Fusion has been the surgical reference for treating degenerative disc disease, nevertheless in the last two decades the recognition of it’s inconvenients, such as the degenerescence of the adjacent level, the growing demand for a better life quality by the patients and the evolution of the knowledge regarding the biomechanics of the spine and of the intervetebral disc itself, have stimulated the development of new technologies for the treatment of DDD among which the Disc Replacement.

In this symposium will be analysed the biomechanics of the disc and disc replacement, enhancing the already known benefits of the movement preservation, by discussing the different philosophies of the available systems: non-constraint; semi-constraint; and constraint.

The analysis of the overview results in the literature of fusion in comparison with disc replacement will also proportionate a fundamental actualization when deciding over the current perspectives in the treatment of DDD, considering the treatment alternatives developed in the meanwhile.

The disc replacement is an actual challenge with believers all over the world as an important step forward towards better life quality of patients with incapacitant low back pain. But with indications and limits that must be well known. Besides that it’s a demanding technique with potential risks associated and that demands specialization in this domain for its practice.

Always considering the different phases of evolution of the DDD, which can occur simultaneously in the same patient, different therapeutics solutions are considerate and which application deserves a profound reflexion according to the diagnosis characteristics, its staging, the ponderation of risks and benefits and as well its socioeconomics consequences.

The multiplicity of factors that influence the clinical evolution of discopathies, determine a great diversity in its presentation.

The barely known genetic predisposition, the individual morphological aspects, the age and sex, the associated co-morbidities as well as the patient environment define in its all an individual context that influences decisively the treatment for each patient.

On the other hand, the identification in each case of the different stages of the multilevel DDD, causes doubts regarding the involvement of each segment in the respective clinical condition.

To singly identify all sources of pain, and not only each painful level, is the main challenge poised to the spine surgeon when defining the treatment strategy.

The diagnosis aggressiveness must be proportional to its doubts, and the discography, the disco-scanner and the facet blocks are fundamental when the conventional clinical investigation is inconclusive.

The use of minimal invasive techniques such as IDET or Coblation can be considerate as alternatives, especially in the early stages of single-level DDD.

The nucleoplasthy – nuclear prosthesis- is an interesting alternative in the intermediate stages of the discogenic pain DDD, as well as in the predominant facet pain or in the foraminal dynamic stenosis is the dynamic stabilization. Those are techniques with controversial results and which liability in some cases is yet to be proven.

Last, the use of different techniques in different levels in the context of multi-level DDD – ex: fusion + disc replacement; disc replacement + dynamic stabilization with or without decompression procedures in the spinal canal- must be rigorously considered according to the specific dysfunction of each segment and considering the anatomical and functional reconstruction of the spine.