Back Surgery In Your 40s: Total Disc Replacement, Fusion, & BalancedBack

Back Surgery In Your 40s: Total Disc Replacement, Fusion, & BalancedBack

By his early 40s, Harvey Fox had been suffering from back pain for years. He was ready to find a solution that would
fix his back, not just treat the pain. His search for fusion alternatives led him to BalancedBack.


Many people in their 40s who suffer from back pain aren’t experiencing it for the first time; often, they’ve been dealing with it to some degree for years. It’s a unique time—40-somethings are still fairly young, yet old enough to have some degeneration starting in the spine. That sets the stage for some important considerations regarding treatment. If you’ve been told you need surgery to address the pain, you may be thinking about a total disc replacement or even fusion. This article points out some things to consider about both options, and discusses a third that you should be aware of: BalancedBack.

Total Disc Replacement Vs. Fusion Vs. BalancedBack

Total Disc Replacement

Also called artificial disc replacement, total disc replacement is when a degenerating, painful disc in your spine is replaced with an artificial disc. The original facet joints that pair with the disc remain intact and are not replaced. Disc replacement surgery is performed anteriorly (from the front, through the belly). Considerations include:

  • Artificial disc replacement will be successful only if the problem is isolated to the disc. If anything else is contributing to the pain—such as a pinched nerve or worn facet joints—a new disc solves only part of the problem, and you will continue to have pain after surgery. Only a very small percentage of patients—approximately 2 to 5%—have the right indications for total disc replacement.
  • Disc replacement surgery is somewhat risky because the frontal approach used by surgeons requires them to work around some vital internal organs and blood vessels to reach the spine.
  • You’re essentially undergoing both abdominal surgery and spine surgery, which makes the recovery process more difficult.


Fusion is when a surgeon removes one or more joints of your spine from functioning entirely (the disc and facet joints) and fuses two levels of your spine into one. The implications of this procedure are:

  • Taking away the function of one or more levels of your spine means the motions and stress caused by your daily movements is transferred to the levels above and below the fused location, creating a heavy burden on those adjacent levels. The accelerated deterioration of the adjacent levels is called adjacent segment disease, and it’s the reason why, within 15 years of having a fusion, there’s a 40% chance you’ll need additional surgery to address it.
  • Fusing two levels of the spine into one negatively affects posture, so you may feel fine in one position (usually standing) but uncomfortable and even painful in another (usually sitting).

Fusion and disc replacement surgery aren’t the only options available for treating back pain. Learn about an innovative new procedure that might be right for you.

BalancedBack Total Joint Replacement

BalancedBack Total Joint Replacement is similar to a hip or knee replacement in that the device replaces the function of both the disc and the facet joints. It is performed posteriorly (from the back).

  • Preserving the natural motion of your spine by replacing a diseased joint with a motion device keeps other joints up and down the spine healthier longer. The significance of motion preservation in a healthy spine has been highlighted in many studies comparing disc replacement vs. fusion—fusion patients are two to five times more likely than disc replacement patients to require additional surgery.
  • The posterior approach gives surgeons broader access to the spine, which means they can address other sources of pain, including pinched nerves, at the same time they implant the BalancedBack device.
  • There’s much less risk of damaging vital internal structures during surgery with a posterior approach.

Forty-somethings: How Your Age & Condition Impacts Your Decision

Now that you know the basics about each of the surgical options above, consider your unique condition.

No two patients are alike, therefore the path you choose to address your pain should be based on a careful assessment of your condition, investigation of your options, and conversations with your doctor. In general, patients in their 40s should consider the following when choosing a treatment method:

  • How healthy are the other discs in your back? If you have multiple levels showing disc degeneration, total (anterior) disc replacement and fusion will only accelerate the breakdown of those discs. (And in the U.S., only single-level disc replacements are available.)
  • How healthy are your facet joints? If your spine is showing any sign of facet joint arthritis or hypertrophy, a total disc replacement won’t entirely relieve your pain.
  • Are there other contributors to your pain besides a disc? If you’re facing other challenges such as nerve compression or spinal stenosis, a total disc replacement won’t solve those problems, either.
  • Are you facing spine stability issues due to recurrent herniated discs? If so, you’re likely not a good candidate for total disc replacement. Fusion can address stability issues (and a range of other problems, too), but at the expense of motion.

A BalancedBack Total Joint Replacement addresses a number of painful conditions with minimal impact to the natural function of your spine. BalancedBack treats leg and back pain, as well as instability. If you’d like to learn more about the procedure—and how it can help you get back to doing the things you love—visit our website to see more patient stories, learn about our spine surgeons, and access a variety of resources on spine care and back surgery.

Lumbar Total Joint Replacement

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