Surgeons have been fusing hips, knees, ankles, and shoulders (as well as spines) for decades. It’s long been a common treatment for severe fractures, infections, and degenerative changes that affect the stability of a joint. Over the years, fusion has been replaced with a newer, better alternative—except with the spine. Hip, knee, and ankle joint replacements are now commonplace, and widely acknowledged as the best option for treatment of compromised joints.
So why have spine treatments not followed suit?
The spine is a more complex joint. It’s a mass of interlocking bones—joint-on-joint and motion segment upon motion segment. In addition, neurologic elements are present in the lumbar spine (your lower back) and the cervical spine (your neck), and there are major arteries to consider. Any type of spine surgery is complicated and somewhat risky—and as a result, technological innovations have been far and fewer between.
That might leave you wondering if there are, in fact, any spinal fusion alternatives. The answer depends on a number of factors; let’s take a look.
Spinal Fusion Alternatives
If you’re investigating spinal fusion, you likely have intolerable pain that’s preventing you from living your life in a meaningful way. The reasons for that pain could be due to any number of factors, from a herniated disc to progressive arthritis to a traumatic injury. Or you could even have an aggressive infection that’s steadily attacking the joint.
But relief from any of these issues doesn’t always come in the form of spinal fusion. Fusion is done for two reasons only: to restore stability of the spine, or to make a correction. But just because there’s pain doesn’t always mean there’s instability, which is why the first course of action is typically spinal decompression.
Decompression is a general term to describe a surgeon doing whatever it takes to fix the problem (and relieve the pain)—short of making the spine unstable. If something’s pressing on a nerve, like a herniated disk or a bone spur, decompression is usually the first attempt to remove or otherwise address the offending material. For example, if you’re experiencing terrible pain as the result of a herniated disc but your spine is stable, this procedure is usually enough to combat the problem. A minimally invasive decompression allows the surgeon to remove pressure from the nerve with just a small incision—no fusion required.
When Decompression Isn’t Enough
Although a surgeon will almost always try decompression first, there are times when it simply won’t work. For example, if the spine is deemed unstable for any reason, further action must be taken—which is usually where fusion comes in.
Looking for options other than spinal fusion? Learn more about an innovative new procedure called total joint replacement.
Sometimes, it’s difficult to determine if the spine is unstable (or will be unstable) until the process of decompression has already begun. If a surgeon has had to remove a fair amount of bone or disc to address the pain, the resulting stability of the spine becomes a concern. In that case a surgeon may decide to fuse the segment so it won’t move. Other times, a surgeon can tell right away that the spine is unstable. With a condition like spondylolisthesis, for example, where the upper vertebral body has slipped over the lower vertebral body, the spine is inherently unstable, which may lead the surgeon and patient to consider fusion instead of decompression.
The problem with fusion is that it simply doesn’t work all that well. To restore your spine’s stability, the fusion surgeon attempts to recreate your lumbar lordosis (the natural curve in the spine) so that your head is positioned correctly over your feet. Your spine is then locked into that position so that freedom of movement is impossible. In many cases, the locked position is not the ideal one for you, leaving your body off-balance. Fusion surgeries tend to have low success rates, which is why so many people are searching for an alternative.
An Alternative To Cervical Spinal Fusion
- If the pain is in your cervical spine (neck), a good alternative to a cervical spinal fusion is cervical disc replacement surgery. The architecture of the joints is different in this area of the spine, so it’s common to perform surgery with an anterior approach (with the surgeon entering from the front). During cervical disc replacement surgery, the surgeon removes the degenerated or herniated disc, and instead of putting a block of bone or a spacer and plate to fuse it, inserts an artificial disk. The joints remain in place, allowing for continual freedom of movement. Cervical disc replacement surgery has shown promising results when the patient does not have severe arthritis and the rest of the cervical spine is in good condition.
Options Other Than Spinal Fusion For Spondylolisthesis & Other Conditions Of The Lumbar Spine (Lower Back)
- Artificial disc replacement is slightly different for the lumbar spine as opposed to the cervical spine, but the procedure remains the same in theory: The surgeon removes the degenerated or herniated disc and replaces it with an artificial disc. The results, however, are not nearly as promising in the lumbar spine because artificial disc replacement is only viable in a small percentage of patients. In order for the surgery to be successful, pain must be originating from a specific disc only—and nothing else. Accessing the lumbar spine from the front is also much more dangerous than in the cervical spine because of neural structures and the great vessels. Anterior disc replacement carries the risk of sexual dysfunction in men and can be dangerous to revise if anything goes wrong over time.
- Disc nucleus replacement procedures are still in the developmental stages. Mostly for the lumbar spine and similar in many ways to artificial disc replacement, nucleus replacement involves placing a small ball or spacer between the vertebral bodies and leaving the disc annulus and facets intact. The spacer helps prevent collapse and allows the patient to maintain motion. At this time the procedure is still relatively rudimentary and, as a result, has fallen out of favor.
- BalancedBack total joint replacement is the latest development in addressing back and leg pain in the lumbar spine by utilizing the next generation of artificial disc technology. It uses the same safe posterior approach and broad decompression as a traditional fusion surgery but retains range of motion by replacing not only the damaged disc but the function of the facet joints as well. It works on the same principle as total joint replacement in hips and knees—that total disc replacement is the best way to eliminate pain and regain full range of motion. Although the procedure is relatively new, results are encouraging with 71% pain reduction, an 89% increase in general health status, and 90% patient satisfaction rates.
Here is a short clip of Harvey, a BalancedBack patient, discussing his surgery options:
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