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.
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.
Bulging Disc In Thoracic Spine
A bulging disc in the thoracic spine is a serious medical condition that occurs when the outer layer of the disc weakens, causing it to bulge outward and put pressure on nerves and the spinal cord. The disc has two components, a soft center and a thick outer layer, and weakening or tears in the outer layer can lead to a bulge. Symptoms include pain, numbness, and weakness in the affected area. The thoracic spine is that portion of the spine that resides below the neck and above the low back. It is commonly referred to as the mid-back. A bulging…
A herniated thoracic disc is especially difficult because there are not as many treatments available as there are for disc herniations in other areas of the spine. To understand Thoracic Disc Herniations, though, we first need to cover thoracic spine anatomy and function. With disc herniation, the annulus fibrosus get small tears throughout the annulus. An annulus is a bunch of concentric fibers, so, as the fibers get damaged and cut, the pressure that is built up within the nucleus pushes the now weakened annulus outward, creating a bulge or herniation. The disc begins to weaken via mild degeneration/tearing of the annular fibers…
We talk a lot about leg pain stemming from a pinched or irritated nerve in the lower back. And, indeed, that’s what our physicians are traditionally taught in medical school—a pinched nerve in the lumbar spine typically presents as a symptom in the leg. However, what if you have some butt pain but no pain or other symptoms in the leg? Does this mean it couldn’t be a pinched nerve? Not so fast. Turns out a pinched low back nerve doesn’t always have to be accompanied by leg symptoms.
Let’s start by taking a look at how the back is structured.
Disc herniation, disc protrusion, overgrowth of the facet joint, and thickening of the ligaments can result in nerve root compression or irritation, causing symptoms of sciatic compression. Some causes of sciatic compression can be interrelated with the following conditions: Degenerative disc disease, Spinal stenosis, damage or injuries to the discs, spondylolisthesis, piriformis syndrome, osteoarthritis. The symptoms of sciatica include pain in the lower back, buttock, and down your leg, numbness and weakness in low back, buttock, leg, and/or feet, pain increase with movement, “Pins and needles” feeling in your legs, toes, or feet., loss of bowel control, and incontinence. Sciatica can be treated…
Spinal stenosis is the narrowing of the central spinal canal and is a cause of significant pain and disability. Common causes of spinal stenosis include disc protrusion, facet overgrowth and ligamentum flavum thickening. Surgery is often chosen when conservative therapies fail despite the lack of convincing evidence that it is a superior treatment option. Are there alternatives to back surgery for spinal stenosis? Yes. Regenexx DDD utilizes precise platelet injections into the facets, muscles, and ligaments to treat the lumbar stenosis, treating all of the components of the issue, which is crucial. Spinal stenosis is often an age-related condition attributed…
Spondylolisthesis means that one vertebra is slipping forward or backwards on another. This causes the hole where the nerve exits (foramen) to get smaller (also called foraminal stenosis). It also causes more wear and tear on the facet joint which can lead to arthritis or what’s called “facet hypertrophy”.
The amount of slippage is graded 1-4, with grade 1 meaning that the one vertebra has slipped up to 25% on the other vertebra. Grade 2 means that one bone has slipped from 25-50% with higher grades indicating more slippage. The vast majority of patients are grade 1 to 2.
Degenerative disc disease is a clinical condition that refers to the gradual deterioration of the discs located in the thoracic spine and the associated symptoms. Pain, weakness, muscle spasms, and restriction in range of motion are common. Degenerative disc disease can occur at each level of the spine: cervical, thoracic, and lumbar. Studies have demonstrated that degenerative disc disease in the thoracic spine most commonly occurs in the third to fourth decades (1) and occurs most frequently in the lower thoracic segments from T7-T12. Thoracic degenerative disc disease has four main stages that start with mild symptoms and progress in severity…
Thoracic radiculopathy is a painful medical condition that affects both men and women alike. Pain, paresthesia, decreased sensation, and weakness are the major symptoms. Radiculopathy refers to the whole complex of symptoms that can be caused by irritation or compression of a nerve root in the spine. Thoracic radiculopathy is irritation or compression of a thoracic spinal nerve. Causes of radiculopathy in the thoracic region are thoracic disc injuries, thoracic facet arthritis, ligament thickening, facet cyst, unstable rib attachments, and bone spurs. Diagnosis of thoracic radiculopathy can be difficult. Treatment options vary upon severity and when appropriate should always start with conservative care.
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 R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…
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.
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.
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…