Disc Replacement VS Fusion

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

Disc Replacement VS Fusion

Spinal fusion has been the "gold standard" surgical treatment for many types of back problems for a long time.  But according to proponents, disc replacement - a newer procedure in the United States -  may show some promise as an alternative to spinal fusion.

By far and away, spinal fusions are performed more frequently than total disc replacements for common spinal conditions such as degenerative disc disease, scoliosis and more.

(This is despite the persistence of concerns and unanswered questions about fusion.) An analysis comparing the ratio of lumbar spinal fusions to lumbar total disc replacements performed between years 2000 and 2008 found that disc replacements represented 2% of all spinal surgeries given.

Why Disc Replacement Surgery?

Total disc replacement was developed, at least in part, out of a concern for the effects that a spinal fusion may have on vertebral segments above and below the surgery site. Because two adjacent bones are fused together, the biomechanics of your spine may be altered, which in turn, may result in pressure on the adjacent joints. Some experts believe the added pressure results in degeneration in those areas. Others are not so sure that such post-fusion spinal changes are attributable to the surgery.

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, a disc replacement surgery may help reduce the incidence of joint stresses in neighboring joints, when compared with spinal fusion. (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?

Because motion preservation surgery (disc replacement is the most common type) is still new in the United States, researchers are still collecting long-term data, and it’s certainly possible that techniques and strategies for performing disc replacement surgery have yet to be perfected.


As of March 2016, disc replacement surgery seems to have benefits over spinal fusion, but this doesn’t mean it makes the best choice of treatment for you.

A 2007 study published in Spine Journal reviewed records of 627 spine surgery patients, and found that based on the fact that an array of conservative treatments exists from which patients might choose, and on the history of how new spine surgery technologies are introduced to the market, the risk for overuse of total disc replacement surgery is real.

A 2011 study published in The British Medical Journal evaluated 173 spine surgery patients (spinal fusion and disc replacement) to compare disc replacement surgery with conservative care (rehabilitation). The researchers wanted to know which of the two approaches was the most effective way to address chronic low back pain. The authors of the study found that those who initially had spinal fusion were twice as likely to have a revision surgery as those whose first surgery was a disc replacement.


The study authors warned that while disc replacement surgery, when compared with a course of rehabilitation (i.e. physical therapy and non-invasive care), did result in improved ability to cope with one’s daily tasks and activities in a significant number of the 173 study participants, doctors and patients would do well to factor in the risks that accompany surgery before committing their patients to it.

Are You a Good Fit For Total Disc Replacement Surgery?

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 a cervical discectomy with spinal fusion. (The latter is the most common type of neck surgery.) The authors of this study comment that few guidelines telling doctors what to do during a re-operation or revision exist, leaving spine surgeons to make these determinations for themselves.

The authors advise surgeons to be very careful about who they take as patients for re-operations or revisions and to adhere to strict patient selection standards.  They also advise surgeons to use very precise techniques.

According to Dr. Joshua D. Auerbach, chief of spine surgery, Bronx-Lebanon Hospital Center, New York City, up to about 5% of patients who need a spine surgery are candidates for a total disc replacement. The limiting factors may include patient selection -- i.e. what are the odds you’ll experience a safe and successful outcome?

In his study, “The prevalence of contraindications to total disc replacement in a cohort of lumbar surgical patients,” Auerbach lists some of the contraindications to a total disc replacement surgery as:

A 2011 study published in Asian Spine Journal performed a retrospective review of lumbar spine surgery patient charts and also found that more than 2 level degenerative disc disease was a contraindication, as well.


Auerbach, J., MD. Chief of Spine Surgery, Bronx-Lebanon Hospital Center, Assistant Professor of Surgery, Albert Einstein College of Medicine. Phone Interview. March 2012.

Awe OO. et. al. Impact of total disc arthroplasty on the surgical management of lumbar degenerative disc disease: Analysis of the Nationwide Inpatient Sample from 2000 to 2008. Surg Neurol Int. 2011;2:139. Epub 2011 Oct 12. http://www.ncbi.nlm.nih.gov/pubmed/22059134

Chin KR. Epidemiology of indications and contraindications to total disc replacement in an academic practice. Spine J. 2007 Jul-Aug;7(4):392-8. Epub 2007 Feb 12. http://www.ncbi.nlm.nih.gov/pubmed/17630136

Gerometta A, Rodriguez Olaverri JC, Bittan F. Infection and revision strategies in total disc arthroplasty. Int Orthop. 2012 Feb;36(2):471-4. Epub 2011 Dec 24. http://www.ncbi.nlm.nih.gov/pubmed/22198361

Hellum et al. Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two year follow-up of randomised study. BMJ. 2011; 342: d2786. Published online 2011 May 19.

Huang RC, Lim MR, Girardi FP, Cammisa FP Jr.The prevalence of contraindications to total disc replacement in a cohort of lumbar surgical patients. Spine (Phila Pa 1976). 2004 Nov 15;29(22):2538-41. http://www.ncbi.nlm.nih.gov/pubmed?term=The%20prevalence%20of%20contraindications%20to%20total%20disc%20replacement%20in%20a%20cohort%20of%20lumbar%20surgical%20patients

Park S., Lee C., Chung S., Lee K., Kim W., Lee J.Long-term Outcomes Following Lumbar Total Disc Replacement Using ProDisc-II Average 10-year follow-up at a single institute.Spine (Phila Pa 1976). Feb 18 2016. Accessed: March 2016.

Quirno M, Goldstein JA, Bendo JA, Kim Y, Spivak JM. The Incidence of Potential Candidates for Total Disc Replacement among Lumbar and Cervical Fusion Patient Populations. Asian Spine J. 2011 Dec;5(4):213-9. Epub 2011 Nov 28. http://www.ncbi.nlm.nih.gov/pubmed?term=The%20Incidence%20of%20Potential%20Candidates%20for%20Total%20Disc%20Replacement%20among%20Lumbar%20and%20Cervical%20Fusion%20Patient%20Populations.

Skovrlj, B., et. al. Reoperations Following Cervical Disc Replacement. Asian Spine J. Jun 2015

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