Lumbar disc replacement is a developing primary surgical treatment for patients with degenerative disc disease. The goals of disc arthroplasty are to remove the native nucleus pulposus and to preserve motion at that disc level. Devices being developed include artificial replacement of the nucleus pulposus and artificial replacement of the entire disc. With the recent approval by the Food and Drug Administration of the Charite artificial disc, this procedure will be used with increasing frequency. This article reviews pertinent anatomy and pathology of the functional spinal unit as well as the types of devices being developed and the factors related to development of a successful implant. Clinical outcomes and complications are also discussed.