Introduction: The existing data in the literature regarding comparative clinical outcomes after total disc replacement (TDR) versus anterior lumbar interbody fusion (ALIF) for lumbar degenerative disk disease (DDD) is still controversial. The authors performed a retrospective controlled cohort study of patients with diagnosed degenerative disc spinal pathology who received surgical intervention, either TDR or fusion (ALIF) for DDD.

Methods: TDR and control subjects for the control group were selected using the same inclusion and exclusion criteria. The authors evaluate the clinical outcomes measured by the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) pain questionnaires preoperatively and at four standard post-operative follow-up time points: six weeks, three months, six months, and one year post-operatively. The authors also document blood loss and return to work after 1 year for both groups.

Results: At the univariate analysis, there were significant differences in back pain scores between the experimental and control groups at all time intervals except at baseline at the TDR patients had significantly less back pain than patients who received spinal fusion starting at 6 weeks. There was, a significant difference in the number of days to return to work, with TDR patients returning to work on average 65 days sooner than ALIF patients. There was no significant difference in the total amount of blood loss between both groups.

Conclusions: In our retrospective controlled cohort study TDR patients had significantly less back pain as well as lower disability scores than patients who received spinal fusion through ALIF. Although there were no significant statistical difference between either intra-operative blood loss or employment rates at 1-year follow-up between both groups, the ‘time to return to work’ after TDR were significantly lower than in ALIF patients.

Patient Care: The knowledge about the current level of evidence of the outcomes of TDR and ALIF will help them in the selection of the most appropriate neurosurgical intervention for lumbar DDD.

Learning Objectives: - To understand the current level of evidence regarding the outcomes of the neurosurgical alternatives for lumbar spine DDD treatment - To learn the how the current studies contribute to the knowledge about the outcomes of TDR and ALIF

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