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ASK THE DOCTOR: Motion preservation in spine surgery

ASK THE DOCTOR: Motion preservation in spine surgery

One of the main procedures in spine surgery is called a lumbar fusion. This procedure is done to relieve pain from a damaged disc and is accomplished by removing the disc and connecting the two adjacent vertebral bodies.

Fusion operations are very effective in relieving back and neck pain. However, since fusion remove the movement from the fused vertebras there has been the desire to have a more natural like procedure to solve this problem.

In other parts of the body such as the knee and hip, the damaged joint is removed and replaced with an artificial joint which relieves the patient’s pain while allowing movement. This type of surgery has been very successful since it allows for the patient’s damaged joint to function almost naturally. This goal of relieving pain while allowing motion is now making its way into spine surgery.

There are now disc replacement devices to treat a damaged disc in both neck and the lower back.

Unlike a fusion, with a disc replacement the damaged disc is removed and replaced with a device that supports the adjacent vertebral bodies while allowing the spine to maintain movement. This is obviously a more natural solution than a fusion.

That said, not every patient with a damaged or arthritic neck or lower back level is a candidate for a disc replacement. In those patients the arthritis is too advance to preserve the motion in that level and the patient is better served by a fusion.

The decision on which damaged disc to fused and which to replace is based on a number of factors such as the patient’s age, how many damaged disc there are and most importantly how badly damaged the disc is.

If the disc is severely damaged to the point that there are additional arthritic changes to the joints adjacent to the disc then a disc replacement while preserving motion will only lead to continued pain ion those joints. In these cases a fusion is the better option.

An important benefit of disc replacement is that by preserving motion it will remove some of the stresses from the disc above and below the damaged disc when compared to a fusion.

This is an important benefit of a disc replacement when compared to a fusion. Whenever a fusion is done the adjacent disc have to do more work and therefore with age can wear out faster leading to arthritis and perhaps another surgery at those levels. Disc replacements have been shown to prevent this consequence.

The surgery for a disc replacement in the neck is very similar to that of a cervical fusion. The damage disc is removed through an exposure from the front of the neck but instead of plate and screws to hold the adjacent vertebras together a disc replacement device is placed.

The recovery is quicker than a fusion since neck movement is encouraged right away. The lumbar disc replacement similarly is done from an anterior exposure through the abdomen rather than an exposure through the back of the spine. Once again rather than restricting movement early movement is encouraged.

In the right patients, both cervical (neck) and lumbar (lower back) disc replacements are important advancements in the treatment of both neck and back pain due to a damaged disc over that of a fusion. They allow for resolution of a patient’s pain while maintain near normal movement.

But despite these important benefits, a disc replacement is similar to any other joint replacements meaning that over time the disc replacement can wear out over time.When this occurs the patient might begin to experience pain at that level again and the worn out disc replacement might need to be removed and replaced.

Dr. Dwight S. Tyndall, FAAOS, is a minimally invasive spine surgeon practicing in the Region at His column, which appears every other week, covers a wide range of health and medical issues. 


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