The promise of spinal non-fusion technologies, while initially large during its infancy, has tapered somewhat with challenges developing in specific non-fusion device segments due to insufficient evidence of clinical efficacy. Currently, total disc replacement (TDR) represents the most frequently performed spinal non-fusion surgery. In particular, the safety and efficacy of cervical total disc replacement (C-TDR) has been established with a growing body of level-1 evidence that is compelling enough to no longer consider this surgery investigational. This evidence is bolstered by experience with multiple devices, at multiple sites, in and out of the investigational setting and with short-, intermediate-, and long-term follow-up. At this point, C-TDR is widely seen as a viable alternative to anterior cervical discectomy and fusion surgeries in select indications. The increasing availability of clinical efficacy data, together with the rising prevalence of degenerative spine diseases and the industry’s aggressive efforts on physician training and DTC marketing, is propelling the market forward. In fact, the C-TDR market has already started to cannibalize a small portion of the spinal fusion market.
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