Alternative Treatment Options

Minimally Invasive Spinal Fusion

Fusion in this context means joining together with bone. Spinal fusion joins together the vertebrae adjacent to painful degenerative discs and facet joints. This can be achieved in various ways but will often involve removing the degenerative structures and replacing them with a bone graft. The aim is for this to form a solid mass of bone that will eliminate any movement, which is often painful, between the vertebrae involved. To help hold things still and to provide structural support while the fusion develops, various forms of screws, rods and cages may be used. Spinal fusion is a tried and tested technique and one which has evolved and improved, particularly over the past few years, to give more reliable results associated with less risk. However, when compared with total disc replacement there are certain drawbacks. For example, the recovery and recuperation after spinal fusion is certainly slower. Furthermore, the rigid immobilization of one part of the spine will transfer movement and stress to other levels which may then become troublesome in future years, a problem known as 'adjacent level disease'. Bone graft is usually taken from the pelvis and this can cause ongoing discomfort. There are some risks associated with inserting screws, rods and cages as these can break or loosen at a later stage, particularly if a fusion does not develop which happens in a small proportion of cases. All of these problems can require further surgery. On the other hand, disc replacement also has its own set of risks and uncertainties.

Spinal fusion will often be the more appropriate option in such cases where total disc replacement may be inadvisable (see above).

Wallis Dynamic Stabilization

These techniques aim to treat back pain, and sometimes leg pain, by off-loading and protecting the painful degenerative structures in the spine. As the structures are therefore left in place and are not excised, the procedure has the advantage of being far less invasive. The downside, however, is that these structures may still potentially give rise to symptoms. There are different ways of achieving dynamic stabilization but the techniques all avoid some of the drawbacks of spinal fusion.

There are certainly cases where these methods will be more appropriate than total disc replacement, particularly where a significant part of the problem involves compression of nerve roots, such as in spinal stenosis. In other cases, the more conservative and reversible procedure of dynamic stabilization may be an important option to consider, especially for younger patients or in cases of more modest degenerative change.

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