Our Summary

The research paper is an analysis of multiple studies on two types of spine surgery: fusion and total disc replacement (TDR). It found that out of 80 studies, the majority found TDR to be a generally good option, though some were undecided or negative.

When compared to fusion surgery, TDR was often deemed better. However, TDR does have complications, ranging from 3% to 50% of cases. There is also a debate about whether TDR can cause adjacent disc degeneration disease.

An issue that came up in several studies was that TDR isn’t always covered by state healthcare, making it financially difficult for some patients. There are also concerns about ‘salvage surgery’ (surgery to fix or replace a failed implant), which, while rare, is very problematic.

The paper also mentioned that performing TDR can be challenging, with risks of minor to severe complications. Some studies also raised questions about the durability of the implants used in TDR and whether they are the best materials for the job.

Overall, the use of TDR in spine surgery is decreasing, currently making up less than 2% of procedures. This is most likely due to the challenges and potential issues with the surgery, as well as problems with healthcare coverage.

FAQs

  1. What is the general consensus on total disc replacement (TDR) as a spine surgery option according to the research paper?
  2. What are some of the complications and challenges associated with TDR?
  3. Why is the use of TDR in spine surgery decreasing?

Doctor’s Tip

In light of these findings, a doctor may advise a patient considering lumbar fusion to carefully weigh the risks and benefits of both fusion and total disc replacement surgery. They may also recommend discussing with their healthcare provider about insurance coverage and potential complications associated with TDR before making a decision. Additionally, the doctor may suggest exploring alternative treatment options and seeking a second opinion to ensure the best possible outcome for the patient’s spinal health.

Suitable For

In contrast, lumbar fusion surgery is a more commonly recommended procedure for certain types of patients. Typically, patients who are recommended for lumbar fusion surgery are those who have:

  1. Severe back pain that does not respond to conservative treatments such as physical therapy, medication, or injections.
  2. Degenerative disc disease causing instability in the spine.
  3. Spondylolisthesis, where one vertebra slips forward over another.
  4. Spinal stenosis, where the spinal canal narrows and puts pressure on the nerves.
  5. Herniated discs that are causing nerve compression and pain.

Lumbar fusion surgery is often considered when conservative treatments have failed to provide relief and the patient’s quality of life is significantly impacted by their back pain. It is important for patients considering lumbar fusion surgery to discuss the risks and benefits with their healthcare provider and to explore other treatment options before making a decision.

Timeline

Before lumbar fusion:

  1. Patient experiences chronic back pain, leg pain, and limited mobility.
  2. Patient undergoes diagnostic tests such as X-rays, MRI, and CT scans to determine the cause of their symptoms.
  3. Patient tries conservative treatments such as physical therapy, medications, and injections to manage their pain.
  4. If conservative treatments are ineffective, patient is recommended for lumbar fusion surgery.

After lumbar fusion:

  1. Patient undergoes pre-operative evaluations and tests to ensure they are a suitable candidate for surgery.
  2. Patient undergoes lumbar fusion surgery, where the damaged discs in the spine are removed and the vertebrae are fused together using metal hardware and bone grafts.
  3. Patient experiences post-operative pain and discomfort, and may need to stay in the hospital for a few days for monitoring.
  4. Patient undergoes physical therapy and rehabilitation to regain strength and mobility in the spine.
  5. Patient may experience improvements in their back pain and leg pain over time, with full recovery taking several months to a year.
  6. Patient may need to follow up with their surgeon for periodic check-ups to monitor their progress and address any issues that may arise.

What to Ask Your Doctor

Some questions a patient should ask their doctor about lumbar fusion surgery include:

  1. What are the potential risks and complications associated with lumbar fusion surgery?
  2. How long is the recovery process after lumbar fusion surgery, and what can I expect during this time?
  3. What are the success rates of lumbar fusion surgery, and what factors can affect the outcome?
  4. Are there any alternative treatments or procedures to lumbar fusion surgery that I should consider?
  5. How long do the results of lumbar fusion surgery typically last, and are there any risks of future complications or issues?
  6. How experienced are you in performing lumbar fusion surgery, and what is your success rate with this procedure?
  7. Will I need physical therapy or rehabilitation after lumbar fusion surgery, and how can I best prepare for this?
  8. Are there any lifestyle changes or restrictions I will need to follow after lumbar fusion surgery?
  9. What is the cost of lumbar fusion surgery, and will my insurance cover this procedure?
  10. Are there any long-term effects or considerations I should be aware of before undergoing lumbar fusion surgery?

Reference

Authors: Kovač V. Journal: Int Orthop. 2019 Apr;43(4):981-986. doi: 10.1007/s00264-018-4228-9. Epub 2018 Nov 13. PMID: 30426178