Is Disc Replacement Surgery a Good Idea?

Often plugged as a better alternative to spinal fusion, the idea behind disc replacement surgery is that it relieves pain by replacing a damaged or diseased disc with an artificial one. But is it a good idea?

Cervical Fusion vs. Disc Replacement

A spinal fusion fuses two or more discs into a solid unit, stopping movement and putting heavy stress on adjacent segments above and below the fusion. The case argued for disc replacement instead of fusion is that disc replacement allows for motion in the spine and has fewer side effects.

While disc replacement does indeed allow for motion, no artificial device can function exactly like the native part it is replacing, and it appears that artificial discs not only distort normal motion but also come with many additional side effects. More on this in a moment. First, let’s take a look at a disc replacement surgery.

What Does Disc Replacement Surgery Look Like?

The surgeon first accesses the spinal column (for example, in the cervical spine, the surgeon would access the spine through an incision in the front of the neck). From here the surgery is quite aggressive as the disc is scraped and chiseled out of the disc space. Pins are screwed into the vertebrae above and below the disc space that will anchor the space in place as the surgeon works. A tool is inserted into the disc space and used to further separate the upper and lower vertebrae, enlarging the space. The vertebrae surfaces within the disc space are prepared by, in effect, sanding the surfaces smooth. The artificial disc (made of metal plates and a polyethylene cushion) is then inserted, the pins removed, and the site is then closed.

Contrast this to a fusion where the disc would also be removed, but instead of inserting an artificial disc, the space is packed with fusion material and bone graft, which will fuse the upper and lower vertebrae into one solid piece of bone, stopping movement in that part of the spine.

Disc Replacement Side Effects

While disc replacement my seem like a better option than a spinal fusion, disc replacement is also a major and highly invasive surgery that can lead to many side effects, such as wear-and-tear of the artificial device, causing metal ions in the blood. Wear particles have been found to cause inflammatory reactions, and when these reactions are around the spinal nerves, as they would be in this case, it can create pain and other symptoms. We know that wear particles after a disc replacement can create tissue reactions that are just as severe as those following hip or knee replacements, which involve much larger artificial devices.

Ongoing chronic pain, revisions, and even adjacent segment disease, as we’ll discuss below, are some additional problems associated with disc replacement.

What Is Adjacent Segment Disease?

Adjacent segment disease (ASD) is commonly associated with spinal fusion as fusing the spine causes adjacent segments to work harder, overloading these segments, and leading to more damage. Unfortunately, we’ve seen that ASD may be a disc replacement side effect as well. Why? Because while a fusion stops motion in the spine, one study suggests that disc replacement creates abnormal motion in the spine. This abnormal motion can not only put extra stress on the affected area of the spine but also on those areas above and below it.

So is disc replacement a good idea, or at least a better idea than spinal fusion? In both cases, while restoration of the spine is the goal, it appears that the result is surgical damage to accomplish that goal and the risk of many side effects, including ongoing pain and ASD. The risks, in most cases (there are always extreme cases that will be the exception), really do seem to outweigh the benefits when the pros and cons of disc replacement are considered.

What’s the BEST Alternative?

Since 2014, we have been treating craniocervical instability with a procedure called the PICL. That procedure uses posterior and image-guided injections into the cervical spine to tighten lax ligaments around C0 – C2, making it one of the most comprehensive, non-surgical Cervical treatments available.

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…