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Spine and Back Health

Artificial Disk Replacement

12/09/2008

Question:

I have just been informed that I need to have a fusion in my lower back. My MRI shows bulges and protrusions from L3-L4 down to L5-S1. In L4-L5 there is posterior central, right paracentral and lateral broad base disc protrusion with right posterolateral and lateral annulus tear, mild right neural canl narrowing. I unfortunately was injured at work and am going through workers comp for this injury which isn`t a good feeling AT ALL. I am an x-ray tech and have always seen that hardware in other people and never wanted it inside of my body. I`ve read there is a procedure where orthos can use laser surgery to do artificial disk replacement instead of having to have all of that metal inside of you. Being on workers comp, am I able to find an orthopedic doctor that would perform that surgery or am I stuck with a fusion that I`m not sure I can handle? Please help!

Answer:

Hello, thank you for your question. Obviously I can't recommend a specific surgical procedure for you without having done a full medical history and physical examination of you. You are incorrect in your belief that an orthopedic surgeon can offer you any type of procedure that a neurosurgeon couldn't. These days, both types of spinal surgeons perform essentially the same kinds of procedures, although different individual surgeons may not offer the same techniques.

There is no "laser disc replacement" surgery that currently exists in generally accepted standard spine surgery practice. The use of lasers is usually a marketing gimmick, and often advertised by unorthodox spine surgery "clinics". When lasers are used in spine surgery, it is usually for limited procedures, often (but not always) done by non-surgeons such as pain management doctors, and intended to shrink a bulging disc. Keep in mind, however, that this essentially "cooks" the disc and damages its internal structure, which often leads to worse problems a few years down the road. Most artificial disc replacement surgeries are not currently covered under many insurance plans, although worker's comp often will cover it. You would need to find out first. Also, many patients who need fusions are not candidates for artificial disc replacement. Only your surgeon can determine that.

Finally, you should know that artificial disc replacement has never been shown to be any better for patients than a fusion, they've simply been shown to be about the same in terms of success, and it still involves an artificial implant made of similar metal as the implants you've seen on the xrays. I hope this information helps. It sounds to me like you should talk to your surgeon about these concerns, or get a second opinion and ask about these issues. Good luck.

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Response by:

David J Hart, MD David J Hart, MD
Associate Professor of Neurosurgery
School of Medicine
Case Western Reserve University