At Texas Neurosurgery, when patients have tried conservative approaches for their back pain for six months or longer to no avail, the next option is often surgery. This is especially true if their back pain is making simple everyday activities an exercise in torture. People need to be able to live.
Patients wonder what the parameters are for having either spinal fusion, where two or more adjacent spinal vertebrae are fused together into a single unit, or artificial disc replacement, where the herniated spinal disc is replaced with an artificial disc.
In this first blog of summer, let’s get into both procedures.
Spinal fusion, particularly in the lumbar spine (the lower back), has been the traditional approach to eliminate movement between two vertebrae and remove the source of pain. This surgery involves forming a direct bony connection between the vertebrae surrounding the painful disc(s). The discs are removed in the fusion, eliminating the chronic pain.
There are a wide variety of approaches available for fusion procedures. Each has advantages and disadvantages. Surgical techniques include fusion approached from the front, the back, or both. The instruments used to fully immobilize the vertebrae during the fusion process can be rods and pedicle screws or plates. Bone graft material can come from the patient or from synthetic sources.
Artificial disc replacement is far less common. The procedure is designed to bring about pain relief by removing the painful disc, replacing it with a prosthetic implant. This has more in common with artificial joint replacement than with fusion, as motion is maintained between the vertebrae, rather than merging them into a single piece (as in fusion). Not every patient is eligible for disc replacement, however.
Comparing the two
With fusion, there is no longer any space or movement between the fused vertebrae. This can be perceived as a limitation in the person’s mobility, but the reality is that due to their prior chronic pain their mobility probably increases when the pain is removed with fusion. Plus, if you fuse the last lumbar vertebra into the sacrum there isn’t much movement there even in a fully healthy spine.
Disc replacement is designed to leave the disc space mobile to some degree, although it cannot replicate the complex movements allowed by the natural disc and vertebrae.
There is a possibility with both fusion and disc replacement of degeneration of the surrounding vertebrae. In fusion, the vertebrae above and below the fused section take more stress and can deteriorate. In disc replacement, there is some evidence that the facet joints at the back of the vertebrae can degenerate due to the abnormal motion provided by the artificial disc in between them.
If you’re even considering spinal surgery to relieve chronic pain, you need to do your research. And you need to call the expert neurosurgeons at Texas Neurosurgery, (214) 823-2052, so we can walk you through the pros and cons of each available option.