Lumbar Disc Replacement

Comparing the Benefits to Spinal Fusion Surgery

Spinal disc replacement surgery, also known as lumbar disc replacement, can be a treatment option for some types of lower back pain associated with disc disease. First approved by the U.S. Food and Drug Administration (FDA) in 2004, this surgery is supported by years of real-world application, primarily in Europe, where the procedure has been performed for more than 30 years.

Spinal discs
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About Degenerative Disc Disease

Degenerative disc disease (DDD) is caused by wearing away of the cartilaginous cushion that rests between the bones of the spine. However, (DDD) is a misnomer since it isn't really a disease at all. DDD is seen on an MRI as a dark, flat disc. Some doctors believe that DDD can cause back pain.

As a structure, the spinal column is made of stacked vertebral bones. Bones are separated by spinal discs. Each disc is composed of tough, but pliable collagen fibers that help maintain the position and integrity of the spine while allowing movement between the vertebrae. This complex structure provides us the stability needed to stand upright, as well as the flexibility to bend and twist in multiple directions.

Discs can age, becoming increasingly brittle and gradually wearing away over time. To an extent, this type of deterioration is normal; most people will experience it to some degree as they get older. In some cases, it doesn't cause any problems, but sometimes disc degeneration can lead to pain.

If you develop severe back pain of any sort, it is important that you are evaluated by an orthopedic specialist to pinpoint the exact cause. If you start treatment early, and you can usually alleviate problems with conservative management, like anti-inflammatory medications, physical therapy, and epidural steroid injections. Early treatment can help you avoid the need for surgery.

Understanding Spinal Fusion Surgery

Prior to considering surgery, treatment for DDD should be limited to non-invasive or minimally invasive options. Most cases are treated non-operatively. However, spinal fusion has long been considered the standard surgical treatment for DDD when non surgical options have been exhausted.

During spinal fusion surgery, the damaged disc is removed to stimulate bone growth within the remaining space. Over time, the space that had been occupied by the disc will gradually fill with bone and effectively fuse the vertebrae together. By preventing movement of this segment, pain relief may be achieved.

However, there may be problems that can limit the effectiveness of the surgery.

Problems with spinal fusion surgery include:

  • The rate of successful spinal fusion is around 80%. While complete fusion is not always necessary for pain relief, inadequate bone remineralization can undermine the benefits of the surgery.
  • Fusing the spine may lead to back stiffness and a loss in the range of motion.
  • By fusing the spine, the segments above and below the fusion are subject to increased stress and people who have undergone fusion may be more likely to develop problems with the adjacent discs in the future.

Benefits and Risks of Lumbar Disc Replacement

Lumbar disc replacement is similar to other types of joint replacement, such as those involving the knee or hip. The surgery involves the removal of a damaged disk and replacement with a metal or plastic implant.

The potential advantage of disc replacement surgery is that the spinal prosthetic may preserve (and sometimes even restore) motion in the damaged segment without transferring stress elsewhere. It might maintain the integrity of the spine while achieving the same level of pain relief as a spinal fusion.

Moreover, disc replacement surgery tends to require shorter hospital stays which, according to an analysis from Cedars-Sinai Spine Center in Los Angeles, can reduce hospitalizations cost by as much as 54$.

This is not to suggest that lumbar disc replacement surgery is not without its limitations.

Limitations include:

  • A 2014 study published in the journal International Orthopaedics concluded that, while highly beneficial, there is no evidence that lumbar disc replacement is superior to spinal fusion.
  • While newer prosthetic discs offer greater durability, they can still wear out and may require additional surgeries down the road.

With that being said, when comparing the potential benefits of a disk replacement surgery (motion preservation, reduced incidence of adjacent segment disease) to spinal fusion, sometimes disc replacement is selected as a treatment option over spinal fusion.

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By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.