If you’re considering surgery for back pain or degenerative disc disease, likely you’ve heard of two key treatment options: artificial disc replacement and spinal fusion surgery. Which may lead you to ask: Which is better, disc replacement or spinal fusion?

In short, disc replacement offers some clear advantages over spinal fusion, but not everyone is a candidate for disc replacement. In some cases, spinal fusion surgery may still be your best option.

Disc replacement is surgery in which a damaged disc is removed and replaced with an artificial disc. Spinal fusion links, or fuses, vertebrae (small bones in the spine), so they heal into a single, solid bone. As with any surgery, the choice between disc replacement versus spine surgery should be made carefully and in consultation with an experienced surgeon.

In most cases, spine surgeons don’t typically recommend surgery unless conservative, nonsurgical measures such as rest, physical therapy and medications have failed to deliver relief.

Disc Replacement Surgery

In disc replacement surgery, a damaged disc is removed and replaced with an artificial disc. You may also see this procedure referred to as “artificial disc replacement surgery” (ADR surgery), “total disc arthroplasty,” or “total disc replacement” (TDR), or simply “disc replacement.” Disc replacement may be performed in the lumbar spine (lower back) or cervical spine (neck area).

“Disc replacement is typically a good option for patients diagnosed with herniated disc, spinal stenosis or another form of degenerative disc disease,” according to Scott Blumenthal, M.D., a spine surgeon on the medical staff of Texas Health Center for Diagnostics & Surgery and co-director of the hospital’s Center for Disc Replacement. “Some patients with leg or arm pain may also get good results with disc replacement.”

A key advantage of disc replacement surgery is that it is “motion preserving.” Because there’s no fusing of bones, the patient does not lose range of motion in the spine.

“With disc replacement, you have a far lower chance of needing more spine surgery in the future, compared to spinal fusion surgery,” said Dr. Blumenthal.

How Invasive Is Disc Replacement Surgery?

Cervical disc replacement is performed with a 1-2 inch incision in the front of the neck, while lumbar disc replacement is performed with a 3-4 inch incision in the abdomen. The procedure is performed under general anesthesia and usually takes one to two hours. Disc replacement surgery usually has a faster recovery period compared to fusion. Most patients are up and walking shortly after surgery and released from the hospital within one or two days. Studies suggest that patients return to work significantly faster than with fusion surgery.

How Long Can Disc Replacement Surgery Last?

“I get that question all the time, and the answer is, the disc lasts longer than the patient,” Dr. Blumenthal said. “In fact, the younger you are, the better disc replacement surgery is for you, because the chance of needing more surgery after a spinal fusion goes up as you get older. If you had a fusion at age 35, likely you’d need another spine surgery by age 60. Whereas that’s not the case with disc replacement.”

Dr. Blumenthal speaks from 22 years of experience - he was the first spine surgeons to perform a total disc replacement in the United States as part of an FDA trial.

Spine Fusion vs Disc Replacement

In simple terms, spinal fusion surgery links, or fuses, painful or unstable vertebrae (small bones in the spine), so they heal into a single, solid bone. Spinal fusion may be performed in any area of the spine; most commonly, it’s done in the cervical (neck) spine or lumbar (low back) area of the spine.

Surgeons typically recommend spinal fusion surgery when motion or instability is the source of pain. This pain may be due to degenerative disc disease, arthritis, trauma or a fracture, or conditions such as scoliosis or spondylolisthesis. By limiting the motion of painful vertebrae, fusion surgery can reduce or eliminate pain. That’s also a key disadvantage of spinal fusion: it limits range of motion, placing additional stress on adjacent vertebrae. This sometimes leads to a need for additional surgery in the future.

Keep in mind, while disc replacement offers some advantages over fusion, it’s not right for everybody. For example, disc replacement is not recommended for patients with conditions that cause spinal deformity, such as scoliosis. In addition, older patients who have overall degeneration affecting the entire spine may not be good candidates for disc replacement. The condition of your bones and the location of the diseased disc or injury will also determine whether disc replacement is right for you. A spine surgeon can help recommend the best surgical option for you.

Deciding Between Disc Replacement and Fusion

Both disc replacement surgery and spinal fusion are safe and effective procedures that provide relief to many patients. The best option for you will depend on your age, the cause and location of your neck or back pain, and the condition of your spine. A spine surgeon can help you weigh your options and make the best choice for you.

Contact the Center for Disc Replacement at Texas Health Center for Diagnostics & Surgery in Plano to find out if you could be a candidate for artificial disc replacement surgery.