Herniated discs, commonly (and incorrectly) called slipped discs, are among the most common cause of both upper and lower back pain. This pain results from the degeneration of the cartilage discs that cushion each vertebra in the spine. If the discs begin to flatten, they can press on the spinal nerves, leading to pain, weakness or numbness.
What are the traditional treatments for herniated discs, and why is artificial disc replacement becoming a more popular option?
Diagnosis and Treatment
Herniated discs are usually diagnosed by some form of imaging — X-ray, CT or CAT scan, or MRI — or by the use of nerve conduction studies. The latter uses electrical impulses to determine if the nerves have been damaged or are healing from a compression injury.
In most cases, these discs are treated with pain medication (specifically NSAIDs — non-steroidal anti-inflammatory medication) or with an injection of epidural steroids if the pain medication is not sufficient to manage the pain.
Other treatment options include physical therapy, but that will depend on the location of the herniated disc and the level of pain the patient is experiencing.
Surgery is also an option if the pain caused by the herniated disc is incapacitating and is not responsive to any other treatment methods.
Surgical Options
The most common surgical options include:
- Discectomy — removing part or all of the damaged spinal disc.
- Laminectomy — removing part or all of the bony arch of the vertebra
- Laminotomy — opening a hole in the bony arch to relieve nerve pressure
- Spinal fusion — two or more vertebrae are fused together with bone grafts to provide additional spinal support.
- Artificial disc surgery — the damaged spinal disc is removed and replaced with an artificial one.
For the sake of this piece, we’ll be discussing the last two surgery options — spinal fusion and artificial disc replacement.
Spinal Fusion
Traditional spinal fusion is one of the most common treatment options for herniated discs. It’s completed in one of two ways — either bone grafts are placed on the vertebrae to be fused, or metal framework is inserted to support the vertebrae while they grow together. It is an inpatient surgery, often requiring a multiple-day hospital stay and extended rehabilitation.
Some risks post surgery includes bone graft rejection, pain at the graft site and fusion failure. One of the downsides of spinal fusion surgery is that it reduces the mobility of the spine.
Artificial Disc Replacement
Artificial disc replacement surgery is similar to a discectomy in that it removes all or part of the damaged spinal disc. The difference here is that once the damaged tissue is removed, it is replaced with an artificial spinal disc.
This surgery relieves the nerve pain associated with herniated discs without compromising the mobility of the spine. The surgery is minimally invasive, unlike traditional spinal fusion surgery which can take several hours and is extremely invasive. Additionally, patients enjoy less discomfort and reduced recovery time.
The Future of Artificial Disc Replacement
According to a report released by Research and Markets, the use of artificial discs is expected to grow by more than 20% every year between now and 2020. Non-fusion devices like artificial discs are growing in popularity because:
- The surgery itself is less invasive.
- Recovery is faster.
- It does not interfere with mobility like spinal fusion can.
This has lead companies to create new techniques for the installation of these artificial discs, as well as techniques for spinal decompression and stabilization before and after surgery.
Disc Replacement vs. Spinal Fusion
Spinal fusion and artificial disc replacement are two very different procedures, and they have been studied extensively for years. Studies show that short and midterm results for these procedures are positive. Long-term study results are just starting to come in from studies reaching as far back as 1973. After collecting the data from 16 studies between 1973 and 2008, researchers found that patients experienced a higher satisfaction and greater pain reduction when assessed both two years and five years after surgery.
While there were some cases that required revision, such as rare cases of implant migration or dislocation, almost every study reported higher short- and long-term satisfaction and pain relief with artificial disc replacement when compared to spinal fusion surgery.
Spinal fusion is also known to cause a condition known as pseudarthrosis, or a bone fracture that does not mend normally because the body considers the two pieces of the fracture to be separate bones.
Originally, it was recommended that disc replacement surgery only be used to further scientific research, but in the decade since the last study referenced was published, multiple advances have been made in the fields of artificial spinal discs, making them a viable option for individuals looking for relief from back pain. These advances include new artificial discs that offer more shock absorption for the spine than previous models, as well as new disc designs that more closely mimic the natural spinal discs they are designed to replace.
If you are experiencing back pain and have been diagnosed with herniated discs, don’t think that surgical spinal fusion is your only option. Artificial disc replacement is a less invasive surgery that has a proven track record of better results than traditional spinal fusion. By having the discs replaced, you can relieve the pain you’re experiencing while maintaining the natural mobility of your spine. This is one of the main reasons this surgical option is becoming so popular and is expected to grow in popularity in the coming years.
