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.
Fusion & Disc Replacement Surgery: The Shortcomings
Both fusion and anterior 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 Compare them, for example, to the long-ago (and now outdated) hip and knee fusions, which were not only painful but also eliminated motion at the joint completely.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 eliminates back and leg pain and restores 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.
BalancedBack Posterior Total Joint Replacement is different from both artificial disc replacement and fusion. Instead of removing a joint or replacing a disc, a BalancedBack surgeon implants a device that replaces the function of the worn-out joint completely. As a result, it helps you avoid the problems associated with artificial disc replacement and the long-term side effects of lumbar fusion.
So how should you decide which type of back surgery is best for you—spinal fusion vs. disc replacement vs. BalancedBack Total Joint Replacement? Here are four things to consider.
Anterior Disc Replacement Vs. Fusion Vs. BalancedBack: 4 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, and disc replacement surgery does not address this condition. (Only about 2%-5% of patients would benefit from disc replacement surgery at all.) It also does not address other common conditions such as spondylolysis or spinal stenosis. 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.
The BalancedBack Total Joint Replacement uses a posterior (through the back) approach, rather than an anterior approach used for disc replacement surgery. It’s the preferred approach for lumbar spine procedures and one that allows surgeons to address a broader range of problems—everything from degenerative disc disease and arthritic facet joints to pinched nerves and more. It works on the same principle as total joint replacement in hips and knees: that total joint replacement is the best way to eliminate pain and regain full range of motion.
2. The Health Of The Related Joint
Anterior 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. Your facets should be no more than “mildly degenerative” in order to move ahead with this surgery. (Your doctor can determine the degree of degradation with a CAT scan.) If they are more than mildly degenerated, look for another option.
BalancedBack Posterior Total Joint Replacement replaces the function of the facet joints as well as the disc, relieving the pain associated with arthritic joints as well as a degenerating disc.
3. Your Age
If you’re among the small percentage of patients for whom disc replacement surgery would work, consider your age. Patients of any age—but especially those in their 30s and 40s—should choose a surgical alternative that won’t restrict their movements. Mobility after spinal fusion is limited because the surgery removes a joint in your spine.
In contrast, anterior disc replacement surgery and BalancedBack Total Joint Replacement preserve motion, allowing you to stand, sit, lie down, and bend over without pain and stiffness. However, it’s important to note that artificial disc replacement is less likely to be effective for most patients in their 50s and 60s. At that age, simply replacing a worn-out disc with a new one often doesn’t go far enough to address the source (or sources) of pain, which also usually include arthritic facet joints, among other things. A BalancedBack Total Joint Replacement both preserves mobility and addresses a host of other problems as well.
4. The Future Consequences
It’s impossible to know exactly what the future holds for each individual patient, but reviews of artificial disc replacement surgeries and lumbar fusions over time have helped us understand the implications down the road.
Lumbar fusion removes the joint and fuses two spine levels into one. The resulting inability to move naturally causes enormous stress directly above and below the fused location. Those abnormal loads add stress to the nearby facet joints and discs and make them work harder, and as a result, they rapidly start to weaken, resulting in adjacent segment disease. All that wear and tear causes thickening of the spinal ligaments, which could lead to spinal stenosis; or, a disc may wear out in an effort to manage the extra load, which could lead to spondylolisthesis or a herniated disc. Therefore, the likelihood of needing additional surgery after lumbar fusion is substantial.3
Reviews of artificial disc replacement studies shows that continued natural movement in the spine slows the breakdown of adjacent levels.4 Disc replacement surgery maintains range of motion and therefore reduces the likelihood of adjacent segment disease; however, the chances that it will relieve your pain are limited by only addressing the disc (see #2).
The new joint implanted during a BalancedBack Total Joint Replacement procedure also keeps you moving naturally, which means there’s less stress placed on the adjacent levels of your spine.
Want to know if BalancedBack Total Joint Replacement might be right for you?
Here is a short clip of Harvey, a BalancedBack patient, discussing his surgery options:
If you have debilitating back pain and are concerned about the problems with artificial disc replacement and the long-term effects of spinal fusion, we encourage you to read more about BalancedBack and discuss it with your doctor.
BalancedBack isn’t right for everyone. But many patients, of all ages, have already benefited from this innovative alternative to disc replacement surgery and fusion. To learn more, take a look at our patient stories, or talk to us to find out if you’re a candidate.
1 Levin, D. A., Hale, J. J., & Bendo, J. A. (2007). Adjacent segment degeneration following spinal fusion for degenerative disc disease. Bulletin of the NYU Hospital for Joint Diseases, 65(1), 29-29.
2 Salzmann, S. N., Plais, N., Shue, J., & Girardi, F. P. (2017). Lumbar disc replacement surgery—successes and obstacles to widespread adoption. Current reviews in musculoskeletal medicine, 10(2), 153-159.
3 Martin, B. I., Mirza, S. K., Comstock, B. A., Gray, D. T., Kreuter, W., & Deyo, R. A. (2007). Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures. Spine, 32(3), 382-387.
4 Huang, R. C., Tropiano, P., Marnay, T., Girardi, F. P., Lim, M. R., & Cammisa Jr, F. P. (2006). Range of motion and adjacent level degeneration after lumbar total disc replacement. The Spine Journal, 6(3), 242-247.