Lower back pain is one of the most common problems affecting millions of people around the world. Lower back pain is most prevalent in age groups between 20-64 years. However, your spine doctor might suggest conventional treatment based on your condition. If the standard non-surgical treatment fails to relieve the patient’s chronic back pain, then surgical treatment might be a viable option. In most cases, spinal fusion surgery is suggested. However, until a few years back, artificial disc replacement (ADR), also known as total disc replacement (TDR), was preferred for back surgery. In this modern era, it is no longer practised, and fusion procedure took its place.
Early studies say that when disc replacement is practised to treat people with cervical problems, the outcomes are the same as doing fusion. However, the chance of additional surgery after fusion is high as compared to the disc replacement surgery of the olden days. That’s a significant discussion for disc replacement surgery and spinal fusion. But now, with advanced technology, spinal fusion is more beneficial.
Anatomy Of Spine & Origins Of Injuries
The spine is a combination of small bones piled up on top of one another called vertebrae. Lower back pain occurs in the lumbar region of the spine, as it has a natural c-shaped curve. A healthy spine stabilizes your balance, movement, & range of motion. Disc problems result due to ageing or injuries to your vertebrae, muscles, ligaments, nerve tissues, and intervertebral discs.
Lower back pain varies from person to person and may occur suddenly. The pain may be constant or can come at irregular intervals, and slowly increase in intensity. The common reason for lumbar pain include:
- Overuse of the vertebral column
- Disc tear or disc prolapse including other injuries
- Degeneration of discs
- Degenerative spondylolisthesis or other spondylolisthesis conditions
- Scoliosis and other deformities
- Spinal stenosis
- Vascular or arterial diseases
Lumbar Spinal Fusion
Spinal fusion is a surgical intervention that joins two or more vertebrae into a single structure. The surgery aims to prevent movement between them when motion is the cause of back pain. Once they are fused, they heal into a single bone. This helps to avoid the stretching of the nerves, ligaments, and other muscles that causes discomfort.
When it comes to spinal fusion techniques, a wide range of treatment options are available. Surgical procedures include fusion progressing from the front, back, or both or sideways. Fusion is supported by spinal instrumentation in the form of implants providing structural stability internally while the bone fuses.
Lumbar Artificial Disc Replacement(ADR)
ADR is another surgical option to treat painful lumbar discs using artificial discs. A lumbar artificial disk replacement is a type of back surgery that involves replacing the worn-out or damaged disks in the lower back of your spine with a prosthetic disc imitating the functions of the original disc.
Though lumbar TDR was popular once, now it has gone out of fashion. This is because lumbar disc replacement has gone into disrepute because of various complications reported during the procedure and also during revision. It has been only used in very uncommonly in select centres. In this procedure, patients are implanted with a Charite III artificial disc in the lower back. Nowadays, this treatment modality is not used frequently.
Lumbar Spinal Fusion vs. Lumbar Artificial Disc Replacement (ADR)
The main difference of ADR over a spinal fusion is that the spine surgeon removes the problematic disc, and a prosthetic disc is inserted in place. Whereas in the case of fusion, the two vertebrae of the patient are fused together. ADR is performed through open or less invasive surgery, and fusion procedures are Minimally Invasive Spine Surgeries(MISS) such as OLIF, XLIF, and PLIF.
OLIF (oblique lateral interbody fusion) is a minimally invasive spinal fusion surgery in which the spine surgeon reaches and repairs the damaged lumbar spine from the front and side of your body.
Extreme lateral interbody fusion (XLIF) is another minimally invasive spine procedure in which the surgeon accesses the space between spinal discs from sideways, rather than the front or backside of the body to treat spinal disorders that are not respondING to regular treatments.
Posterior lumbar interbody fusion (PLIF) is also a type of MIS fusion procedure that utilizes the back area for incision and approaches the lumbar spine bones to fuse together.
Which is Good, Artificial Disc Replacement, or Spinal Fusion?
Fusion surgery is still far better and the most prevalent surgery than ADR because many patients may not be ideal for a disc replacement. It can only treat limited patients with certain types of disc pathology.
The primary difference of Artificial Disc Replacement compared to spinal fusion surgery is the preservation of vertebral motion. But normal disc motion in flexion and expansion is considerably complicated. It may not replicate “natural” spinal motion.
There are many unanswered questions regarding disc replacement like – Can artificial disc replacement prevent or reduce disc degeneration? How long does the total disc replacement last? If disc replacement fails, weather patients, need another disc replacement or end up fusion after all? These are a few of many questions left unanswered associated with disc replacement versus spinal fusion.
An experienced spine surgeon can identify how each procedure changes spinal motion and movement patterns and measure final, long-term outcomes. He can suggest an ideal surgical option that suits you. Dr Surya Prakash, the best spine surgeon in Hyderabad, says, “Spinal fusion success rate varies around 60% to 95% depending on the type of fusion technique used and experience & skill of the surgeon.” He has more than two decades of experience and has performed thousands of spinal surgeries. If you or your family member are experiencing any kind of back problem, don’t hesitate to get a consultation.