One of the most common causes of disability throughout the world is low back pain, and over two-thirds of the population will experience back pain at some point in their lives.2 The good thing is that there are a number of different treatments for back pain, both surgical and non-surgical. It can be difficult to determine which is best for your specific issue, but doing so is essential in order to get the most effective treatment for your pain.
Spinal fusion is one of the most common surgical treatment options for those with severe back pain that has failed to see relief from conservative treatments. Artificial disc replacement has been increasing in popularity as well since gaining FDA approval in the early 2000s.2 However, the question is, what’s the real difference between these procedures?
Artificial Disc Replacement
When trying to determine what treatment is best for you, you should start by working with your doctor to identify the source of your back pain. This can be difficult because there are so many causes of back pain, such as arthritis of spine joints, disc herniation, instability of the spine like spondylosis, and degenerative disc disease.2
It can help to understand that the goal of artificial disc replacement is to remove and replace damaged spinal discs that are causing back pain, restore the normal height of the disc, decrease discogenic back pain, allow for motion in the affected area, and improve the patient’s function.2 This is usually done with artificial discs made of either metal or some combination of metal and plastic. Whereas fusion, as the name implies, permanently fuses 2 or more vertebrae together, disc replacement generally allows for more mobility after the procedure.3
Diagnosis for Artificial Disc Replacement
Before determining whether you’re a candidate for artificial disc replacement, your doctor will have to perform a thorough evaluation in order to pinpoint the source of your back pain.2 Having an understanding of what exactly is causing your back pain is crucial in determining whether or not artificial disc replacement is the right treatment for you. This evaluation will most likely involve a physical exam focusing on establishing which body positions or movements cause pain. Your doctor may also want to discuss your medical history.2
Other tests may be ordered if your doctor can’t determine the source of back pain from the physical exam alone. X-rays, magnetic resonance imaging (MRI), and computerized tomography (CT) are commonly used to assess bones and spinal discs. If determine to be necessary, your doctor may recommend further testing of the spinal discs through a discogram. This will help determine whether a spinal disc is the cause of back pain.2
Artificial disc replacement will not always be recommended. There are some back issues for which it is not an effective treatment, but generally, if you meet the following guidelines, artificial disc replacement may be an option.3
- Only 1 or 2 spinal discs are the source of your back pain.
- You have 1 disc that has caused pain for over 6 months.
- You do not have joint disease or compression of spinal nerves.
- You are not excessively overweight.
- You have not previously had spinal surgery.
- You do not suffer from scoliosis or other spinal deformities.
Artificial Disc Replacement Process
During the surgical process of artificial disc replacement, an incision is made in the patient’s abdomen.2 Through this incision, your surgeon will remove the affected disc and replace it with the artificial disc.3
Artificial discs are made to imitate the functions of a normal spinal disc, such as carrying load and allowing motion of the spine. The design of these artificial discs have two main types: total disc replacement and nucleus disc replacement. For total disc replacement, the complete disc, or most of it, is removed and replaced with a device that is then implanted between the vertebra, where the natural spinal disc would be. In a disc nucleus replacement, only the nucleus pulposus at the center of the spinal disc is removed and replaced.1
Artificial disc designs generally have two plates as well. One plate will attach to the vertebra above the spinal disc that is being replaced and the other attaches to the vertebra below. These artificial discs usually have soft, compressible pieces between these two plates with the purpose of allowing the spine to be mobile.1
Some artificial disc replacements are also designed for the replacement of spinal discs in the neck (the cervical spine). However, artificial discs for the cervical spine have not been in use as long as replacement discs for the lumbar spine.1
Issues With Artificial Disc Replacement
As with any other surgical procedure, there are risks associated with artificial disc replacement. Because artificial disc replacement requires more access to your spine than a spinal fusion does, it can have a greater risk than spinal fusion surgery.3 Other risks include a need for supplementary surgeries in order to remove the implant or replace it. It is also possible to have an allergic reaction to the artificial disc materials, which would necessitate further surgery. There is also a risk for bleeding or blood vessel problems following artificial disc replacement. Artificial disc implants have also been known to bend, break, loosen, and even move. There may also be issues with infection at the site of the incision.2
Other complications from artificial disc replacement include2:
- Male sexual dysfunction.
- Pain or discomfort following the procedure.
- Side effects from anesthesia.
- Spinal cord or nerve damage.
- Spinal fluid leakage/tears of the dura (a layer of tissue covering the spinal cord).
- Spinal stenosis (narrowing of the spine) due to a breakdown of spinal bones.
- Issues as a result of an improperly positioned implant.
- Some stiffness or rigidity in the spine.3
Unfortunately, there is also still debate within the medical community regarding the long term effectiveness of artificial disc replacement. In many trials, patients with artificial disc implants noticed improvements in their back pain following surgery. However, the difference in improvement between patients that underwent artificial disc replacement and patients that underwent spinal fusion surgery was not considered significant.2
Another concern is regarding how long these artificial disc implants last. There are many documented cases of an artificial disc moving out of place for unknown reasons, and this is an important cause for concern. Further, the long-term durability of the material the disc is made of is in question as well. Artificial discs have shown wear over time and the effect of this wear on the spine is still unknown. It’s important to monitor the implants over time in order to have a proper understanding of safe artificial disc replacement really is in the long-term.2Further, other complications and risks may arise depending on the specific medical conditions you may have. It’s important to fully understand your risks and discuss them with your doctor before undergoing an artificial disc replacement.3
Spinal Fusion Surgery
Spinal fusion is a surgery that has the goal of permanently connecting two or more vertebrae of your spine in order to cease motion between them. This is done using techniques that are meant to mimic the natural healing process of broken bones.5
Spinal fusions are similar to welding, although the vertebrae do not immediately become welded to each other during the surgery itself. Instead, the bone grafts placed around the spine during surgery eventually heal in a way that fuses the affected vertebrae together, becoming one solid unit.4 This is done to improve the stability of the spine, fix deformities, and alleviate back pain.5
Reasons For Spinal Fusion
Spinal fusion will likely be recommended to correct spine deformities, such as scoliosis. Fusion may also be recommended to add stability to the spine following the removal of a herniated disc.5
It can also add stability to the spine if you’re suffering from instability. Spine instability is caused by excessive motion between two vertebrae5 and it is believed to cause both neck and back pain as well as damage or irritation to surrounding nerves. Surgeons disagree on the exact definition of spine instability, but most agree that if one or more segments of the spine lack stability, spinal fusion surgery is appropriate.4
The spine may also sustain a hairline fracture that can allow the vertebrae to slip forward on each other. This is known as spondylolisthesis and is an indication for spinal fusion surgery. A complete fracture is also a common reason for spinal fusion surgery and is considered one of the least controversial reasons for surgery. You should note that vertebral fractures do not always require surgery, but when a fracture is linked to spinal cord or nerve injury, spinal fusion is usually required.4
Spinal Fusion Process
In the process of spinal fusion, bone, or bonelike material is placed in the area between two vertebrae. Metal plates, screws, and rods may also be used to hold the vertebrae together in order to ensure that they heal into a solid unit.5
Although this is generally how spinal fusion is performed, there are a number of techniques used for spinal fusion surgery. The technique your surgeon chooses to use will depend on the location of the vertebrae that need to be fused, the reason for your spinal fusion, as well as your overall health and body shape.5
However, spinal fusion surgery will generally involve an incision, bone graft preparation, and fusion.5
During the incision, your surgeon will make an incision in one of the following areas: the neck or back directly above the spine, either side of your spine, or in the abdomen or throat in order to access your spine from the front of your body.5
If a bone graft, rather than bone-like materials, are used for the fusion, it will come from one of two places: a bone bank or your own body. If your own bone is used, it is usually taken from the pelvis. In order to get the bone needed, another incision will be made above your pelvic bone, a small portion will be removed, and the incision will be closed.5
Finally, your surgeon will place the bone or bonelike material between your vertebrae and use metal plates, screws, or rods to hold the vertebrae and bone together during healing. This is what will allow the vertebrae to fuse together once your spine is fully healed.5
Issues With Spinal Fusion
One of the most well-known problems of spinal fusion surgery is the stress it places on the spinal levels above and below the area that has been fused.2 This is due to the fact that spinal fusion immobilizes a section of your spine, and it can increase the degeneration of the spinal discs in these areas. This generally leads to a need for additional spine surgeries.5
Further, although spinal fusion has been shown to be an effective treatment for fractures, deformities, or instability in the spine, studies show that it may not be effective when the cause of back or neck pain is unable to be ascertained. In many cases of nonspecific back or neck pain, spinal fusion is no more effective than conservative treatments.5
Unfortunately, it’s common for doctors to be unable to pinpoint the exact cause of back or neck pain in patients. Even when a herniated disc or bone spur is shown in X-rays, this doesn’t necessarily mean that those issues are the exact cause of your pain. There are some cases in which patients have X-ray evidence of back issues but never experience pain as a result. This makes diagnosing the cause of pain through imaging difficult to do with any certainty.5
Another issue that even when spinal fusion surgery is successful and provides pain relief, it doesn’t prevent you from developing more back pain as a result of other issues in the future. Most degenerative conditions of the spine are believed to be caused by arthritis, a condition that spinal fusion surgery cannot treat.5
Other issues known to be a product of spinal fusion surgery include5 :
- Improper healing, or pseudoarthrosis.2
- Infection of the surgery site.
- Poor wound healing.
- Blood clots.
- Damaged blood vessels or nerves in and around the spine.
- Pain resulting from the bone graft at the site it was taken from.
What is the Discseel® Procedure?
If you feel that surgery is your only option for effective treatment, there is another way. The Discseel® Procedure is a non-invasive, non-surgical procedure that is shown to be effective in treating back and neck pain related to herniated discs, degenerative disc disease, chronic low back pain, and sciatica.
The Discseel® Procedure does this using a substance known as fibrin, which is a natural biologic made from human blood. This fibrin is an FDA approved biologic used off label, similar to how corticosteroids are used for epidural injections.
Dr. Pauza introduces the fibrin into damaged spinal discs in your lumbar or cervical spine. It then seals the disc and promotes the tissue in the disc to grow and heal the torn spinal discs.
The Discseel® Procedure generally takes less than an hour and allows patients to be up and walking within the same day.
If this sounds like the right option for you, apply for the Discseel® Procedure today and find out if you’re a candidate.
- Artificial Disc Replacement. (n.d.). Retrieved May 28, 2020, from https://www.spine.org/KnowYourBack/Treatments/Surgical-Options/Artificial-Disc-Replacement
- Artificial Lumbar Disc Surgery. (n.d.). Retrieved May 28, 2020, from https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Artificial-Lumbar-Disc
- Lumbar Disk Replacement. (n.d.). Retrieved May 28, 2020, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/lumbar-disk-replacement
- Spinal Fusion. (n.d.). Retrieved May 28, 2020, from https://www.spine.org/KnowYourBack/Treatments/Surgical-Options/Spinal-Fusion
- Spinal fusion. (2019, August 10). Retrieved May 28, 2020, from https://www.mayoclinic.org/tests-procedures/spinal-fusion/about/pac-20384523