Finally, we can say that there is a viable alternative for spinal fusion.
When it comes to neck and back pain, it is often a cause and effect’ process: one thing always leads to another. “Discs” are semi-soft complex structures that cushion the individual bones (vertebra) of the spine. The outer layer of the disc consists of a cartilage-like tissue that gives the disc some rigidity. The inner portion is made of softer tissue to give the spine its flexibility. The discs themselves are pretty tough, but aging or injury can damage the outer layer and begin a degenerative process that may ultimately lead to problems like a “pinched” (or compressed) nerve. The patient will often develop pain or numbness that can affect the extremities (arms, legs), or the entire body.
When a patient comes to me for their neck and back pain, I’ll order an MRI and X-rays that usually reveal disc degeneration very clearly. As your surgeon, I’ll correlate the results of the screenings with findings I make from a physical examination and a discussion of your health history and lifestyle.
Even when degenerative disc disease is found, I don’t always jump on surgery as the ‘be all – end all’ solution. When appropriate, I may suggest a combination of nonsurgical therapies: physical therapy, exercise, nutritional program, and supplements. The fact is, I will not recommend surgery for disc-related disorders unless the resulting pain is so severe or for a prolonged period (typically, more than over six months) and my patient has completed all possible nonsurgical alternatives.
My reason is very simple: surgery is an extreme solution for things that go wrong with the body. Frankly speaking, not all surgical solutions are the best option for back and neck pain. Moreover, the more invasive the treatment, the longer the patient must endure rehabilitation. If surgery is required, I pick the least invasive procedure with the highest potential for recovery.
If indicated, I’ll start with outpatient procedures that are all performed with microsurgical tools. A laminotomy removes a part of the vertebra that may be causing nerve ‘compression’ (pinched nerve). A foraminotomy widens the opening (the foramen) between the vertebrae where a nerve passes from the spinal cord. A discectomy involves the reduction of a portion of a herniated or bulging disc that may be irritating the spinal nerve. In very rare cases, a facet thermal ablation may be required, where the affected nerve is deadened so that the patient no longer detects the pain from arthritic pain in the region.
When I went to medical school nearly thirty years ago, spinal fusion was the ultimate and only solution for severe cases of degenerative disc disease. I thought then as believe now: fusion surgery is a brute force solution for injuries and disease of the spine. The goal is simple: stop the movement of vertebral segments where pain and numbness originate. The thinking is that if you immobilize the segment (or “level”), the result is decreased pain generation. But at what cost to the patient?
A patient of mine is a professional ballet dancer. She had an accident and suffered an injury to her lumbar region. Another patient is a long-distance cyclist who developed degenerative disc disease. In both cases, had we met thirty years ago, the only thing I could suggest for either of them was multi-level vertebral immobilization through spinal fusion. Such a treatment would ensure that the dancer never danced on stage again. The cyclist would lose his hobby and possibly endanger his career as a chef.
But it’s not twenty years ago, and fusion is not the only answer. I just concluded a major 7-year study that proves this point. The study compared patients who had two-level cervical disc replacement surgery with patients who had multi-level cervical fusion. 397 patient cases were included. My colleagues and I found statistical superior results for artificial disc replacement (ADR) in every measurable outcome. ADR patients were – by and large – healthier and (I may add) happier than their counterparts.
The advantage of ADR over fusion are so numerous that it is hard to offer a cogent list. But the chief advantage is that ADR patients tend to recover from surgery faster, and they regain painless movement of their neck and back. They have full flexibility. They retain full movement. With fusion, none of this is possible.
However, this is not about one procedure over another. Thanks to this work in ADR, every patient now has a new treatment alternative. Spinal fusion is no longer the only solution. It is only one of many possibilities. As a surgeon, I have a duty to my patients who see me at my office in Beverly Hills or those whom I treat as a surgeon at Cedars-Sinai Medical Center in Los Angeles. My attention is wholly focused on producing the best outcomes.
In my mind, movement is life. And I will do all that I can to ensure that my patient has all the movement I can give them.
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