James Hawkins, MD, is a spinal surgery specialist on staff at Banner Estrella Medical Center.
Question: I have had back problems for years and have tried physical therapy, chiropractic, and medicines without significant relief. I have been told by a spine surgeon that I need to have a spinal fusion. I am still only in my 40s and am concerned about the long-term effects of having a spinal fusion. Are there any alternatives to this procedure?
Answer: Spinal fusions are typically performed for fractures, mechanical instability, arthritic changes and/or significant degenerative disc disease of the spine. The treatment for these conditions is typically physical therapy, medical management, occasional injections, and passage of time.
If these fail to provide relief, then there are indications for a spinal fusion. The fusion means stopping the irregular and/or painful movement between two vertebral bodies in your spine to decrease pain and improve function.
As with any surgery there can be potentially long-term negative effects such as adjacent segment breakdown. Fusing or stopping the motion at one segment in the spine may increase the stresses or movements of the sections above or below the fused area during normal activities and therefore cause earlier breakdown or degeneration. In order to help avoid this potential problem, there have been recently developed total disc replacements for the spine.
The total disc replacement is indicated for cases of isolated degenerative disc disease. These devices have been used in Europe for several years, but have recently gained approval here in the United States.
Because of the recent release through Food and Drug Administration, disc replacements have been tested against a typical gold standard of lumbar fusion and evaluated with outcomes such as the patient’s pain, function, complication rates, and overall satisfaction with their outcome. In general, the total disc replacements for the cervical and lumbar spine have shown equivalent, if not slightly superior results to lumbar fusion.
The long-term benefits of a disc replacement will really be seen as the years progress with the implant in position. The idea being to not only improve the patient’s pain and function at the time of the index procedure, but also help prevent the long-term potential complications of earlier degenerative changes at the levels above and below the implant.
In summary, these total disc replacements offer an effective and exciting solution to pain in the spine related to degenerative disc disease. To go over all of the indications and contraindications of the device, one would need to speak with their spinal surgeon.