I need some help please! I saw two different orthopedic surgeons and one micro-neurosurgeon about my back pain. They all agree I have degenerative disc disease that could be helped with surgery. The two orthopedic surgeons recommended a spinal fusion. The micro-neurosurgeon was equally convincing that I should have a disc replacement. How do these two treatments really compare? I have no way of figuring this out without some help!

There is a new study from The Netherlands that might be helpful to you. They conducted an extensive survey of the published studies comparing three treatment approaches to symptomatic lumbar degenerative disc disease: conservative care and rehabilitation, spinal fusion, or the newer option of disc replacement

Current clinical practice seems to be moving away from spinal fusion and more toward lumbar disc replacement for symptomatic degenerative disc disease. The implants were first invented and designed to help with the problem of adjacent spinal disease that often occurs at the level above or below a fused segment.

After an extensive search on-line, the authors found seven studies that compared results of disc replacement, fusion, or rehabilitation. Combining all the patients in all seven studies, there was a total of 1301 people included. Only one of those studies really looked at rehabilitation.

Analysis of findings showed that patients improved no matter what type of treatment was applied. Patient satisfaction was greater in the group who had a total disc replacement. As intended, these implants did allow patients more natural motion.

But using a five-point criteria for assessing these studies, they found all had low quality evidence. None of the studies looked at subsequent adjacent segment disease, which is the main reason the implants were developed in the first place. The follow-up was two years or less, so long-term results aren’t really available. And many of the studies are funded by disc manufacturers, so there is a need for unbiased research without conflicts of interest.

The authors suggest directed their comments to surgeons and advised caution in the use of disc replacements. They suggested that until high-quality studies with long-term results are available, it should not be assumed that “newer is better.” In other words, this new direction away from spinal fusion toward disc replacement hasn’t been adequately proven as the best approach for everyone. That doesn’t mean this treatment method isn’t ever to be used. Careful patient selection and surgeon experience and expertise with the procedure are key ingredients to a successful result.