Overcoming Suboptimal Bone with Disc Replacement

The patient has endplate disruption at L4-5 and a painful discography at L3-4. Her Dexa t score was -1.0. At surgery, I filled the defect with bone graft and placed a large disc replacement to capture the outer rim of the disc space which is the strongest bone. The patient is 2 years post-op without subsidence and the bone graft healed, further supporting the artificial disc implant. If the disc replacement was not possible, plan B was to fuse L4-5.