Patients in need of spine surgery have two viable options: spinal fusion or total disc replacement. If you are considering one of these options, it’s important to know what each entails, the advantages and the risks. It’s also imperative to have your physician’s input as the type of spine surgery you undergo could depend on the type of disc issue you’re experiencing.
Originally, spinal fusion surgery was performed on patients with scoliosis or spinal deformities. However, it has become a popular choice for those with discogenic pain—pain in a particular area of the spine. If there is a problem with one of the vertebrae or discs, a physician may recommend a spinal fusion to prevent further mobility in that section of the spine. This tried and true method links that together two or more individual vertebrae with the rest of the spine, eliminating the source of pain. There are two type of spinal fusion surgery:
- Anterior Inter-Body Spinal Fusion – This type of spinal fusion requires an abdominal incision. The vertebrae are adjusted with the patient on their back and a femoral ring (cadaver bone) or a cylindrical cage is inserted between the two vertebrae. The femoral ring or cylindrical cage is filled with bone graft usually obtained from the patient’s hip.
- Posterior Spinal Fusion – This type of spinal fusion, also called post-erolateral spinal fusion, is performed while the patient is facing down. A bone graft, usually obtained from the hip, is inserted between the transverse processes.
Spinal fusion surgery can last anywhere from 2 to 12 hours, and it can be quite different for each spinal surgery patient. General anesthesia is provided.
Your physician may suggest using a type of spinal instrumentation to hold your vertebrae together. Spinal instrumentation may depend of a variety of factors such as your age, the number of vertebrae involved and other health factors.
To be successful, spinal fusion surgery requires the stimulation of new bone growth between the fused vertebrae. There are several choices available to the patient: the pelvis (autograft), bone chip donation (allograft) or a manufactured bone substitute made from genetically engineered proteins. These bone substitutes could be from your body or that of a bone ban. As the new bones grow, the vertebrae will be joined, reducing movement and pain.
After surgery, expect to stay in the hospital for several days. You will experience a considerable amount of pain and discomfort, but can be managed with oral and intravenous medications. Once you’re released, your body will need several weeks, maybe even months, to heal depending on the condition of your body, your age and the physical demands of your everyday life. Because spinal fusion is similar to a broken bone healing, most doctors would suggest that it will take about six weeks for recovery. Rehabilitation will be needed and may begin as early as four weeks after the procedure.
The Risks of Spinal Fusion
While the spine surgery has been very successful for thousands of patients throughout the years, especially those with scoliosis, it does have a few limitations.
- The vertebrae do not fuse with new bone growth
- Nerve injury
- Blood loss
- “Adjacent level” degeneration – arthritic changes could occur above and below the fused disc
- Limited mobility
- Damage to the spinal cord or the nerves
It is important to note that if you are a smoker in need of spinal surgery, quit immediately. The risk of bone growth failure goes up 500%.
Total Disc Replacement
The other option is total disc replacement. While it is still in its infancy in the U.S., successful replacement surgery has been performed internationally for those who want to preserve spine mobility and reduce joint stress in the adjacent vertebrae. Medical tourism companies have many surgeons in their network who have years of experience with this type of surgery, making it possible for patients to move again without pain and discomfort.
One advantage to total disc replacement is that the neighboring discs above or below do not wear out as quickly as they would with a spinal fusion procedure. Studies show that the artificial disc replacement surgery success rates are significantly higher than that of fusion.
If your physician gives you a choice—making you a part of the small percentage of candidates that could undergo total disc replacement—consider a 2011 study which was published in The British Medical Journal. One hundred and seventy-three spine surgery patients were evaluated—those with spinal fusion and disc replacement compared to those with disc replacement surgery. It was determined that the total disc replacement patients were less likely to return to surgery.
Once general anesthesia is administered, the surgeon removes a diseased or damaged disc and permanently replaces it with a man-made device—made of plastic or metal—allowing the patient full mobility. Total disc replacement is a complicated surgery, and 90% of all disc replacement surgeries are performed on the lumbar spine.
As with any surgery, there are a number of complications that may occur.
- Anesthesia complications
- Blood clots
- Allergic reactions to the implant material
- Implants imperfections
- Neck and/or arm pain
- Tissue swelling
- Issues with pregnancy (miscarriage and birth defect)
- Impaired sexual activity
- Difficulty swallowing
- Impairment or a change in speech
- Injury to the nerve or spinal cord injury
- Numbness or tingling in arms and legs
- Tear in the protective membrane covering the spinal cord
- Loss of motion
- Blood clots and blood flow restrictions