Spine fusion surgery vs. alternatives
for degenerative disc disease
The decision to have a spine fusion procedure
done to treat low back pain is a very personal
one, and it is entirely the patient’s decision.
Degenerative disc disease is for the most part
a non-crippling, non-progressive type of back
condition, although in a minority of cases it
can be cause severe back pain and can significantly
impact on an individual’s ability to function.
Each patient has to weigh the risks of a major
surgical procedure with a long healing process
with the potential benefits. The spine fusion
surgery works best for treating one level of
the spine, although two levels can be fused if
the patient has severe low back pain. As the
number of levels fused increases, the risks of
the procedure increase (e.g. a nonunion) and
the potential benefits decrease. Only in extreme
cases would most spine surgeons recommend or
even offer a three or four-level spine fusion
surgery.
Alternatives to a spine fusion surgery
If a patient does not wish to undergo a fusion
surgery, there are a couple of different options
that may also be considered.
- IDET, or Intradiscal electrothermal
coagulation (or annuloplasty) is available.
This procedure seeks to decrease the motion
of the disc space by inserting a probe into
the disc space and heating up the annulus (the
outer core of the disc space). This tightens
the collagen and limits the motion at the disc.
- Artificial discs are currently in
trials at several centers in the US and are
being used in practice in some European counties.
The disc is cut out through an anterior incision
and a disc replacement is inserted. The artificial
discs also somewhat limit the motion of the
disc space, but more motion is allowed than
after a fusion surgery. The hope is that by
maintaining some of the normal motion the disc
above the level of the fusion will not experience
added stress and breakdown later.
- Disc regeneration through gene therapy
is currently being researched, although there
are no currently available treatments.
- Conservative care (such as medication
and exercise) to try to manage the painful
symptoms and living with the discomfort is
always an option. When considering this option,
it is important to note that degenerative disc
disease is a benign injury that does not lead
to neurological deficits or result in a progressive
crippling condition. The natural history is
for the low back pain to improve with time
as the body stiffens the disc space itself.
With continued degeneration, bony growth around
the disc will try to capture the excess motion.
By: Paul
C. McAfee, MD
November 15, 2000
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