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An AOA Critical IssueDisc Replacements: This Time Will We Really Cure Low-Back and Neck Pain?*
Scott D. Boden, MD1; Richard A. Balderston, MD2; John G. Heller, MD1; Edward N. HanleyJr., MD3; Jack E. Zigler, MD4
1 The Emory Spine Center, 2165 North Decatur Road, Decatur, GA 30033
2 Pennsylvania Hospital, 800 Spruce Street, Philadelphia, PA 19107
3 Department of Orthopaedics, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC 28232
4 Texas Back Institute, 6300 West Parker Road, Plano, TX 75093
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (consultants to Medtronic). In addition, a commercial entity (Spine Solutions) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
This report is based on a symposium presented at the Annual Meeting of the American Orthopaedic Association on June 13, 2003, in Charleston, South Carolina.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Feb 01;86(2):411-422
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Intervertebral disc replacements have been under design for over three decades but are now receiving increased attention. This is largely due to several devices that have received Investigational Device Exemption status from the United States Food and Drug Administration, resulting in clinical trials in the United States. There is tremendous early enthusiasm for the concept of disc replacement and motion preservation as an alternative to arthrodesis, with the hope that adjacent segment degenerative changes can be averted. Skeptics hold the position that adjacent segment changes are due more to the individual's genetic predisposition and normal aging than to the mechanical changes resulting from a spinal arthrodesis. In addition, there are potential long-term consequences to disc replacement that remain unknown. These issues include failure, wear debris, and the effects of stress-risers as patients age and become osteopenic. The two basic categories of disc replacements are nuclear replacements and total disc replacements. The critical issues pertaining to total disc replacements were recently explored in a symposium at the 2003 Annual Meeting of the American Orthopaedic Association in Charleston, South Carolina, and are summarized in this review.
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