Disc replacement or fusion—which is better? A study conducted at Cedars-Sinai Spine Center and reported by Laura Miller of Becker’s Orthopedics examined 209 patients with damaged cervical spine discs who underwent either cervical disc replacement or spinal fusion. Richard Delamarter, M.D., co-director of the Cedars-Sinai Spine Center, found that the fusion patients were four times more likely to need additional surgery, four years later. Half of the follow-up operations were necessary because of problems with the vertebral discs at levels adjacent to the levels fused in the earlier operation.
Another study, reported by Miller, compared the cost of care between disc replacement and fusion on patients suffering from three-level lower back disc disease. The hospital costs for the disc replacement patients were, on average, 49% lower than were the costs for fusion patients.
In a study of 187 patients who had one-level cervical disc disease, those who had cervical disc arthroplasty had better outcomes than those who were treated with anterior cervical discectomy and fusion (ACDF). According to Becker’s, two years after surgery the arthroplasty group experienced significantly greater improvement in cervical spine range of motion when compared with the ACDF group.
Finally, Miller reports that “lumbar disc arthroplasty had better results than fusion for patients suffering from degenerative disc disorders (DDD). In a randomized study of 577 patients with degenerative disc disorders, surgeons either treated the patients with a stand-alone interbody fusion or lumbar disc arthroplasty using the Maverick disc. The arthroplasty patients reported better outcomes on the Oswestry Disability Index scores, back pain scores and patient satisfaction. Hospital stays were similar for both groups and the arthroplasty patients reported fewer implant or procedure-related adverse events. However, surgical time and blood loss rates were higher among the arthroplasty group.”