{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T10:09:05Z","timestamp":1790244545833,"version":"4.1.0"},"reference-count":39,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"SpineWay"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: The optimal surgical approach for patients with lumbar degenerative disc disease (DDD) remains a subject of ongoing debate, particularly when comparing anterior lumbar interbody fusion (ALIF) and total disc replacement (TDR). The primary objective of this study was to compare short-term outcomes between these two surgical approaches in terms of clinical efficacy, patient satisfaction, and safety profile. The secondary objective was to evaluate patient-specific variables associated with postoperative improvement in order to identify potential factors that may guide a personalized surgical strategy. Methods: This retrospective, single-center observational study included 87 patients who underwent single-level lumbar surgery using either an ALIF (n = 38) or TDR (n = 49) approach between January 2021 and May 2025. Eligible patients were younger than 45 years and had complete preoperative, intraoperative, and 1-year follow-up data. Demographic, clinical, preoperative, and intraoperative variables, as well as patient satisfaction and quality-of-life improvement, were collected, analyzed, and compared between groups. The primary between-group analysis used analysis of covariance (ANCOVA) with adjustment for baseline outcome values and prespecified confounders (age, sex, body mass index, smoking status, ASA class). Longitudinal effects were assessed using a linear model with treatment \u00d7 time interaction and cluster-robust standard errors. A formal smoking \u00d7 surgical-strategy interaction was tested in a multivariable regression on 12-month Oswestry Disability Index (ODI) change. Reporting followed the STROBE guidelines for observational studies. Results: Both groups showed substantial within-group improvement at all follow-up time points (all p &lt; 0.05 except ALIF leg pain at 6 months; paired Wilcoxon test). Baseline-adjusted between-group comparisons (ANCOVA) showed a numerically modest early difference favoring TDR for Visual Analogue Score (VAS) low-back pain at 3 and 6 months (adjusted \u0394 = \u22121.46, 95% CI \u22122.63 to \u22120.30, p = 0.016 at 3 months; \u22121.35, 95% CI \u22122.63 to \u22120.07, p = 0.043 at 6 months), below the minimum clinically important difference of 2 points though neither survived Holm\u2013Bonferroni correction for multiple comparisons. The formal treatment \u00d7 time interaction test was not significant for any outcome (ODI p = 0.39; VAS back p = 0.29; VAS leg p = 0.06. Overall, 92% of patients in the ALIF group and 86% of patients in the TDR group reported being satisfied or very satisfied, and 60\u201372% of patients returned to work. Radiographic analysis in the TDR group showed maintained segmental mobility, with median range of motion of 4.0\u00b0 (IQR 2.0\u20138.0\u00b0) overall (median 6.0\u00b0, IQR 4.0\u20138.5\u00b0 at L4\u2013L5; 3.0\u00b0, IQR 2.0\u20136.0\u00b0 at L5\u2013S1). A multivariable regression model on 12-month ODI change, adjusted for age, sex, BMI, ASA class, and baseline ODI, showed a highly significant smoking-burden \u00d7 surgical-strategy interaction (dose\u2013response smoker code \u00d7 TDR coefficient = \u22129.47, 95% CI \u221215.6 to \u22123.3, p = 0.004): higher preoperative smoking burden was associated with reduced ODI improvement specifically in the TDR group (Spearman r = \u22120.41, p = 0.004) but not the ALIF group (Spearman r = +0.17, p = 0.32). Conclusions: This cohort study suggests that both ALIF and TDR were associated with substantial clinical improvement and high patient satisfaction at 1 year postoperatively; because treatment selection was not randomized, these findings should not be interpreted as evidence of comparative effectiveness. A modest early difference favoring TDR was observed for VAS low-back pain (below the minimum clinically important difference); no statistically significant between-group differences were demonstrated for any outcome after correction for multiple comparisons. The observed associations between 1-year ODI improvement and patient-specific variables require confirmation in larger independent cohorts. The finding of a significant smoking-burden \u00d7 surgical-strategy interaction is an exploratory and hypothesis-generating and, if confirmed in prospective cohorts, may inform preoperative optimization strategies for TDR candidates.<\/jats:p>","DOI":"10.3390\/jcm15197409","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:07:54Z","timestamp":1790240874000},"page":"7409","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anterior Lumbar Interbody Fusion Versus Total Disc Replacement with a Viscoelastic Prosthesis for Single-Level Lumbar Degenerative Disc Disease in Young Adults: A Comparative Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1617-5959","authenticated-orcid":false,"given":"Cl\u00e9ment","family":"Jacquemin","sequence":"first","affiliation":[{"name":"Department of Spinal Surgery Unit, H\u00f4pital Priv\u00e9 Francheville, 24000 P\u00e9rigueux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthieu","family":"Campana","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Unit, H\u00f4pital Priv\u00e9 Francheville, 24000 P\u00e9rigueux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Etienne","family":"Castelain","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Unit, H\u00f4pital Priv\u00e9 Francheville, 24000 P\u00e9rigueux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houssam","family":"Bouloussa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO 64108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0074-9244","authenticated-orcid":false,"given":"Vincent","family":"Challier","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Unit, H\u00f4pital Priv\u00e9 Francheville, 24000 P\u00e9rigueux, France"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3401-1838","authenticated-orcid":false,"given":"Soufiane","family":"Ghailane","sequence":"additional","affiliation":[{"name":"Department of Spinal Surgery Unit, H\u00f4pital Priv\u00e9 Francheville, 24000 P\u00e9rigueux, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1177\/2192568218770769","article-title":"Degenerative Lumbar Spine Disease: Estimating Global Incidence and Worldwide Volume","volume":"8","author":"Ravindra","year":"2018","journal-title":"Glob. 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