Viscoelastic Disc Arthroplasty Provides Superior Back and Leg Pain Relief in Patients with Lumbar Disc Degeneration Compared to Anterior Lumbar Interbody Fusion

Orthopedic Spine Surgeon Dr. Kingsley R. Chin Medical Paper

Scientific Paper

Rischke B1Zimmers KB2Smith E2.

Interested medical professionals can read through the full paper, as published in International Journal of Spine Surgery, here.


Lumbar disc degeneration (LDD) is one of the most frequently diagnosed spinal diseases. The symptoms these disorders cause are anticipated to increase as the population in Western countries ages.


Compare back and leg pain alleviation in patients with LDD and a viscoelastic disc prosthesis documented in the SWISSspine registry versus patients with anterior lumbar interbody fusion documented in the Spine Tango registry.

Study Design

Prospectively collected clinical and outcome data in two independent spine registries. Outcome Measures were back and leg pain relief on 0 to 10 numerical rating scales.

Materials & Methods

The analysis included a single surgeon series of 48 patients with viscoelastic total disc replacement (VTDR) from the SWISSspine registry which were compared to 131 patients with anterior lumbar interbody fusion (ALIF) from the Spine Tango registry.

Two linear multivariate regression models were built to assess the associations of patient characteristics with back and leg pain relief. The following covariates were included in the models: patient age and sex, disc herniation as additional diagnosis, number of treated segments, level of treated segment, treatment type (VTDR, ALIF), preoperative back and leg pain levels and follow-up interval.


Both models showed VTDR to be associated with significantly higher back (2.76 points; 95% confidence interval (CI) 1.78 – 3.73; p < 0.001) and leg pain (2.12 points; 95% CI 1.12 to 3.13; p < 0.001) relief than ALIF. Other influential factors for higher back pain relief were female sex compared with male sex (1.03 additional points; 95% CI 0.27 to 1.78; p = 0.008), monosegmental surgery compared with bisegmental surgery (1.02 additional points; 95% CI 0.21 to 1.83; p = 0.014), and higher back pain at baseline (0.87 points additional pain relief per level of preoperative back pain; 95% CI 0.70 to 1.03; p < 0.001). Other influential factors for leg pain relief were monosegmental surgery (0.93 additional points; 95% CI 0.10 to 1.77; p = 0.029) and higher leg pain at baseline (0.83 points additional pain relief per level of preoperative leg pain; 95% CI 0.70 to 0.96). In both models the L3/4 segment showed 2.36 points (95% CI -4.27 to -0.45; p = 0.016) and 3.69 points (95% CI -5.66 to -1.71; p < 0.001) less pain relief than L5/S1.


Significantly higher back and leg pain relief were observed after viscoelastic total disc replacement in comparison with anterior lumbar interbody fusion. The new less rigid materials used in the second generation total disc replacements (TDRs) may make artificial disc replacement an increasingly attractive option for patients with degenerative lumbar disc disease. Further controlled and long-term follow-up studies are required for more detailed comparisons of the outcomes of these types of disc implants.

The Freedom Lumbar Disc is limited by U.S. federal law to investigational use only.

About Author Dr. Kingsley R. Chin

Postoperative Cervical Haematoma Complicated by Ipsilateral Carotid Thrombosis and Aphasia After Anterior Cervical Fusion: a Case Report
Dr. Kingsley R. Chin, founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board-certified Harvard-trained orthopedic spine surgeon and professor with copious business and information technology experience. He sees a niche opportunity where medicine, business and information technology meet and is uniquely experienced at the intersection of these three professions. He currently serves as Professor of Clinical and Biomedical Sciences at the Charles E. Schmidt School of Medicine at Florida Atlantic University and Professor of Clinical Orthopaedic Surgery at the Herbert Wertheim College of Medicine at Florida International University and has experience as Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School and Visiting Professor at the University of the West Indies.

Learn more about Dr. Chin here and connect via LinkedIn.

About Less Exposure Surgery

Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD

About The LESS Institute

The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit to learn more.

About SpineFrontier

The above study utilized LES Technology from SpineFrontier – leading provider of LES Technologies and instruments – offering surgeons and patients superior technology and services.

Scientific Paper Author and Citation Details


Rischke B1Zimmers KB2Smith E2.

Author information

  1. Center of Excellence for Dynamic Spine Arthroplasty, Zürich, Switzerland.
  2. AxioMed LLC, Garfield Heights, Ohio, USA.

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