Lumbar Arthroplasty in Degenerative Disc Disease: A Systematic Review of Diagnostic Criteria, Surgical Techniques, Postoperative Management, and Functional Outcomes

Introduction: Lumbar degenerative disc disease (DDD) is a major cause of chronic low back pain and functional limitation among adults. While spinal fusion has been the traditional surgical approach for advanced DDD, lumbar arthroplasty including total disc replacement (TDR) and facet joint replacement has emerged as a motion-preserving alternative aimed at restoring segmental mobility and reducing adjacent segment degeneration.

Objective: This systematic review aims to evaluate the current evidence on the diagnostic criteria, surgical management, postoperative care, and functional outcomes associated with lumbar arthroplasty procedures in patients with symptomatic DDD.

Methods: The review followed PRISMA guidelines. A structured search was conducted in PubMed, Scopus, Embase, and Web of Science to identify studies published between January 2000 and July 2025. Inclusion criteria comprised randomized controlled trials, cohort studies, and systematic reviews involving adult patients undergoing TDR, facet arthroplasty, or hybrid procedures. Two independent reviewers conducted data extraction and quality appraisal using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. Data were synthesized narratively due to heterogeneity among studies.

Results: Thirty-seven high-quality studies were included. Diagnostic confirmation relied on clinical and radiological indicators such as axial low back pain, Modic changes, disc height loss, and MRI or CT findings. Surgical interventions using prostheses like ProDisc-L, Charité, and TOPS demonstrated efficacy in maintaining motion, reducing pain (VAS), and improving functional indices (ODI). Postoperative strategies prioritized early mobilization, physiotherapy, and radiographic monitoring. Complication rates were comparable or lower than fusion, and outcomes were favorable up to 10 years postoperatively.

Conclusion: Lumbar arthroplasty is a safe and effective surgical option for selected patients with DDD. When guided by appropriate diagnostic protocols and applied within evidence-based indications, motion-preserving surgery offers significant improvements in pain, function, and quality of life. Future longitudinal studies and refinement of patient selection criteria are essential to optimize long-term success.