Total joint replacement of the lumbar spine: report of the first two cases with 16 years of follow-up.

Background: Total joint replacement (TJR) of the lumbar spine is a revolutionary procedure that couples the clinical benefits of neural decompression with preservation of natural motion and sagittal balance at the operative level. The TJR procedure involves reconstruction of the entire motion segment using a posterior bilateral transforaminal approach to access the disc space. The TJR implant (MOTUS, 3Spine, Chattanooga, TN, USA) replaces the function of the intervertebral disc and facet joints, performing biomechanically as a new articulation for the resected, degenerated disc and facets. The implant has been optimized to simulate the kinematic characteristics of the three-joint complex. Case Description: Two male patients, ages 32 and 38 years, underwent the first TJR procedures in 2007 in South Africa. Both patients had imaging evidence of advanced spinal degeneration with unremitting back and leg pain refractory to conservative management. Symptom amelioration was achieved postoperatively with markedly reduced pains scores and improved function at clinical follow-up. Both cases were recently re-examined after 16 years and the patients reported that the procedure significantly changed their lives. Neither believes they have a lingering back condition and they have been able to fully participate in all functions related to work, family and recreation. There was little to no imaging evidence of adjacent segment disease or arthritic changes at this long-term follow-up interval. Conclusions: After 16 years of clinical follow-up, the implant continues to function normally, without evidence of adjacent segment degeneration and both patients continue to enjoy activities of daily living without back or leg pain or other functional impairments.