Disc Surgery Options: Discectomy, Fusion, or Disc Replacement?

If surgery for a lumbar disc problem to treat severe lower back pain or chronic sciatica is being considered, the next question is which procedure. There are three, and they work in fundamentally different ways. This page sets out what each one does and doesn’t do.

Discectomy is the most commonly performed spinal operation. The surgeon removes the part of a herniated intervertebral disc that has pushed out of position and is pressing on a nerve root, usually the sciatic nerve in the lower back. The aim is to relieve the nerve compression that causes leg pain, numbness, or weakness. The term microdiscectomy refers to the same procedure performed using a microscope or magnified guidance, and in practice the two terms are often used interchangeably.

The procedure is carried out through a small incision in the back, and recovery is quicker than for spinal fusion. It is best suited to patients whose main problem is sciatica from a clearly identifiable disc herniation on MRI, rather than lumbar back pain from broader disc degeneration. Discectomy treats the herniation but not the underlying degeneration of the disc, so it is usually only provides temporary relief from sciatica caused by nerve compression.

Spinal fusion removes the damaged intervertebral disc, and permanently fuses vertebrae together using bone graft and titanium screws, rods, or cages. Once fused, the segment no longer moves, and the disc is no longer a source of pain.

For decades, fusion was the only surgical treatment for severely degenerated lumbar discs, and it remains widely performed. Principal concerns are:

• The risk of the procedure, as it is undertaken through an incision in the back in close proximity to spinal nerves
• Recovery time, as back muscles can take months to heal
• Permanent loss of movement at the treated level, causing adjacent discs to take on additional mechanical load. Over time, this can accelerate wear at those levels, a phenomenon known as adjacent segment disease.

Total lumbar disc replacement removes the entire diseased intervertebral disc, and replaces it with an artificial implant such as Prodisc® L. It is the only procedure that completely addresses the root cause of the problem and safely restores spinal mobility, allowing a return to an active, pain-free life.

For patients with degenerative disc disease causing severe lower back pain and chronic sciatica, total lumbar disc replacement addresses both the mechanical and neurological aspects of the problem, providing permanent symptom relief. The procedure requires specialist surgical expertise – one reason why the choice of surgeon and the number of procedures they undertake each year are critically important.

Spinal fusion has been the standard surgical response for severely degenerated and herniated discs for decades, and for some patients it remains the right option. But for the majority of patients, Prodisc® L total lumbar disc replacement is a considerably better choice, as it safely restores spinal mobility instead of compromising it, permanently relieves symptoms, carries the lowest risk, and is minimally invasive to provide the shortest recovery time.

The main reason it is not routinely offered is surgeon familiarity. Most back surgeons are trained to operate through the back.

Total lumbar disc replacement is undertaken through a small incision in the abdomen and requires the aorta (the body’s main artery which runs down in front of the spine) to be gently moved to one side to permit placement of the implant. The majority of back surgeons are unfamiliar with this approach.

If spinal fusion is being recommended to you, you should seriously consider Prodisc® L total lumbar disc replacement as a significantly more effective, lower risk alternative.

The outcome of disc surgery depends on the surgeon’s experience with the specific procedure being performed. This applies to all three operations, but it is especially true for total lumbar disc replacement, which uses an anterior approach, and requires precise implant positioning around the aorta.

CCV Montpellier, SpinePro’s surgical partner, performs over 800 Prodisc® L total lumbar disc replacement procedures every year, more than any other centre worldwide. The surgical team performs the procedure routinely, with proven protocols for patient selection, operative technique, and post-operative recovery.