Download Full Text (5.6 MB)

Document Type



Chronic low back pain leads to activity limitations for the patient and widespread burdens on health care systems. Lumbar fusion has been the “gold standard” surgery for severe chronic low back pain non-responsive to conservative treatment, however it has been associated with continued limitations in spinal mobility. This study was executed in order to compare an alternative surgical intervention, artificial disc replacement, with lumbar spinal fusion in the treatment of chronic low back pain in terms of long term spinal function. Literature searches of trials, guidelines and systematic reviews within the past 5 years were completed exploring surgical procedures, associated long term outcomes, cost analyses, and adverse effects of artificial disc replacement as an alternative to lumbar fusion. Chou et al. (2009) found superiority of artificial disc replacement to lumbar fusion on a composite index of success but no statistical differences in disability decrease (p<0.0001). Fritzell et al. (2009) identified potential cost savings with artificial disc replacement but no advantages in terms of overall cost effectiveness (95% CI). Based on these and similar findings, there is not significant evidence to recommend artificial disc replacement over lumbar fusion surgery with regard to long term spinal function. Findings of this study indicate that, while artificial disc replacement may be advantageous in select cases, clinical indications per individual patient remain the deciding factor regarding surgical intervention for chronic low back pain.


Physician Assistant Studies

Degree Name

Master of Physician Assistant Studies (MPAS)

First Advisor

Susan Kuntz

Second Advisor

Vikki McCleary

Publication Date



Low Back Pain -- surgery; Spinal Fusion; Total Disc Replacement; Comparative Study


Orthopedics | Surgery

Artificial Disc Replacement as an Alternative to Lumbar Spinal Function in the
Treatment of Chronic Low Back Pain