Procedural Rates, Economic Costs, and Geographic Variation of Primary and Revision Lumbar Total Disc Replacement

Lumbar total disc replacement (TDR) surgery is a new procedure that treats degenerative disc disease, a remarkably common, disabling, and costly condition. Three distinct studies were conducted to address the longevity, costs, and geographic variation of the lumbar TDR procedure. These three studies found lumbar TDR to have a revision burden and economic revision burden that has remained consistent since this procedure’s introduction in themid-2000s. The economic revision burden made this a lower-cost procedure than lumbar fusion, with a tradeoff in terms of revision burden being higher for lumbar TDR. The overall rate at which this procedure is performed has declined significantly, however. An uncommon and unstudied variant of TDR, the lumbar TDR hybrid, was found to make up about 16% of all lumbar TDR procedures performed. Lastly, substantial geographic variation was found in the procedural rates of lumbar TDR across the U.S. The results of these studies are potentially useful to surgeons, policy makers, and patients. This project also speaks to the viability of observational data in addressingquestions of medical device lifespan, costs, and geographic variation of surgical procedures.