution. While revision procedures carried higher risks, patient selection and implant choice were key to success. Despite clinical advantages, the widespread adoption of arthroplasty remains limited due to cost and policy constraints.

Conclusion

Spinal arthroplasty techniques, including TDA and facet joint replacement—are safe and effective alternatives to fusion in selected patients with degenerative spinal conditions. These procedures offer superior motion preservation, functional recovery, and biomechanical advantages. Although underutilized, the current evidence supports broader integration of arthroplasty into clinical practice, with future efforts needed to address long-term outcomes and economic accessibility.