Disc Replacement or Spinal Fusion?

Two spine surgeons operating.

BSIP/UIG/Collection:Universal Images Group / Getty Images

Spinal fusion has been the "gold standard" surgery for many types of back problems for a long time. But according to proponents, disc replacement—a newer procedure in the United States—may one day take over. 

For now, though, many more spinal fusions are performed than total disc replacements for common spinal conditions such as degenerative disc disease, scoliosis and more. And this is despite persistent concerns and unanswered questions about fusion.

An analysis comparing the ratio of lumbar spinal fusions to lumbar total disc replacements performed between the years 2000 and 2008 found that disc replacements represented 2% of all spinal surgeries given. The study was published in the October 2011 issue of the journal Surgical Neurology International.

Why Disc Replacement Surgery?

Total disc replacement was developed, at least in part, out of a concern for the effects a spinal fusion may have on vertebral segments above and below the surgery site. Because two adjacent bones are joined together in a spinal fusion—eliminating all movement in that level of your spine—the way your spine moves after the operation may be altered, with extra pressure being placed on the adjacent joints. Some experts believe the added compression leads to degeneration in those areas. Others are not so sure that such post-fusion spinal changes are attributable to the surgery.

Either way, the thinking behind a total disc replacement is that it preserves your spine’s ability to move at the level(s) the procedure is done. In this way, having a disc replacement may help reduce the incidence of post-surgical degenerative changes in the neighboring spinal joints.

Degeneration in spinal joints above and below the site of a spinal fusion is commonly known as adjacent segment degeneration or ASD.

Disc Replacement Surgery—What Do We Know?

Although motion preservation surgery, with disc replacement as the most common type, is still relatively new in the United States, evidence points to its effectiveness. Just the same, researchers continue to collect long-term data on results and risks.

By identifying specific outcomes, a 10 year, long term outcome report published in the journal (Scientific Reports) in 2017 strengthened the common knowledge (among surgeons and experts, at least) that results of disc replacement and fusion surgeries are approximately equal. The researchers found that development of ASD after the procedure, speed of recovery and pain outcomes were all approximately equal between the two procedures. 

A 2017 study published in the Global Spine Journal compared outcomes between total disc replacement and fusion surgery types in low back patients. The researchers found that disc replacement patients showed more improvements in pain relief and disability than spinal fusion patients at every post-surgery time period studied (six weeks, three months, six months and one year.)

Also in this study, disc patients returned to work on average sixty-five days sooner than fusion patients.

Are You a Good Fit for Total Disc Replacement Surgery?

But this was just one study on revision rates. A 2015 study published in the Asian Spine Journal found that so far, at least, re-operations and revision surgeries happened at about the same rate regardless of whether the initial (called "index") surgery was a cervical disc replacement or the very commonly given cervical discectomy with spinal fusion.

That said, according to Dr. Joshua D. Auerbach, chief of spine surgery at Bronx-Lebanon Hospital Center, New York City, only up to 5% of patients who need a spine surgery make good candidates for a total disc replacement. The limiting factors, he says, may include patient selection. In other words, what are the odds you’ll experience a safe and successful outcome?

Possible contraindications to a total disc replacement surgery may include:

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