Disc Replacement or Fusion?
- Posted on: Jun 15 2017
Unrelenting back pain has few rivals when it comes to impacting the quality of life. At DFW Center for Spinal Disorders, it’s our mission to help our patients get past the pain, whether through conservative treatments such as postural training, all the way to spinal surgery.
When the problem is a spinal disc, sometimes the disc has degenerated to the point that there are two options, both surgical. A patient can opt to have the degenerating disc replaced with an artificial disc or to remove the disc completely and fuse the two vertebrae together.
The question is — which is the way to go?
Lumbar spinal fusion
The traditional approach to treating pain and disability from the lumbar degenerative disease has been spinal fusion. Formerly, this was the only real option, as artificial cervical discs were only invented around a decade ago. If you’re a golf fan, disc fusion is also in the news lately, as Tiger Woods opted to two discs fused together after a couple of microsurgeries failed to alleviate his back pain.
Lumbar spinal fusion involves forming a direct bony connection between the vertebrae surrounding the painful/damaged disc or discs. Since fusion precludes the vertebrae from moving, they can’t contact surrounding nerves and cause pain. Surgical techniques we use at DFW are varied: approached from the front, the back, or both. Once the damaged disc is removed, we use intervertebral cages and pedicle screws to provide internal structural support while the two discs fuse together. To make that happen, we use bone grafts.
Lumbar disc replacement
Replacing the damaged cervical disc was not an option until October 2004. That’s when the first artificial disc was implanted into a patient from the general population. A second technology became available in August 2006, and there are now additional options. With this rapidly changing technology, artificial disc replacement is becoming more and more popular. We see it as a valid option for your degenerating discs.
In replacement surgery, the damaged disc is removed, and a prosthetic implant made of metal replaces it. The artificial disc may or may not have plastic on the contact areas. It allows the two vertebrae on each side of the implant to move somewhat similar to what is allowed with the natural disc.
So, which is better?
At this time, fusion surgery is still far more prevalent. Plus, not all patients are eligible for disc replacement, as their condition doesn’t match the necessary disc profile.
Fusion can be used to treat issues beyond degenerative discs. We use fusion to address arthritis of the facet joints, as well as issues with instability such as spondylolisthesis, and progressive deformity of the spine.
Fusion does stop painful motion of the disc or the facet joints, so people assume it will limit mobility. But because their back pain was so severe, their mobility was limited before. Fusion, by eliminating pain and facilitating movement again, may make the person’s mobility better than before the surgery.
For artificial disc replacement, the patient must have little or no arthritic changes in the facet joints. Also, currently available implants are FDA approved for use in a single painful disc level from L3-S1 or L4-S1. Patients must have good bone quality for disc replacement, so those with osteoporosis are not likely to qualify.
Disc replacement is intended to leave the disc space mobile to a certain degree, but it doesn’t return normal spinal motion. Each implant model has different characteristics, as well. There is some thought that maintaining spinal motion with artificial disc replacement is believed to lead to less degeneration and problems with the surrounding discs. But this is not backed up by long-term studies, as artificial discs have not been around all that long.
This is a complicated decision. The team at DFW Center for Spinal Disorders will walk you through every aspect of your decision. As always, surgery is the last resort after we try more conservative approaches.
Call us at 817-916-4685 to make an appointment.
Posted in: Degenerative Disc Disease