Historically, when we had problems with the spine that couldn’t be solved with physical therapy or pain management, we turned to fusion surgery. Fusion literally fuses together the very bones that allow us to bend and flex our bodies. As a result, fusion is the end of flexibility and range of motion. In my medical opinion, there are only a few, outlier reasons to continue our reliance on fusion surgery. But now, in my medical work with patients, we can restore lost motion by reversing fusions.
The bones in question – the vertebrae – allows the human body such a fantastic range of motion. Between the vertebrae are semi-flexible discs that cushions and limits movement so that we don’t damage the spinal cord and the dozens of tributaries that emanates from the spine and distributes nerves throughout the body. Each disc and vertebral pair represents a ‘level’ of potential movement. Each level is also wholly dependent on its neighbor for structural support as the pressure and weight are distributed throughout the chain of bones, ligaments, cartilage, and muscle. But like all moving parts, sometimes things break down.
The spine – cervical (neck), thoracic (upper back), lumbar (lower back) – is susceptible to many disorders and diseases. Discs may eventually herniate and lose their semi-flexible properties. An injury can cause discs to collapse completely. As we age, the network of channels (foramen) that facilitate nerve distribution from the spinal column may become obstructed or narrow. Cartilage may wear out, and joints become arthritic.
Fusion was developed nearly 100 years ago to help patients suffering from scoliosis (curvature of the spine). The procedure was reintroduced in the 1940s when it proved useful in solving other disorders of the spine like the ones I mentioned above. Ever since spinal fusion surgery has been the ‘go-to’ procedure to relieve common chronic disorders of the spine.
Fusion literally fuses two or more vertebral levels together as one. Major surgery is required to install a system of rods and plates that are screwed into the bones of the affected levels. Bone grafts are added to add strength to the fusion. The end result: the end of spinal flexibility.
But that’s not necessarily the end.
I am a spinal fusion patient. A disc in my neck (cervical) completely collapsed, and I had one level (two bones) fused to decompress the affected nerves. It worked, for a while. However, as engineers will tell you, any time you change a complex structure (like the spine), you must expect consequences.
When we fuse one level of the spine, we not only stop the flexibility of that level, we add new structural pressure on adjacent levels. Moreover, the levels above and below the fusion will move more than is usual, thus increasing wear and tear on discs, bones, and cartilage. That’s why one fusion often leads to additional ones. Some patients end up with two or three-level fusions; sometimes more.
However, we don’t have to feel boxed in by fusion.
Artificial disc replacement surgery does as the name suggests: we replace the herniated disc with an artificial one. No rods. No plates. No bone grafts. And the significant gain: we retain the natural flexibility of all levels of the spine. Sounds great, doesn’t it? Want even better news? It works.
Over the last 11 years, artificial disc replacement surgery has gained validation from dozens of clinical studies and thousands of performed surgeries. Also, the long-term clinical data has shown very impressive results.
On head-to-head comparisons between patients of artificial disc replacement and fusion surgery, there are at least equivalent results in immediate cessation of chronic pain from nerve decompression. However, artificial disc replacement produces statistically significant improvement in terms of long-term patient outcomes: fewer revision surgeries, more infrequent incidence of nerve recompression, shorter post-operative recovery. You can read a summary of a recent clinical study I led.
Which leads me back to the headline. An increasing number of former fusion patients are asking for (and receiving) restorative motion surgery. They are having their fusions removed and replaced with artificial discs. In some cases, like mine, we may avoid additional fusions by adding artificial discs to adjacent levels. In other cases, we will remove one or more previous fusions.
I have successfully performed several restorative motion surgeries – a combination of artificial disc replacements and fusion reversals. This is an off-label procedure: while not tacitly approved by the FDA, it is not prohibited. “Off-label” use opens a way for surgeons, such as myself, to customize treatment for unique patient situations. It is also entirely appropriate considering my background as a research clinician, board-certified neurosurgery specialist practicing medicine for 25 years, a professor at the University of California Los Angeles, and a member of the Cedars-Sinai Institute of Spinal Disorders.
With the help of my patients, my work is advancing a diagnostic process and procedure that is giving patients a new outlook on their spine health – one that includes the full natural range of motion. I have proven that we can retain movement with artificial disc replacement surgery. I am now declaring that we can restore motion by surgically reversing past fusions.
Motion is life!