Disc Replacement or Spinal Fusion?

Spinal fusion and disc replacement are two surgical methods used to treat certain types of spine disease, such as degenerative disc disease. Each type of surgery has its risks and benefits and involves recovery time and rehabilitation.

Two spinal surgeons operating
BSIP / UIG / Collection:Universal Images Group / Getty Images

Why Disc Replacement Surgery?

Total disc replacement surgery is intended to preserve your spine’s ability to move at the levels. Having a disc replacement may help reduce post-surgical degenerative changes in the neighboring spinal joints.

Spinal fusion is the surgical adherence of vertebral segments. Because 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. Added compression may contribute to degeneration in those areas, but it isn't clear if post-fusion spinal changes are always attributable to the surgery.

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

Disc Replacement Surgery—What Do We Know?

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

A 10 year, long term outcome report published in Scientific Reports in 2017 suggested that results of disc replacement and fusion surgeries are approximately equal. The researchers reported that the 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 lower back total disc replacement and lower back fusion surgery. 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?

A 2015 study published in the Asian Spine Journal found that re-operations and revision surgeries happened at about the same rate regardless of whether the initial surgery was a cervical disc replacement or a 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 are good candidates for a total disc replacement.

Possible contraindications to a total disc replacement surgery may include:

Additionally, a history of implant rejection or risk of anaphylaxis to implant material is a contraindication as well.

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  1. Büttner-Janz K, Guyer RD, Ohnmeiss DD. Indications for lumbar total disc replacement: selecting the right patient with the right indication for the right total disc. Int J Spine Surg. 2014 Dec 1;8:12. doi: 10.14444/1012. PMID: 25694946; PMCID: PMC4325514.

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