Total Disc Replacement vs. Spinal Fusion: Which Is Right for You?

If you have a bulging or herniated disc that’s impinging on your spinal nerves, but conservative treatment modalities don’t help, surgery may be an option. But how do you know which procedure is for you? We have the answer for you here.

Your spine is an amazing structure, allowing you to stand up straight, flex, bend, twist, and support your body during movement. Unfortunately, like every other part of your body, it can sustain damage, causing pain and other uncomfortable symptoms.

At HAAS Spine & Orthopaedics, orthopedic surgeon Dr. Stepan Kasimian and our team treat all types of spinal problems from our offices in Glendale, Santa Ana, and Upland, California. For disc problems, we may perform one of two surgical procedures: a total disc replacement or spinal fusion. Which one is right for you? The doctor explains both procedures here.

Spinal structure

Your spine is a complex structure with 24 bony vertebrae in a column with facet joints connecting each pair. Intervertebral discs act as cushions between the joints. These discs, which have a hard outer shell and a gel-like interior, allow movement and absorb shock.

A hollow tube called the spinal canal runs down the center of the column and contains the spinal cord, related nerves, and nerve roots. If any structure near a nerve has an injury such as a herniated nucleus pulposus or excessive inflammation, pain occurs and may travel along the length of the nerve.

Ligaments, tendons, muscles, and connective tissue support the entire structure to ensure its safety.

What is degenerative disc disease (DDD)?

Degenerative disc disease isn’t a disease; it’s a set of age-related changes to the intervertebral discs that may produce no symptoms or cause shooting pain, tingling, weakness in a nerve, stiffness, and/or difficulty moving. Most cases come from a lifetime of activity; some come from dehydration of the disc material, which flattens the disc so it can’t absorb shocks as well.

About 90% of DDD problems happen in the lowest portions of your lumbar spine because of its ability to move — the rest form in the cervical (neck) spine, also due to movement.

Routine stress on your back can cause tiny tears in the outer disc wall, which contains nerves. Any tears near the nerves can trigger pain, and if the wall breaks down, the disk’s inner gel may push through so that it bulges or slips out of place, known as a slipped or herniated disc. An inflammatory response may affect nearby nerves and nerve roots.

Total disc replacement vs. spinal fusion

At HAAS Spine & Orthopaedics, we reserve surgery as a treatment of last resort. We start conservatively, using nonsurgical modalities like medication, physical therapy, and epidural steroid injections to reduce the symptoms in patients who have them.

However, if your pain is not getting better and the pain is affecting your quality of life after months of reasonable conservative care, we might broach the subject of a surgical procedure. Which procedure we choose depends on your individual needs.

Total disc replacement

In a total disc replacement, we replace the damaged disc with an artificial disc with similar qualities as a naturally occurring one so the post-surgery function closely matches your spine’s natural movement.

Recovery from total disc replacement involves specialized physical therapy and takes around 6-12 weeks to gain full function. Most people can return to light work and driving within a week of the procedure.

However, returning to heavier lifting and more vigorous activities needs about 2-3 months of therapy and recuperation. If you had severe nerve irritation before surgery, the nerve may continue to heal for 1-2 years afterward. Unfortunately, occasionally the nerve remains symptomatic because of nerve damage.

Spinal fusion

Spinal fusion involves removing the damaged disc and fusing the affected vertebrae with a graft that facilitates bone growth between the two vertebrae. This procedure provides excellent stability but effectively prohibits movement at that level.

Most people spend 2-4 days in the hospital after lumbar spinal fusion surgery. You can start driving after a couple of weeks, but only if you’re off of all opioid medications. For most patients, it takes about 4-6 weeks to return to an office or sedentary job, but you can expect 3-6 months to return to more physically demanding activities.

Want to learn more about disc replacement and fusion? Contact HAAS Spine & Orthopaedics by phone or online today.