A narrative literature review: dynamic stabilization versus fusion—is there a difference in outcomes?

Background and Objective: Research findings concerning artificial disc replacement (ADR) and fusion surgery is conflicting in some studies. The objective of this narrative review is to evaluate and compare the effectiveness and safety of ADR versus fusion in the lumbar spine. Methods: A comprehensive literature search was conducted using various electronic databases, including PubMed, Embase, and Google Scholar. Relevant studies published between 1990 and 2023 were included. The search terms used were "artificial disc replacement", "disc arthroplasty", "fusion", "lumbar spine", and "clinical outcomes". The included studies were critically evaluated to determine the current evidence regarding the efficacy and safety of ADR and fusion. Key Content and Findings: The analysis of available studies indicates that both ADR and fusion procedures have shown positive outcomes in the treatment of lumbar degenerative disc disease. ADR offers advantages such as motion preservation, decreased risk of adjacent segment disease, and better range of motion compared to fusion. Furthermore, ADR results in faster recovery, reduced need for reoperation, and improved patient satisfaction. On the other hand, fusion has been well-established and has a longer history, demonstrating reliable outcomes and fusion rates. However, fusion can lead to loss of motion and increased stress on adjacent segments, potentially leading to adjacent segment disease. In relation to complication and re-operations, both techniques were comparable and had similar safety levels despite the clear differences in reported rates across different studies. Conclusions: While both ADR and fusion have their advantages and limitations, the evidence suggests that ADR may offer potential benefits in terms of motion preservation and reduced risk of adjacent segment disease. However, further studies are needed to evaluate long-term outcomes and cost-effectiveness. Individual patient factors should also be considered when choosing between ADR and fusion, and a comprehensive evaluation should be conducted to determine the most suitable treatment option for each patient.