If you’ve been advised to undergo spinal fusion surgery, it’s important to seek a second opinion from a surgeon who’s experienced in artificial disc replacement surgery. For patients who are candidates, disc replacement may offer advantages over spinal fusion.
“Both disc replacement and spinal fusion are designed to reduce or eliminate pain,” said Dr. Scott Blumenthal, a spine surgeon on the medical staff at Texas Health Center for Diagnostics and Surgery (THCDS) in Plano, Texas. “However, disc replacement preserves range of motion. The benefit to a patient is number one, a quicker return to function, and number two, the chance that’ll you need more surgery in the future is significantly reduced.”1
In disc replacement surgery, the surgeon removes a damaged disc and replaces it with an artificial disc, a prosthesis that recreates the motion of a normal disc. Disc replacement may be performed on the cervical spine (neck area) or lumbar spine (lower back).
In spinal fusion, the surgeon connects two or more vertebrae (bones) in any part of the spine. Connecting the bones prevents movement between them, which places an additional load on the vertebrae nearby. That may eventually lead to other problems later which create the need for a second surgery.
Patients who’ve been advised to undergo spinal fusion surgery often come to THCDS for a second opinion, Dr. Blumenthal added. Because members of the THCDS team of spine surgeons perform disc replacement as well as spinal fusion procedures, they’re equipped to help patients weigh their options for spinal fusion versus disc replacement.
“If you see a surgeon who recommends a spinal fusion, ask them if they do disc replacement as well,” he said. “That's probably the number one question you need to ask your surgeon if he or she recommends a spinal fusion: ‘What about a disc replacement?’ If they don't, then you really owe it to yourself to get an opinion from a surgeon who really does both spinal fusion and disc replacement. Because you want to know which option is better for you.”2
When choosing a surgeon, Dr. Blumenthal also encourages patients to ask how many times the surgeon has performed the planned procedure.
“For any very complex, highly technical surgery, experience matters,” he said. “For disc replacement surgery, research shows that the more times a surgeon has performed the surgery, the better results the patient can expect.”
Few surgeons can boast as much experience as Dr. Blumenthal. He performed the first artificial disc replacement procedure in the United States in March 2000. Since then, THCDS spinal surgeons have performed more than 3,000 surgical disc replacements, using more than 14 different types of implanted devices.
For that reason, patients come to THCDS from around the U.S. to determine whether they’re suitable candidates for disc replacement.
“We evaluate them for the criteria for disc replacement,” he said. “Many meet the criteria, but some do not. For some patients, spinal fusion is more appropriate. But many can benefit from this newer technology of disc replacement.”
Are You a Candidate?
Spine surgery is a significant step. The decision to undergo any type of spine surgery should always be made carefully and in consultation with a qualified surgeon. Generally, surgeons don’t recommend spine surgery unless other options have been tried -- and failed.
Who is a candidate for artificial disc replacement? That determination involves several factors, including the patient’s age and overall health. Artificial disc replacement is usually not recommended, for example, for patients with facet joint syndrome or with spinal deformities such as scoliosis.
“The signs that you may benefit from a lumbar disc replacement would be unremitting, functionally limiting lower back pain, that hasn't gotten better with standard rehabilitation type efforts,” said Dr. Blumenthal. “In the cervical spine, you may be a candidate for an artificial disc if you've got neck pain along with arm pain, or what's called myelopathy, which is difficulty walking because your spinal cord is affected.”3
In cervical disc replacement, a small incision is made at the front of the patient’s neck. The important structures of the neck are carefully moved to the side so that the surgeon can see the vertebrae and the cervical disk. The affected cervical disk is removed, and the artificial disk is then secured into the empty disk space.4
Artificial disc replacement in the lumbar spine is also performed from the front through the abdomen. By accessing the spine through the abdomen, the surgeon avoids disturbing the spinal nerves. The organs of the abdomen and blood vessels are moved to the side so that the surgeon can see the backbone. Next, the surgeon removes the damaged portion of the disk and inserts a new artificial disk in its place.5
“Lumbar disc replacement is very consistent in how it's done,” said Dr. Blumenthal. “Lumbar disc replacement is always done from the front of the spine, whereas spinal fusion can be done using six or seven different techniques.”6
With both cervical and lumbar disc replacement, the key advantage over spinal fusion is that range of motion is preserved.
“A mobile or moving prosthesis is placed in the spine,” Dr. Blumenthal said. “That prosthesis moves just like your spine was meant to move. It wasn't meant to be fused.”
Not everyone is a candidate for artificial disc replacement. But patients considering other options should at least inquire as to whether it’s an option.
“If you've been told by a surgeon that you need spinal fusion, you really owe it to yourself to get another opinion from someone who does both disc replacement and spinal fusion,” said Dr. Blumenthal. “See if you might be a candidate for what we feel is the superior technology, disc replacement surgery.”7
[1]From Blumenthal video: What’s the difference between disc replacement and fusion in the cervical spine? https://www.youtube.com/watch?v=bkRxEIkmhq0
[2] Blumenthal video: What are some questions a patient should ask their spine surgeon when being evaluated?
https://www.youtube.com/watch?v=Ahu2RVgLcfo
[3] Blumenthal video: What are the signs someone may benefit from disc replacement surgery?
https://www.youtube.com/watch?v=btimja4ApUk
[4] Information here is from Dr. Blumenthal's interview and the John Hopkins website: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/cervical-disk-replacement-surgery#:~:text=The%20cervical%20disk%20that%20is,sutures%20that%20minimize%20any%20scarring.
[5] Information from Dr. Blumenthal's interview augmented with Mount Sinai website info: https://www.mountsinai.org/health-library/surgery/disk-replacement-lumbar-spine#:~:text=Doing%20the%20operation%20through%20the,artificial%20disk%20in%20its%20place.
[6] From Blumenthal video: What’s the difference between disc replacement and fusion in the cervical spine? https://www.youtube.com/watch?v=bkRxEIkmhq0
[7] From Blumenthal video: What’s the difference between disc replacement and fusion in the cervical spine? https://www.youtube.com/watch?v=bkRxEIkmhq0
This is general information for educational purposes only. You should discuss your symptoms with your provider.