Artificial Disc Replacement vs. Lumbar Spinal Fusion for Your Low Back Pain: You Decide
- Lower back pain affects more than 26 million Americans ages 20-64.
- While spinal fusion has been the gold standard for spine surgery for decades, lumbar artificial disc replacement allows patients to maintain normal range of motion and requires a shorter recovery time.
- There are two FDA-approved lumbar artificial available in the U.S.
- The FDA only allows single-level surgeries at the present time.
Lower back pain is the most common form of frequent or chronic pain, affecting more than 26 million Americans between the ages of 20-64, according to the American Academy of Pain Medicine. The National Fibromyalgia & Chronic Pain Association says nearly all people with chronic pain seek alternative treatments such as Artificial Disc Replacement (ADR), also known as Total Disc Replacement (TDR) regardless of the prescription or over-the-counter drugs they are taking or the nature of their pain.
When conventional therapies fail to help the patient's chronic back pain, a surgical treatment may be a viable option — either artificial disc replacement (ADR), also known as total disc replacement (TDR) surgery or a spinal fusion.
"Fusion changes the biomechanics above and below that level of the spine, sometimes resulting in adjacent segment disease."
A spine fusion and disc replacement surgery involve comparable steps, initially. For both operations, the surgeon makes a small incision on the patient's stomach, normally directly below the belly button. Then, the surgeon shifts the intestinal organs gently to the side. This is done so the surgeon can firmly see the spine to protect the anatomic structures inside the patient's stomach. At this point, the spinal surgeon is ready to remove the patient's damaged, degenerated disc and perform either ADR or a fusion.
The main difference ADR has over a spinal fusion is that after the chronic back pain patient's surgeon removes the disc, a fusion is not performed.
Instead, an artificial disc is inserted into the patient's spine, replacing the damaged disc with an artificial one.
Chronic back pain patient Tom Atkinson, and attorney at law has handled workers compensation disability matters for over 20 years in Minnesota and has met some interesting doctors and patients alike with crazy complications along the way. The back pain patient and attorney also learned a lot, too. "I recently attended a seminar involving ADR in which the surgical technique was demonstrated by a surgeon," Atkinson shares. "It was clear that the ADR (artificial disc replacement) had certain advantages over microdiscectomy and fusions."
What are the Advantages and Disadvantages?
The primary advantage ADR has compared to spinal fusion surgery is motion preservation, as seen in the picture below. Motion preservation should diminish the back pain patient's long-term degeneration of adjacent discs unlike in spinal fusion surgery where the patient is at an increased risk for this degeneration.
Caption: Photo of discs treated with ADR (right) as compared to a lumbar fusion (left) in a follow-up X-ray of a degenerative disc disease patient.
Atkinson, who has undergone both cervical and lumbar surgeries, reports, "Other advantages include shorter recovery time, fewer complications, faster return to work, and less wear and tear on adjacent discs."
Artificial disc replacement (ADR) surgery grants a reversible, effective, and a predominantly safer option to a fusion for the chronic back pain patient. By implanting an artificial disc rather than undergoing spinal fusion surgery, the possibility of lessening damage to any nearby discs and joints proves artificial disc replacement (ADR) surgery wins this one. An artificial disc replacement provides relief for motion preservation without further damaging the spine.
The FDA is required to conduct long-term testing and outcomes. Artificial disc replacement (ADR) surgery technology has only been around for a comparatively short amount of time. Therefore, the FDA doesn't have adequate data on the long-term outcomes.
That said, artificial disc replacement (ADR) surgery may need more time to fully win them over, but there's hope. In addition, there may be certain restrictions that actually limit the use of an artificial disc in artificial disc replacement (ADR) surgery for back pain patients who need medical treatment on multiple degenerated discs.
Multi-level ADR requires a higher level of knowledge as compared to a single-level surgery. Most likely, the FDA aspires that American and Canadian surgeons gain more experience before going to multi-level surgery.
Spinal fusion surgery actually has potential risks. Those dangers include loss of motion and flexibility, a permanent alteration of motion preservation —with the potential for an accelerated disc degeneration —above and below the fused discs. This may actually lead the patient to experience increased pain and perhaps a second (sometimes third) surgery, which adds another advantage to the artificial disc replacement (ADR) option.
On Atkinson's journey to fix his degenerative disc disease, he went to the Mayo Clinic's Rochester campus for further insight on which surgery to choose — spinal fusion or artificial disc replacement (ADR).
"I started researching," Atkinson says. "I saw four different neurosurgeons and each provided different options. One recommended taking out three discs and doing a fusion, and another said surgery wasn't an option at all."
Lower back pain affects more than 26 million Americans between the ages of 20-64
On campus, he met with neurologist Rodolfo Savica, M.D., Ph.D. and neurologic surgeon Mohamad Bydon, M.D. to discuss his surgical options. With Bydon's direction, Atkinson named artificial disc replacement (ADR) surgery as his preferred alternative to spinal fusion surgery partly because it promotes a natural neck movement while addressing his cervical stenosis.
"Fusion changes the biomechanics above and below that level of the spine, sometimes resulting in adjacent segment disease," Bydon remarks. "Using the artificial disc preserves the natural range of the spine and, according to early data, can reduce the risk of adjacent segment disease."
"I would say that I was a little nervous going into surgery, and everyone involved with my prep was totally amazing," Atkinson remembers.
Bydon completed the ADR surgery that replaced Atkinson's degenerated disc with an artificial healthy one. This minimally-invasive procedure requires only a small incision along the front of the neck that also reduces the risk of blood loss.
Plus, Atkinson was only in the hospital for a few days before returning home to rest and recover. He did need prescription painkillers after surgery; however, Bydon advised that he would have needed a larger dose and more pills if he had gone with spinal fusion surgery. On top of it all, he would have been in the hospital for an extended period of time as compared to two days for artificial disc replacement (ADR) surgery.
Three months post-op, Atkinson has decreased his need for pain medication and is hopeful to see even more improvement over the upcoming months. He's back at the office fighting for his clients as he continues to fight for his back pain recovery.