Spinal surgery is a class of surgical procedures that are used to treat patients with spine conditions such as degenerative disc disease, isthmic spondylolisthesis, degenerative spondylolisthesis, and other disorders of the spine.
There are four principle types of spinal surgery: laminectomy, discectomy, spinal fusion, and artificial disc replacement. The specific procedure that a physician will prescribe depends on the diagnosis. When degenerative disc disease is diagnosed, the physician will look for patient discomfort in the form of pain at or near the location where a spinal disc has herniated or ruptured. The patient may also complain about pain and numbness in the extremities; e.g., arms and fingers if the rupture is in the cervical (neck) region of the spine; legs and feet if the trouble is in the lumbar (lower back) region.
For patients that I meet at my practice in Beverly Hills, CA and at Cedar-Sinai Medical Center in Los Angeles, I will often start with conservative non-surgical treatments such as physical therapy combined with pain management. I may also recommend a wellness regimen that adds fitness, nutrition, disease screening, and adjustments to body chemistry. I will recommend surgery if the patient cannot find relief or if the pain increases after 6 to 12 months of non-surgical treatment. For less advanced cases, minimally invasive procedures such as micro-laminectomy or microdiscectomy will likely be proscribed. For more advanced cases, the choice is usually between spinal fusion and artificial disc replacement.
What is an Artificial Disc?
Artificial disc replacement (total disc replacement) is a surgical procedure that uses a man-made disc to replace a natural spinal disc that has degenerated or is damaged in some way.
There are many different models and variations of the artificial disc, but all are precision surgical prostheses made from high-quality materials such as metal, for the structure, and softer, more pliable materials such as plastic-like biopolymers that mimic the function of a natural, healthy spinal disc.
The concept of using an artificial disc to replace damaged natural discs originated in Europe in the mid-1980s. The procedure and manufacture of artificial discs were introduced into the United States in 2000. Currently, the FDA (U.S. Food and Drug Administration) has approved several manufactures and models of artificial discs. The procedure itself has undergone extensive clinical trials. The most recent of these have shown that artificial disc replacement provides better long-term patient outcomes than the alternative, spinal fusion.
Artificial disc replacement surgery has undergone intense study in numerous clinical trials. The procedure is ideal for the lower back (lumbar spine) and neck (cervical spine). The goal of the procedure is to solve the cause of pain, but also to preserve full natural range of motion. Clinical studies have also shown that artificial disc replacement surgery does not add structural stress on other parts of the spine, thus reducing the need for resurgery.
What is spinal fusion surgery?
The main purpose of spinal fusion surgery is to prevent motion where a spinal disc has degenerated or ruptured. The surgery results in at least two vertebral segments permanently joined together with a highly-developed system of steel screws, rods, plates, and a bone graft which permanently stabilizes the two vertebrae.
Bone graft material is added around the two segments. The graft may come from the patient’s hip or a bone donor. Some surgeons may use synthetic bone graft material. If all goes well, the graft will grow into the two vertebral segments and create the “fusion.” Once the patient is fully recovered, back and neck pain is gone thanks mainly to the fact that the vertebrae in the treatment area have been immobilized.
Spinal fusion has been in use for nearly 100 years. Back in those times, fusion was used to limit spinal deformity caused by tuberculosis infections. Much later, surgeons found that they could use the procedure to solve persistent back and neck pain. While the method has been nearly uniformly applied for degenerative disc disease for generations, it comes at a very steep price for the patient.
Since the goal is to prevent motion of vertebrae, the result is permanent limitation in the natural range of motion. This procedure may also trigger successive fusion surgeries due to the stresses that are added to other levels.