Spinal fusion and disc replacement are two surgical methods used to treat certain types of spine issues, especiallydegenerative disc disease (DDD). Each type of surgery has its risks and benefits and involves recovery time and rehabilitation.
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About Degenerative Disc Disease
People can have disc degeneration that doesn’t cause any problems, but sometimes, it can lead to pain.
How Is Degenerative Disc Disease Treated?
Disc Replacement vs. Spinal Fusion
Though the two surgeries have similar aims, there are important differences between them. In short, disc replacement is a newer, less-proven approach, but it may have advantages compared to spinal fusion.
Goals of Each Surgery
Before considering surgery, treatment for DDD should focus on non-invasive or minimally invasive options. Surgery for DDD is controversial and it is considered a last ditch effort to treat low back pain when an exhaustive course of conservative methods likephysical therapyandanti-inflammatory medicationdon’t provide relief
In a spinal fusion procedure, a damaged disc can be removed and replaced with a bone graft to stimulate bone growth. Over time, the space of the absent disc gradually fills with bone, fusing the vertebrae.
On the other hand, lumbar disc replacement is similar to other types of joint replacement, such as those involving the knee or hip. The difference here is that while the cause of hip and knee pain in arthritic joints is well known, the cause of low back pain is not well understood. The surgery involves removing a damaged disc and replacing it with an artificial disc that mimics a healthy one, which can preserve the spine’s mobility.
Pros and Cons
However, because adjacent bones are joined together in a spinal fusion—eliminating all movement in that level of your spine—the way your spine moves after the operation may be altered, with extra pressure being placed on the adjacent joints.
Problems with spinal fusion surgery can also include:
Degeneration in spinal joints above and below the site of a spinal fusion is commonly known as adjacent segment degeneration (ASD).
Total disc replacement surgery is intended to preserve your spine’s mobility and help reduce post-surgical degenerative changes in the neighboring spinal joints.
However, this does not suggest that lumbar disc replacement surgery is not without its own limitations.
These include:
What the Research Says
When comparing the two procedures, some research shows that there is not much of a difference when it comes to success rates, which is why surgery is typically not recommended to treat low back pain.
However, emerging research suggests that disc replacement surgery may be a potentially more beneficial procedure than spinal fusion surgery.
A 2017 study published in theGlobal Spine Journalcompared outcomes between lower back total disc replacement and lower back fusion surgery. The researchers found that disc replacement patients showed more improvements in pain relief and disability than spinal fusion patients at every post-surgery time period studied (six weeks, three months, six months, and one year).
In addition, two 2020 systematic reviews, one published in the journalTurkish Neurosurgeryand the other in the journalMedicine, found that disc replacement surgery yielded better results in factors like pain and range of motion when compared to spinal fusion.
With that being said, the potential benefits of a disc replacement surgery compared to spinal fusion can sometimes make disc replacement the preferred treatment option. However, treatment decisions should be made in consultation with a healthcare provider or surgeon.
Surgery Eligibility
Not everybody is eligible for disc replacement or spinal fusion surgery.
Your doctor may recommend disc replacement surgery if:
Your doctor may not recommend total disc replacement surgery if you have conditions like:
Additionally, a total disc replacement surgery may not be recommended if you have a history of adverse or allergic reactions to implant material.
Similar to total disc replacement surgery, your doctor may recommend spinal fusion if you’ve had no prior joint or spinal conditions and haven’t had spinal surgery before. Your doctor may not recommend spinal fusion if you have conditions like severe adjacent segment disease or non-symptomatic spondylolysis.
Financial Considerations
The cost of disc replacement surgery can range anywhere from $30,000 to $45,000 or more depending on location and if more than one spinal disc needs to be replaced.
Similarly, the cost of spinal fusion can range from $73,000 to $82,000 or more, but costs can vary due to location and the nature of the procedure—for example, if multiple vertebrae need to be fused.
Summary
Spinal fusion and disc replacement surgery are two surgical methods utilized for spine disease, especially DDD. Although some studies show that the success rates of both surgical procedures are about equal, emerging research shows that there may be some potential benefits with total disc replacement surgery, such as preserved mobility and decreased pain.
However, it’s important to talk with your doctor to see which procedure would be best for your condition and lifestyle.
A Word from Verywell
Be sure to talk thoroughly with your doctor about the risks and benefits of a spinal fusion or disc replacement surgery if you’re considering surgery.
Frequently Asked QuestionsThe effectiveness of disc replacement or spinal fusion surgery can depend on different factors. However, current research suggests that total disc replacement surgery may have more potential benefits, like preserved mobility and decreased postoperative pain compared to spinal fusion.However, not everyone with spinal issues is a candidate for either procedure, and more research is needed to conclude if total disc replacement surgery is more effective.Sometimes, yes. A surgeon may consider disc replacement surgery if a previous spinal fusion surgery failed and you’re a good candidate for a disc replacement.Learn MoreReasons for Revision Spine SurgeryThere are 23 discs in your spine.For either surgery, you’ll probably need to stay in the hospital for a few days after the procedure. Your doctor will give you pain medication as needed. You may also be encouraged to stand, walk, and perform specific rehabilitation exercises soon after either procedure.Your healthcare provider will advise you on other specifics, such as a plan for your diet and gradual return to activities.
Frequently Asked Questions
The effectiveness of disc replacement or spinal fusion surgery can depend on different factors. However, current research suggests that total disc replacement surgery may have more potential benefits, like preserved mobility and decreased postoperative pain compared to spinal fusion.However, not everyone with spinal issues is a candidate for either procedure, and more research is needed to conclude if total disc replacement surgery is more effective.
The effectiveness of disc replacement or spinal fusion surgery can depend on different factors. However, current research suggests that total disc replacement surgery may have more potential benefits, like preserved mobility and decreased postoperative pain compared to spinal fusion.
However, not everyone with spinal issues is a candidate for either procedure, and more research is needed to conclude if total disc replacement surgery is more effective.
Sometimes, yes. A surgeon may consider disc replacement surgery if a previous spinal fusion surgery failed and you’re a good candidate for a disc replacement.Learn MoreReasons for Revision Spine Surgery
Sometimes, yes. A surgeon may consider disc replacement surgery if a previous spinal fusion surgery failed and you’re a good candidate for a disc replacement.
Learn MoreReasons for Revision Spine Surgery
There are 23 discs in your spine.
For either surgery, you’ll probably need to stay in the hospital for a few days after the procedure. Your doctor will give you pain medication as needed. You may also be encouraged to stand, walk, and perform specific rehabilitation exercises soon after either procedure.Your healthcare provider will advise you on other specifics, such as a plan for your diet and gradual return to activities.
For either surgery, you’ll probably need to stay in the hospital for a few days after the procedure. Your doctor will give you pain medication as needed. You may also be encouraged to stand, walk, and perform specific rehabilitation exercises soon after either procedure.
Your healthcare provider will advise you on other specifics, such as a plan for your diet and gradual return to activities.
15 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cedars Sinai.Degenerative disc disease.American Academy of Orthopaedic Surgeons.Spinal fusion.John Hopkins Medicine.Minimally invasive spinal fusion.Health Quality Ontario.Cervical artificial disc replacement versus fusion for cervical degenerative disc disease: A health technology assessment.Ont Health Technol Assess Ser. 2019;19(3):1-223.Virk S, Qureshi S, Sandhu H.History of spinal fusion: Where we came from and where we are going.HSS J. 2020;16(2):137-142. doi:10.1007/s11420-020-09747-7Cleveland Clinic.Is spinal fusion right for you?Texas Back Institute.History of Texas Back Institute.Mattei TA, Beer J, Teles AR, Rehman AA, Aldag J, Dinh D.Clinical outcomes of total disc replacement versus anterior lumbar interbody fusion for surgical treatment of lumbar degenerative disc disease.Global Spine J. 2017;7(5):452-459. doi:10.1177/2192568217712714Li YZ, Sun P, Chen D, Tang L, Chen CH, Wu AM.Artificial total disc replacement versus fusion for lumbar degenerative disc disease: An update systematic review and meta-analysis.Turk Neurosurg. 2020;30(1):1-10. doi:10.5137/1019-5149.JTN.24799-18.2Zhai S, Li A, Li X, Wu X.Total disc replacement compared with fusion for cervical degenerative disc disease: A systematic review of overlapping meta-analyses.Medicine (Baltimore). 2020;99(19):e20143. doi:10.1097/MD.0000000000020143John Hopkins Medicine.Lumbar disk replacement.Büttner-Janz K, Guyer RD, Ohnmeiss DD.Indications for lumbar total disc replacement: Selecting the right patient with the right indication for the right total disc.Int J Spine Surg.2014;8:12. doi:10.14444/1012.Omidi-Kashani F, Hasankhani EG, Ashjazadeh A.Lumbar spinal stenosis: who should be fused? An updated review.Asian Spine J. 2014;8(4):521-530. doi:10.4184/asj.2014.8.4.521Motion Spine Institute.The human spine.John Hopkins Medicine.The road to recovery.
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Cedars Sinai.Degenerative disc disease.American Academy of Orthopaedic Surgeons.Spinal fusion.John Hopkins Medicine.Minimally invasive spinal fusion.Health Quality Ontario.Cervical artificial disc replacement versus fusion for cervical degenerative disc disease: A health technology assessment.Ont Health Technol Assess Ser. 2019;19(3):1-223.Virk S, Qureshi S, Sandhu H.History of spinal fusion: Where we came from and where we are going.HSS J. 2020;16(2):137-142. doi:10.1007/s11420-020-09747-7Cleveland Clinic.Is spinal fusion right for you?Texas Back Institute.History of Texas Back Institute.Mattei TA, Beer J, Teles AR, Rehman AA, Aldag J, Dinh D.Clinical outcomes of total disc replacement versus anterior lumbar interbody fusion for surgical treatment of lumbar degenerative disc disease.Global Spine J. 2017;7(5):452-459. doi:10.1177/2192568217712714Li YZ, Sun P, Chen D, Tang L, Chen CH, Wu AM.Artificial total disc replacement versus fusion for lumbar degenerative disc disease: An update systematic review and meta-analysis.Turk Neurosurg. 2020;30(1):1-10. doi:10.5137/1019-5149.JTN.24799-18.2Zhai S, Li A, Li X, Wu X.Total disc replacement compared with fusion for cervical degenerative disc disease: A systematic review of overlapping meta-analyses.Medicine (Baltimore). 2020;99(19):e20143. doi:10.1097/MD.0000000000020143John Hopkins Medicine.Lumbar disk replacement.Büttner-Janz K, Guyer RD, Ohnmeiss DD.Indications for lumbar total disc replacement: Selecting the right patient with the right indication for the right total disc.Int J Spine Surg.2014;8:12. doi:10.14444/1012.Omidi-Kashani F, Hasankhani EG, Ashjazadeh A.Lumbar spinal stenosis: who should be fused? An updated review.Asian Spine J. 2014;8(4):521-530. doi:10.4184/asj.2014.8.4.521Motion Spine Institute.The human spine.John Hopkins Medicine.The road to recovery.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Cedars Sinai.Degenerative disc disease.American Academy of Orthopaedic Surgeons.Spinal fusion.John Hopkins Medicine.Minimally invasive spinal fusion.Health Quality Ontario.Cervical artificial disc replacement versus fusion for cervical degenerative disc disease: A health technology assessment.Ont Health Technol Assess Ser. 2019;19(3):1-223.Virk S, Qureshi S, Sandhu H.History of spinal fusion: Where we came from and where we are going.HSS J. 2020;16(2):137-142. doi:10.1007/s11420-020-09747-7Cleveland Clinic.Is spinal fusion right for you?Texas Back Institute.History of Texas Back Institute.Mattei TA, Beer J, Teles AR, Rehman AA, Aldag J, Dinh D.Clinical outcomes of total disc replacement versus anterior lumbar interbody fusion for surgical treatment of lumbar degenerative disc disease.Global Spine J. 2017;7(5):452-459. doi:10.1177/2192568217712714Li YZ, Sun P, Chen D, Tang L, Chen CH, Wu AM.Artificial total disc replacement versus fusion for lumbar degenerative disc disease: An update systematic review and meta-analysis.Turk Neurosurg. 2020;30(1):1-10. doi:10.5137/1019-5149.JTN.24799-18.2Zhai S, Li A, Li X, Wu X.Total disc replacement compared with fusion for cervical degenerative disc disease: A systematic review of overlapping meta-analyses.Medicine (Baltimore). 2020;99(19):e20143. doi:10.1097/MD.0000000000020143John Hopkins Medicine.Lumbar disk replacement.Büttner-Janz K, Guyer RD, Ohnmeiss DD.Indications for lumbar total disc replacement: Selecting the right patient with the right indication for the right total disc.Int J Spine Surg.2014;8:12. doi:10.14444/1012.Omidi-Kashani F, Hasankhani EG, Ashjazadeh A.Lumbar spinal stenosis: who should be fused? An updated review.Asian Spine J. 2014;8(4):521-530. doi:10.4184/asj.2014.8.4.521Motion Spine Institute.The human spine.John Hopkins Medicine.The road to recovery.
Cedars Sinai.Degenerative disc disease.
American Academy of Orthopaedic Surgeons.Spinal fusion.
John Hopkins Medicine.Minimally invasive spinal fusion.
Health Quality Ontario.Cervical artificial disc replacement versus fusion for cervical degenerative disc disease: A health technology assessment.Ont Health Technol Assess Ser. 2019;19(3):1-223.
Virk S, Qureshi S, Sandhu H.History of spinal fusion: Where we came from and where we are going.HSS J. 2020;16(2):137-142. doi:10.1007/s11420-020-09747-7
Cleveland Clinic.Is spinal fusion right for you?
Texas Back Institute.History of Texas Back Institute.
Mattei TA, Beer J, Teles AR, Rehman AA, Aldag J, Dinh D.Clinical outcomes of total disc replacement versus anterior lumbar interbody fusion for surgical treatment of lumbar degenerative disc disease.Global Spine J. 2017;7(5):452-459. doi:10.1177/2192568217712714
Li YZ, Sun P, Chen D, Tang L, Chen CH, Wu AM.Artificial total disc replacement versus fusion for lumbar degenerative disc disease: An update systematic review and meta-analysis.Turk Neurosurg. 2020;30(1):1-10. doi:10.5137/1019-5149.JTN.24799-18.2
Zhai S, Li A, Li X, Wu X.Total disc replacement compared with fusion for cervical degenerative disc disease: A systematic review of overlapping meta-analyses.Medicine (Baltimore). 2020;99(19):e20143. doi:10.1097/MD.0000000000020143
John Hopkins Medicine.Lumbar disk replacement.
Büttner-Janz K, Guyer RD, Ohnmeiss DD.Indications for lumbar total disc replacement: Selecting the right patient with the right indication for the right total disc.Int J Spine Surg.2014;8:12. doi:10.14444/1012.
Omidi-Kashani F, Hasankhani EG, Ashjazadeh A.Lumbar spinal stenosis: who should be fused? An updated review.Asian Spine J. 2014;8(4):521-530. doi:10.4184/asj.2014.8.4.521
Motion Spine Institute.The human spine.
John Hopkins Medicine.The road to recovery.
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