Experts estimate that back problems affect 31 million Americans at any given time. Severe lumbar issues such as degenerative disc disease, disc hernias, and scoliosis are pervasive, and can limit our ability to perform even basic physical activities. If nonsurgical options have been exhausted and pain, spasms, or immobility persists for months, patients may consider surgery to restore a functional level of mobility, or reduce pain to a manageable degree.
In doing so, it is hoped that one may continue performing satisfactorily at work, home, and recreationally. Two common procedures for treating back problems are spinal fusion and artificial disk replacement. The offering of either option by the surgeon is complex and involves a very detailed analysis of many factors related to your general health, work, and recreational aspirations type and duration of symptoms and limitations and general home lifestyle.
Deciding which type of surgery is right for you involves understanding what each procedure entails, and why it is performed.
Our spines are a series of bony vertebrae, in between which sit small, rubbery discs of tough ligament; these act as stabilizers,shock absorbers and movement enhancers. Facet joints connect each set of adjacent vertebrae, boosting mobility and further stabilizing the spinal column. By replacing discs and/or facets with a bone graft held in place by metal rods, screws and plates, a spinal fusion attempts to solidify adjacent vertebrae into a single bone structure.
Fusions are the traditional remedy for back pain caused by disc degeneration, and can also be used to treat a variety of issues, including arthritis of the facet joints, painful spine instabilities (i.e. spondylolisthesis), and malformations such as scoliosis.
The common denominator of conditions benefiting from fusion is the presence of various degrees of painful instability. Fusion will restrict a patient’s mobility at the site of the affected vertebrae, but patients suffering from limited mobility and severe pain prior to surgery may find their range of motion the same or improved if pain is adequately reduced as a result of the procedure.
Tiger Woods is a prime example of the success that can follow this procedure. Just last year, he underwent his fourth back surgery to remove a degenerative disc. Following this procedure, Woods was sure he’d be unable to return to the game of golf. However, he quickly realized that most of the pain had subsided, and he was able to fully swing a club again. Not long after, he went on to tie for 2nd place at the Valspar Championship 2018 in Tampa Bay, FL; a remarkable achievement due to the successes of his surgery.
Artificial Disk Replacement (ADR)
ADR, also known as total disk replacement, involves removing a diseased or degenerating disc, and installing a synthetic replica made of metal and/or medical-grade polymers. Replacement discs are designed to mirror the function of their biological counterparts, and a successful ADR procedure will allow patients to maintain spinal function at the surgery site. Another benefit of ADR is that a replaced disc places less stress on surrounding vertebrae than spinal fusion; as such, ADR recipients may see a reduced likelihood of additional degeneration compared to those who undergo fusion.
Because ADR deals exclusively with disc-related issues, it is not recommended for patients with damaged or arthritic facet joints, as replacement may worsen any pain caused by poor joint function. In fact, many lumbar conditions treated by spinal fusion are a contraindication and render patients ineligible for ADR; for instance, patients with bone diseases such as osteoporosis, as well as spinal instabilities or abnormal curvatures of the spine are also not eligible. Implants may also wear out over time, and replacement discs have been reported to demonstrate material wear over time, roughly 10-20 years.
In general, if we are treating instability, we seek to stabilize with a fusion. In other conditions, we seek to preserve stability with disc replacement.
It’s essential that patients consider a second surgical opinion before committing to surgery. Doing so will allow surgeons to evaluate symptoms and diagnoses, and consider those and other relevant factors when offering ‘custom Tailored’ surgical option.The patient should seek to gain a deeper understanding of exactly what each procedure may require in terms of lifestyle changes, medications, therapy and more. In turn, patients should weigh their surgeon’s previous experience with spinal procedures before making a decision.
A patient of mine, Carl Miller, is a testament to these medical practices, stating:
- “9 years later I’m still at 90% mobility and only experience minimal pain and setbacks! … It took me eight years to come to a realization that back surgery was the only option left. I know how apprehension can cripple you with fear and also be your worst enemy in holding you back from living your life fully! So, when I finally researched all my surgical options, read the success and horror stories of patients, and separated fact from fiction, all my findings led me to Miracle Mile Medical Center.”