Disc Fusion Vs Disc Replacement

[LM79]

Hey Guys.

I had my first back operation back in 2002. I had a herniated L4 S5 Disc and had a Discectomy.
Now 8 years later the pain is getting to much and I think I am up for a fusion. One problem this can give is more stress on the vertebrae above and lead to further problems down the track, and being I am not small 6'2" 220 Pound maybe that risk will be increased?
Another option is disc replacement surgery, this is a lot more invasive as they come in through the front just above the underpants line and move everything around to get to the spine, take out the damaged disc and replace it with a artificial one held in with steel components. This maintains mobility but I just wonder if it is as strong as the Fusion?
At the moment I have to see a chiropractor fortnightly to keep my spine straight as all the training can get me quite out of shape.
I'm 31 years old and would really like to get it sorted but am just worried to jump into another operation and being in a further mess in years to come.
I have seen the surgeon that done my first opp about a year ago and was told they would do an MRI with the intention of doing a fusion. I just felt he did not care about anything more than my sothern cross insurance membership.
I have a appointment with a different surgeon for a second opinion on the 3rd December so any advise would be appreciated.

[lovbyts]

I would opt for disk replacement. If it does not go well you can always fuse it later but if you fuse it first you cant replace the disk later.

[yannick35]

Try to look into prolotherapy also to make sure you dont have ligament laxity, subluxation are caused by this, chiros got me a lot worst then better, most of them are quacks. Prolo will get the ligaments and tendons stronge to support the spine.

[Sicko]

I would opt for disk replacement. If it does not go well you can always fuse it later but if you fuse it first you cant replace the disk later.

I second that,Fusion really limits your mobility,also from what I have read on it there can be real issues if scar tissue develops at fusion sight.causing additional mobility and new site pain issues..Im sure ther are a million pros and cons to both,but I personally would op for the disc replacement.Especially with technology advancements of today.It seems to me that fusion is yesteryear,soon to be extinct..
Just my .02

[terraj]

Disc Fusion fvked my Dad's back, they did five discs. If he was not so old he could have sued them...

[LM79]

Gee I have not heard of prolotherapy, mind you I am way down here in New Zealand maybe it has not yet got that far.
Yes I do agree that the Fusion is old tech and wonder what kind of opperation I would get if I were a big sports star?

Has anyone on here had a Disc Replacment? Would be good to know if I could get back to heavy training after rehab.

[feurion]

here i goggled 4 u chk it out

[LM79]

Thank you.
That was very informative. I will be able to understand the surgeon better now. Hopefully the disc replacememt they offer here in NZ is the same as what is in those clips. That one guy was back working in 3 weeks!

[feurion]

Thank you.
That was very informative. I will be able to understand the surgeon better now. Hopefully the disc replacememt they offer here in NZ is the same as what is in those clips. That one guy was back working in 3 weeks!

its ok man i am actually recovering from herniated disc l3,l4 . i m on conservative recovery its been 3 weeks i think jus lying down .its good improvement but pretty slow

[bass]

stay away from fusion!

[LM79]

Ok, so I had an appointment with a surgeon & had a MRI scan. I have an an appointment booked for the 25th of Jan and will be told what opperation he recommends for my condition. I pressed for some info on disc replacement and he said he did not think it would suit me? But would confirm after viewing the scan.

[MuscleScience]

Ok, so I had an appointment with a surgeon & had a MRI scan. I have an an appointment booked for the 25th of Jan and will be told what opperation he recommends for my condition. I pressed for some info on disc replacement and he said he did not think it would suit me? But would confirm after viewing the scan.

Make sure you make a very informed decision on having surgery. Patient success rates, which are different than clinical success rates are somewhere between 20-30% in the literature upon 2 year follow up. Typical clinical success rates are in the realm of 50% in that time frame. Clinical success is evaluated differently and is based on such aspects as radiographic findings as well as patient response. In other words if on xray the surgery looks good and there are no further complications other than pain its deemed a success in some studies.

Im not advocating that you do not have surgery, just be very informed.


http://www.ncbi.nlm.nih.gov/pubmed/20508954

Eur Spine J. 2010 Aug;19(8):1262-80. Epub 2010 May 28.
Total disc replacement surgery for symptomatic degenerative lumbar disc disease: a systematic review of the literature.

van den Eerenbeemt KD, Ostelo RW, van Royen BJ, Peul WC, van Tulder MW.

Department of Orthopaedics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
Abstract

The objective of this study is to evaluate the effectiveness and safety of total disc replacement surgery compared with spinal fusion in patients with symptomatic lumbar disc degeneration. Low back pain (LBP), a major health problem in Western countries, can be caused by a variety of pathologies, one of which is degenerative disc disease (DDD). When conservative treatment fails, surgery might be considered. For a long time, lumbar fusion has been the "gold standard" of surgical treatment for DDD. Total disc replacement (TDR) has increased in popularity as an alternative for lumbar fusion. A comprehensive systematic literature search was performed up to October 2008. Two reviewers independently checked all retrieved titles and abstracts, and relevant full text articles for inclusion. Two reviewers independently assessed the risk of bias of included studies and extracted relevant data and outcomes. Three randomized controlled trials and 16 prospective cohort studies were identified. In all three trials, the total disc replacement was compared with lumbar fusion techniques. The Charité trial (designed as a non-inferiority trail) was considered to have a low risk of bias for the 2-year follow up, but a high risk of bias for the 5-year follow up. The Charité artificial disc was non-inferior to the BAK Interbody Fusion System on a composite outcome of "clinical success" (57.1 vs. 46.5%, for the 2-year follow up; 57.8 vs. 51.2% for the 5-year follow up). There were no statistically significant differences in mean pain and physical function scores. The Prodisc artificial disc (also designed as a non-inferiority trail) was found to be statistically significant more effective when compared with the lumbar circumferential fusion on the composite outcome of "clinical success" (53.4 vs. 40.8%), but the risk of bias of this study was high. Moreover, there were no statistically significant differences in mean pain and physical function scores. The Flexicore trial, with a high risk of bias, found no clinical relevant differences on pain and physical function when compared with circumferential spinal fusion at 2-year follow up. Because these are preliminary results, in addition to the high risk of bias, no conclusions can be drawn based on this study. In general, these results suggest that no clinical relevant differences between the total disc replacement and fusion techniques. The overall success rates in both treatment groups were small. Complications related to the surgical approach ranged from 2.1 to 18.7%, prosthesis related complications from 2.0 to 39.3%, treatment related complications from 1.9 to 62.0% and general complications from 1.0 to 14.0%. Reoperation at the index level was reported in 1.0 to 28.6% of the patients. In the three trials published, overall complication rates ranged from 7.3 to 29.1% in the TDR group and from 6.3 to 50.2% in the fusion group. The overall reoperation rate at index-level ranged from 3.7 to 11.4% in the TDR group and from 5.4 to 26.1% in the fusion group. In conclusion, there is low quality evidence that the Charité is non-inferior to the BAK cage at the 2-year follow up on the primary outcome measures. For the 5-year follow up, the same conclusion is supported only by very low quality evidence. For the ProDisc, there is very low quality evidence for contradictory results on the primary outcome measures when compared with anterior lumbar circumferential fusion. High quality randomized controlled trials with relevant control group and long-term follow-up is needed to evaluate the effectiveness and safety of TDR.

[zebra]

In addition to what was published above, the ACOEM practice guidelines just published state,
"there is limited positive evidence for spinal fusion for chronic spondylolisthesis,
insufficient evidence to recommend it in chronic failed back syndrome (but may be worth considering if a patient is having the third lumbar discectomy on the same disc.)
Based on moderate evidence, fusion is not recommended for non-specific chronic low back pain.
Based on limited evidence, fusion is not recommended for chronic spinal stenosis unless concomitant instability or deformity has been proven.
There is also limited evidence against spinal fusion for patients with radiculopathy from disc herniation or for patients with chronic LBP after lumbar discectomy."
Keep in mind, the reason the doc may be pushing a fusion is that he knows how to do one. When you have a hammer, everything looks like a nail.

[LM79]

Thanks for the info, I was struggling to find anything on Disc replacement.
I got a copy of my MRI scan and can see the disc is buggered. All the other discs and vertebrae have clean lines and the discs appear white. The bad one is black /grey and have jagged lines and is pushing into the spinal cord. Can just see its a real mess and I am definitely not a Doctor.

[zebra]

Good luck, and keep us posted.

[feurion]

Thanks for the info, I was struggling to find anything on Disc replacement.
I got a copy of my MRI scan and can see the disc is buggered. All the other discs and vertebrae have clean lines and the discs appear white. The bad one is black /grey and have jagged lines and is pushing into the spinal cord. Can just see its a real mess and I am definitely not a Doctor.

ok i have the similar problem so my doctor decided to take rest i mean cmplete bed rest so after 3 weeks i fel pretty good i can still feel the pain a bit but its healing
i am goona do a mri again soon to chk it out so lets c ill post both my mri so u can have a look

[The Titan99]

I live in Thailand and had numbness and pain in my right arm which got progressively worse. Went to many different Doctors over the course of 10 months only to be blown off with pain killers and anti-inflammatory drugs. Finally went to the most expensive hospital in Bangkok (Bumrungrad) where I continued to get jerked off for 2 weeks by everyone but the janitor. Fusion was discussed there as well as cervical traction, physical therapy and a host of other things I couldn't do or couldn't afford. Finally I went to the Spinal Center at BNH Hospital with all my tests and records and saw a neurosurgeon named Dr. Wicharn. He told me I needed DISC REPLACEMENT surgery immediately. I told him about the recommendation for fusion and he said that is barbaric bullshit practiced by assholes that didn't know how to do their jobs. Seriously!! Long story short, 2 hour surgery, 2 days in the hospital, 2 weeks off, 2 weeks at 50% max and I'm back to lifting full on with NO residual effects, no numbness, no loss of mobility, no nothing!! At the follow-up visit all the guy could say was how lucky I was not to have got the fusion. This was 50 days ago....the disc replacement that is...

[optionsdude]

I had the medtronics prestige disc replacement in may this year and I was back to work full duty in October. My work is extremely physical. I had replacement at c5-6 level and fusion at c7-t1 level. I am doing great and did not lose much range of motion and the nerve pain is gone. I know this is different from lower back surgery but just wanted to give you another positive outcome of spinal surgery. I trained hard for the surgery and afterwards. I will say I had to take it easy on some exercises until recently. I could not strain to my max since it would cause spasms in my neck. Had to concentrate very hard on muscle isolation. You don't realize how much you get your neck and traps involved with almost every exercise. That part was tough but I managed to do it and I am still gaining strength and increasing amount of strain I can put on traps and neck.

[LM79]

I had the medtronics prestige disc replacement in may this year and I was back to work full duty in October. My work is extremely physical. I had replacement at c5-6 level and fusion at c7-t1 level. I am doing great and did not lose much range of motion and the nerve pain is gone. I know this is different from lower back surgery but just wanted to give you another positive outcome of spinal surgery. I trained hard for the surgery and afterwards. I will say I had to take it easy on some exercises until recently. I could not strain to my max since it would cause spasms in my neck. Had to concentrate very hard on muscle isolation. You don't realize how much you get your neck and traps involved with almost every exercise. That part was tough but I managed to do it and I am still gaining strength and increasing amount of strain I can put on traps and neck.

I'm glad to hear your opperation outcome was positive. I have an appointment on the 25th to review my MRI with the surgeon, I can not wait to see what his advice is.

[Darell55]

Hey Guys.

I had my first back operation back in 2002. I had a herniated L4 S5 Disc and had a Discectomy.
Now 8 years later the pain is getting to much and I think I am up for a fusion. One problem this can give is more stress on the vertebrae above and lead to further problems down the track, and being I am not small 6'2" 220 Pound maybe that risk will be increased?
Another option is disc replacement surgery, this is a lot more invasive as they come in through the front just above the underpants line and move everything around to get to the spine, take out the damaged disc and replace it with a artificial one held in with steel components. This maintains mobility but I just wonder if it is as strong as the Fusion?
At the moment I have to see a chiropractor fortnightly to keep my spine straight as all the training can get me quite out of shape.
I'm 31 years old and would really like to get it sorted but am just worried to jump into another operation and being in a further mess in years to come.
I have seen the surgeon that done my first opp about a year ago and was told they would do an MRI with the intention of doing a fusion. I just felt he did not care about anything more than my sothern cross insurance membership.
I have a appointment with a different surgeon for a second opinion on the 3rd December so any advise would be appreciated.

hi...
Yes with the height you have the risk is greater.
It is much better for you to consult the physician
I advice you to go for the disk replacement rather than disk fusion.
Baltimore fitness

[The Titan99]

Absolutely agree!!

[optionsdude]

LM79 Keep us posted on your back and I hope all goes well.

[lovbyts]

I live in Thailand and had numbness and pain in my right arm which got progressively worse. Went to many different Doctors over the course of 10 months only to be blown off with pain killers and anti-inflammatory drugs. Finally went to the most expensive hospital in Bangkok (Bumrungrad) where I continued to get jerked off for 2 weeks by everyone but the janitor. Fusion was discussed there as well as cervical traction, physical therapy and a host of other things I couldn't do or couldn't afford. Finally I went to the Spinal Center at BNH Hospital with all my tests and records and saw a neurosurgeon named Dr. Wicharn. He told me I needed DISC REPLACEMENT surgery immediately. I told him about the recommendation for fusion and he said that is barbaric bullshit practiced by assholes that didn't know how to do their jobs. Seriously!! Long story short, 2 hour surgery, 2 days in the hospital, 2 weeks off, 2 weeks at 50% max and I'm back to lifting full on with NO residual effects, no numbness, no loss of mobility, no nothing!! At the follow-up visit all the guy could say was how lucky I was not to have got the fusion. This was 50 days ago....the disc replacement that is...

GREAT information and good to hear. If you dont mind what did he charge you.

I agree, as long as you do your research on the doctors I would have no problem going there to have big ticket items done. My last back surgery November 2007 was paid for by insurance 100%. Ruptured L5, L3 and L4 was 2 years prior. I spent almost 1 month in Thailand with GF recuperating. I cant think of a better place to be.

[The Titan99]

The surgery cost 505,000 BHT which would be about 16,800 dollars including hospital and all. I had to pay quit a bit for all the tests leading up to it. Research would have saved me a ton of money.

[lovbyts]

Thanks for the information.
I am going to start doing more research on disk replacement here in the US since I have insurance and I'm sure it's not to far off. I'm getting tired of having cold feet, numb feet and hands most all the time and every time I start stretching or warming up my back hurts worse and my feet and hands go numb.

It also sucks having to roll out of bed and not being able to bend over to put your socks on for 15-20 minutes in the morning. I dont remember what it's like to wake up or go to bed without any pain.

[The Titan99]

Man, the sooner you take care of it the better. It's been 4 months now and I am 110% recuperated. It just so happens as of this moment I am training hard, heavy volume completely injury free for the first time since I can remember. It is a priceless luxury I wouldn't trade for anything. Get it done!!

[lovbyts]

Any information you can forward would be appreciated such as the procedure type, material used etc.