Anterior Disc Surgeries: Options & Considerations

Anterior Disc Surgeries: Options & Considerations

Spinal discs—the complex structures located between the vertebrae—serve a number of critical functions, including separating the vertebrae and acting as pivot points during movement.  Over time, though, degeneration of the spinal discs can cause back and leg pain.

Several disc-related surgical procedures exist to address this discomfort, including anterior lumbar disc replacement, and anterior lumbar discectomy and fusion, both of which can provide relief under the right circumstances.

The Primary Types of Anterior Lumbar Disc Surgery: Anterior Lumbar Disc Replacement, and Anterior Lumbar Discectomy and Fusion

In this context, anterior refers to a surgeon approaching the affected area through the patient’s abdomen. Anterior lumbar disc replacement involves the removal of a degenerated or damaged disc in the lower back, replacing it with an artificial disc. Anterior lumbar interbody fusion, meanwhile, removes the disc, and the two adjacent vertebrae are then fused together, eliminating the joint completely.

These anterior spinal procedures can address discs damaged by trauma or compromised by disease or degeneration.     

Any candidate for these spinal surgeries must understand a few key differences between disc replacement and fusion. Both surgeries remove the disc that is the source of pain; the former replaces the disc with a similar motion device, while the latter fuses the remaining vertebrae to eliminate the affected joint altogether. This fusion, however, prohibits motion at the treated level.

The degree to which these limitations impact daily life will vary for each individual, but limited motion can have other consequences. Fusion redistributes the motion and forces that were once absorbed by the missing joint to those joints above and below, often hastening the onset of adjacent segment degeneration and potentially requiring additional surgery.1

Not all conditions are a good match for anterior lumbar disc replacement. Read about a new alternative that may be more effective for back and leg pain.

Disc Replacement: Is it right for you

Disc replacement has a significant advantage over fusion, in that it enables more natural movement. It is important to note, however, that an anterior disc replacement is not appropriate for all conditions. In fact, just 2-5% of patients are good candidates for lumbar disc replacement, and still others experience only minimal benefit.2 This is due to several limitations.

First, anterior lumbar disc replacement does not address pinched nerves, which are the most common cause of both back and leg pain. The anterior approach makes it almost impossible for surgeons to access these nerves, meaning this type of surgery is unlikely to offer effective pain relief.

What’s more, it replaces only a portion of the functional spinal unit—the disc. For many patients, this solves only part of the problem. Those with signs of spinal arthritis are generally unsuitable candidates, as the facet joints will remain intact. These patients are likely to experience continued facet degeneration and stiff, arthritic joints.

Finally, the anterior approach itself carries significant risk. In order to reach the damaged disc, surgeons must work around vital internal structures—the bladder, kidneys, ureters, part of the colon, and major blood vessels. These organs can sustain damage during surgery, potentially resulting in additional procedures or a prolonged hospital stay. In men, the anterior approach also carries the risk of retrograde ejaculation, a type of sexual dysfunction caused by cutting through small nerves in the stomach to access the spine.

The anterior approach presents an even greater challenge if a patient requires follow-up surgery to address a worn-out disc prosthesis or progression of facet joint arthritis.2 The second time around, those same blood vessels may be scarred and less pliable, increasing the likelihood of a major vascular complication during the operation. Most anterior surgeries require the skills of both a spine and vascular surgeon, and revision surgeries can be life threatening.

An Alternative to Anterior Lumbar Disc Replacement

Even if you are not a good candidate for disc replacement, you may still benefit from an innovative surgery for the lower back: BalancedBack total joint replacement. The BalancedBack procedure addresses degenerative disc disease while replacing the function of both the disc and facet joints, and as the first total joint replacement for the lumbar spine, BalancedBack follows closely in the footsteps of other orthopaedic joint replacement procedures. 

The BalancedBack procedure addresses the same pathologies as fusion, with a few important differences: it preserves range of motion, maintains natural balance, and helps prevent the breakdown of adjacent spinal structures.  And because the BalancedBack device is implanted from the back, surgeons can address a wide range of issues while avoiding the risks associated with anterior spinal surgery. Moreover, as many as 75% of patients may be appropriate candidates for BalancedBack. To learn more, visit our website or schedule a call with a member of our clinical team.

1 Bai, Deng-yan MD; Liang, Long, PhD;, Zhang, Bing-bing, PhD; Tao zhu, MD; Zhang, Hai-jun, MD; Yuan, Zhi-guo, MD Chen, Yan-fei, PhD. (2019). Total disc replacement versus fusion for lumbar degenerative diseases – a meta-analysis of randomized control trials. Medicine, 98:29, 1-11.

2 Gelalis, I. D., Papadopoulos, D. V., Giannoulis, D. K., Tsantes, A. G., & Korompilias, A. V. (2018). Spinal motion preservation surgery: indications and applications. European Journal of Orthopaedic Surgery & Traumatology, 28(3), 335-342.

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