Is Total Disc Replacement Better Than Conservative Treatment?

Total disc replacement (TDR) surgery was developed largely to address concerns with spinal fusion surgery. Fusion surgery can cause adjacent segmental degeneration, meaning the spinal joints and discs surrounding the fused site are prone to premature wear. This is because fusion sets up a rigid segment in the spine, and the surrounding segments must be responsible for more motion and shock absorption.

With disc replacement surgery, an artificial disc is placed in the spine. This allows the segment to remain mobile and absorb shock.

While TDR may be an improvement over spinal fusion, it is still questionable whether as many people need the procedure as are prescribed it. Only recently have studies begun to be conducted comparing the effectiveness of TDR surgery and conservative treatment for discogenic back pain.

Studies

One study compared the effects of TDR with a rehabilitation program over 2 years for 173 patients with one or two levels of degenerative changes in the lumbar spine. Rehabilitation consisted of guided exercise and cognitive intervention.

While results for pain and disability were slightly better in the surgery group, they weren't considered clinically significant. Also worth noting is that 8% of the surgery group had a complication resulting in some kind of impairment at 2 years, 6.5% required re-operation and one patient had a leg amputation as a direct result of second surgery complications. See more on this at http://www.bmj.com/content/342/bmj.d2786.

Another study sought to compare degenerative effects of TDR surgery versus conservative care. This study found adjacent level disc degeneration to be similar between both treatment groups, but found a significant difference when considering joints. Facet arthropathy (meaning joint abnormality) was observed in 34% of the surgery group at two years as compared to 4% of the conservative treatment group. More on this study can be found at http://www.infodoctor.org:8080/uid=22706091.

Surgery comes with a host of risks, including bleeding, infection, nerve damage, instrument breakage and failure to relieve pain. While disc replacement surgery may spare surrounding discs from early degeneration, it could encourage joint deterioration.

For disc degeneration, bulging and herniation, it is always wise to make use of all possible conservative therapies before considering surgery. Physical therapy is the most typical treatment to begin with, as building strong muscles around the affected disc will help to take pressure off it. Inversion or decompression treatments can help to rehydrate discs by using gravity to increase intervertebral space. Inversion tables can be purchased for home use, whereas decompression machines can be found in some chiropractors' offices. Chiropractic manipulation may be helpful for disc compression if spinal misalignment is the cause.

There are a number of back pain treatment options, and surgery should be a last resort. Know the risks of procedures before you agree to them.