Artificial Disc Replacement Surgery vs Fusion

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When is an Artificial Disc Replacement for Neck or Back Surgery Right for You?

Total disc replacement surgery, which first came on the scene in the US in 2004, with the Charite disc, is done on relatively few spine surgery patients. Instead, the most common back surgery in the US is and has been for a long time - spinal fusion. Spinal fusions are done in the neck, low back and mid back for a variety of reasons, including degenerative disc disease, scoliosis and more.

Only up to 0 - 5% of lumbar spine surgery patients get a disc replacement, according to Quirno, et. al. in their study, "The Incidence of Potential Candidates for Total Disc Replacement among Lumbar and Cervical Fusion Patient Populations," which was published in the December 2011 issue of Asian Spine Journal. (Quirno and fellow researchers surveyed the medical literature on the subject.) The estimated number of cervical disc replacements is higher, they report, at 43%.

When should you and your surgeon choose disc replacement over spinal fusion? Slide on to learn how disc replacement compares to other types of spine surgery for the cervical, lumbar and thoracic regions.

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Lumbar Disc Replacement vs Lumbar Spinal Fusion Surgery

Lumbar spine depiction. SEBASTIAN KAULITZK/Collection:Science Photo Library/Getty Images

Quirno et. al. say that most lumbar fusions are done in cases of advanced spinal degeneration, spinal instability (spondylolisthesis) or facet joint dysfunction – or a combination of some or all of these. The authors say that these kinds of back problems are decidedly not the type that calls for a disc replacement. Consequently, few lumbar disc replacements are done in the US.

Along with reviewing the medical literature, the researchers also conducted their own retrospective review of spine surgery patient records. From this, they concluded that about 14.9% of low back cases requiring surgery would likely do well with disc replacement instead of lumbar fusion.

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Cervical Disc Replacement vs Anterior Cervical Discectomy with Fusion

Depiction of Neck and Shoulder Anatomy. SEBASTIAN KAULITZKI/Collection:Science Photo Library/Getty Images

Cervical spine fusion is another very common spine surgery. This is generally done after a discectomy that removes herniated disc fragments. In these cases, a total disc replacement surgery to relieve arm pain (and sometimes accompanying neck pain) may make a good choice, Quirno, et. al. say.

Because of this, more disc replacements are done in the neck than in the low back. In the Quirno study, 28% of fusion candidates were also disc replacement candidates, compared to 14.9% of lumbar patients.

Yet, according to Bao, in his article entitled, "Artificial Disc Technology," published in Neurosurgical Focus in the year 2000, most of the research and development for prosthetic disc technology (i.e. artificial discs) has been focused on lumbar devices.

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Artificial Disc Replacement in the Thoracic Spine (Mid and/or Upper Back)

Depiction of Spinal Column Emphasizing Thoracic. SEBASTIAN KAULITZKI/Science Photo Library/Getty Images

Few, if any, thoracic disc replacements are done in the U.S. This is mainly because disc problems in this area of the spine are rare (although they do occur.) Bao, says that thoracic disc replacements account for less than 1% of all disc arthroplasties.

Sources

Bao, Qi-Bin Bao, Ph.D., Yuan, Hansen. Artificial Disc Technology. Neurosurgical Focus. 2000. Accessed Feb 2016.http://www.medscape.com/viewarticle/405655_4

Chun Kun Park, M.D., Ph.D. Total Disc Replacement in Lumbar Degenerative Disc Diseases. J Korean Neurosurg Soc. Nov. 2015. Accessed Feb 2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688308/

Quirno, M., Goldstein, J., Bendo, J., Kim, Y., Spivak, J. The Incidence of Potential Candidates for Total Disc Replacement among Lumbar and Cervical Fusion Patient Populations Asian Spine J. Dec 2011 Accessed: Feb 2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3230648/