These are the most common solutions for people suffering from severe back and/or leg pain that simply can’t be eliminated any other way. But while these procedures are common, they’re still far from ideal.
Spinal Fusion Vs. Disc Replacement: Putting The Decision In Context
Both fusion and disc replacement are still simply rungs on the evolutionary ladder of spine surgery—there’s a long way to get to the top. Compare them, for example, to the long-ago (and now outdated) hip and knee fusions, which were not only painful but also eliminated motion at the joint completely. (Fusion is the process of fusing two bones together to create a single bone, removing the joint altogether.) At the time, fusion was the best option for people with hip and knee pain.
Looking for an alternative to spinal fusion? Find out more about an innovative new procedure that helps to relieve back and leg pain and restore full range of motion.
Medical advancements in the area of single joint replacement have since transformed those procedures; today, people undergo joint replacement surgery for everything from shoulders and wrists to elbows and ankles—as well as hips and knees. By replacing the entire joint, patients retain full range of motion; plus, the procedure is easier and patients recover better and faster. These types of surgeries are now considered low-risk and address a wider range of problems for more patients than ever before.
Fusion has long been the standard surgery for spine problems, and it has the same effect now as it did for hips and knees way back when—it stops motion at one particular level of the spine. When disc replacement surgery came along in the 1980s and 90s, it was initially thought to be revolutionary. In reality, it was less of a breakthrough and more of an evolutionary turn of the wheel. The procedure still doesn’t replace the two facet joints in the spinal unit—only the disc. And that has its own set of problems, as you’ll see below.
So if you’re faced with the decision of spinal fusion vs. disc replacement, what are some things to consider? Let’s take a look.
Lumbar Disc Replacement Vs. Fusion: Things To Consider
The considerations listed below apply to the lumbar spine, not the cervical spine. The issues associated with replacing a damaged disc in the neck are quite different than replacing one in the lumbar area of your spine (the cervical spine supports your head and is extremely mobile; your lower back bears the weight of your entire body). Contrary to lumbar disc replacements, anterior cervical disc replacements can be very effective and are rapidly replacing cervical fusions.
For a decision between these surgeries as they relate to the lumbar spine, here are a few things to consider:
1. Your medical diagnosis. For most patients, a new disc won’t solve the problem. The most common cause of back and leg pain is pinched nerves; disc replacement surgery does not address this condition. (Only about 2%-5% of patients would benefit from disc replacement surgery at all.) What your spine needs in many cases is a decompression—or removal of the bone pressing on the nerves. Decompression is the first course of surgical treatment for pinched nerves and in some cases, decompression makes the spine unstable, necessitating spinal fusion.
2. The health of the related joint. Disc replacement surgery replaces only a portion of the functional spinal unit (the disc); the attached facet joints are left intact. It’s something of a “half solution.” Even if you get a new disc, if the joints are worn out, your pain isn’t likely to go away. Also, your facet joints will naturally degenerate over time, possibly even becoming arthritic and painful. Your range of motion may also become limited due to your weakened joints. The likely next step—though it may be several years later—would be fusion. So if there’s any indication of early joint degeneration at the time of surgery, disc replacement surgery may not be the best choice.
3. Your age and activity level. Disc replacement surgery preserves motion; fusion limits it. That makes disc replacement a more attractive choice for young, active patients. Also, the fact that disc replacement surgery allows your facet joints to continue working means there’s less stress on the adjacent levels of your spine (compared to fusion, where the resulting inability to move naturally causes enormous stress directly above the fused location). Studies of disc replacements seem to show that the continued natural movement slows the breakdown of adjacent levels. So it’s possible that choosing disc replacement over fusion will reduce your chance of having to get additional surgery—if the related facet joints are in good health.
4. Your insurance. Few insurance companies are willing to cover disc replacement surgery—at least without making you jump through numerous hoops. That’s because artificial disc replacement surgery has shown disappointing results over the long term. And if you’re denied coverage at the outset, an appeal process could take anywhere from 4-6 months. (Insurance coverage varies; it may be different from state to state or for people with military benefits.)
The Next Evolution In Spinal Surgery
Like the incredible progress that was eventually made on knee and hip surgeries, spine surgery is now on the verge of a similar breakthrough—one that more naturally fulfills the human body’s preference for motion. Beyond simply disc replacement vs. fusion, there’s now another option: BalancedBack® Posterior Total Joint Replacement.
Here is a short clip of Harvey, a BalancedBack® patient, discussing his surgery options:
BalancedBack® is a more complete solution for back and leg pain because it replaces both the disc and the joints, allowing you to keep moving like you naturally would. The new, productive joint allows the levels above and below to move naturally, placing no additional stress on adjacent levels of your spine. And because your facet joints are new too, there’s no need to worry about future arthritis.
The BalancedBack® procedure uses a posterior approach (through the back). It’s preferred approach for lumbar spine procedures and one that allows surgeons to address a broad range of problems. That means a lot more patients can benefit from this innovative procedure—and get on with enjoying their lives.
If you’d like to find out more about the BalancedBack® total joint replacement procedure, visit our website or schedule a complimentary call with our clinical coordinator.