Concerns surrounding spinal fusion surgery – including cost, recovery time and risks like adjacent segment degeneration (early wear of surrounding spinal discs) – have led researchers and medical professionals to consider what other options they may have for people with spinal instability caused by worn discs. One potential alternative is total disc replacement surgery.
In this procedure, the damaged disc material is removed and an artificial disc is put in its place. The artificial disc fulfills the normal disc function of shock absorption, thereby reducing the risk of early degeneration of surrounding discs.
Until recently, no long-term research had been done on the efficacy of total disc replacement surgery. This made it difficult to form any conclusions concerning its superiority over fusion. Recently, a study that assessed patients 5-10 years post-operation has been published that may help begin that conversation, if not offer a solid conclusion in itself.
At an average of 7.4 years post-op, 181 recipients of total disc replacement surgery at either one or two spinal levels were assessed for satisfaction, complication and revision surgery rates. They yielded a satisfaction rate of 63.6%, a complication rate of 14.4% and revision surgery rate of 7.2%. It should be noted that complication rates for those with two-level disc replacement were more than twice as high as the rate for those who only had one disc replaced.
See more on this study at http://www.ncbi.nlm.nih.gov.
Putting this into perspective requires some numbers on spinal fusion surgery. Reported satisfaction rates vary from study to study, but are usually between the lower 50’s and lower 70’s percent-wise. One study, found at http://www.ncbi.nlm.nih.gov, determined a revision surgery rate of 11.8% among those who had fusions. Spine-Health.com reports that at least 20% of fusion procedures fail to relieve pain, and that bones fail to fuse in 5-10% of procedures.
It should be noted that one small study found that joints around the site of disc replacement were susceptible to degenerative changes shortly after surgery. In the study, found at www.ncbi.nlm.nih.gov, 34% of participants (20) showed signs of new or increased joint degeneration within two years of the disc replacement surgery.
All surgical procedures come with risks. But the modestly positive results of the long-term study into total disc replacement may encourage the medical system to offer insurance reimbursements for the procedure. With continued research and advances, disc replacement surgery may be a viable alternative to spinal fusion surgery for some.