LDR VS FUSION

Orthopedic Spine Surgeon Located in Long Beach and Torrance, CA

Lumbar disc replacement (LDR) and anterior lumbar interbody fusion (ALIF) are both surgical procedures used to treat degenerative disc disease and disc-related pain in the lower back. While both aim to relieve pain and improve function, they differ in their goals, biomechanics, and long-term impact on spinal motion.

LUMBAR DISC REPLACEMENT (LDR)

• Objective
  • Preservation of Motion: Lumbar disc replacement is designed to maintain natural motion at the treated spinal level by replacing the damaged disc with an artificial implant. Preserving motion may help reduce abnormal stress on adjacent spinal segments and maintain more normal spinal biomechanics.
• Procedure
  • Implant-Based Motion Preservation: In CDR, the damaged disc is removed and replaced with a prosthetic disc made of metal or a combination of metal and plastic.
  • The degenerated lumbar disc is removed through an anterior (front) approach.
  • A prosthetic artificial disc, typically made of metal or metal-and-polymer components, is implanted.
  • The artificial disc is engineered to allow controlled motion similar to a healthy lumbar disc.
• Candidates
  • Lumbar disc replacement is generally considered for patients who:
  • Have chronic discogenic low back pain from one (occasionally two) lumbar levels
  • Have failed conservative treatments such as physical therapy, medications, and injections
  • Have minimal or no facet joint degeneration
  • Maintain good spinal alignment and stability
  • Do not have significant osteoporosis, deformity, or instability
• Advantages
  • Motion Preservation: Maintains movement at the treated level, unlike fusion
  • Reduced Adjacent Segment Stress: May lower the risk of adjacent segment degeneration compared to fusion
  • Quicker Functional Recovery:No need for bone healing, often allowing earlier return to activity
  • Less Postoperative Stiffness: Patients may retain greater lumbar flexibility
• Risks
  • Implant Wear or Failure: Artificial discs may wear over time and could require revision surgery
  • Persistent Pain:Not all patients achieve complete pain relief, particularly if pain originates from facet joints or other structures

ANTERIOR LUMBAR INTERBODY FUSION (ALIF)

• Objective
  • Stabilization Through Fusion:ALIF aims to eliminate motion at the painful spinal segment by fusing the adjacent vertebrae together. By stabilizing the spine, the procedure reduces movement-related pain originating from the degenerated disc.
• Procedure
  • Disc Removal and Fusion: The damaged disc is removed through an anterior approach. A spacer or cage filled with bone graft material is placed into the disc space. Over time, the vertebrae fuse together, permanently stabilizing the segment.
• Candidates
  • ALIF is commonly recommended for patients who:
  • Have disc degeneration with spinal instability
  • Have facet joint arthritis or conditions unsuitable for motion preservation
  • Require correction of disc height, alignment, or sagittal balance
  • Have failed non-operative care and are not candidates for disc replacement
• Advantages
  • Reliable Fusion: ALIF has a long history of predictable fusion and pain relief
  • Established Outcomes: Well-studied procedure with decades of clinical data
  • Effective for Instability: Particularly useful when spinal stability is required
• Risks
  • Loss of Motion: There is a risk of incomplete fusion (pseudoarthrosis), which may require additional surgery.
  • Adjacent Segment Degeneration:Fusion permanently eliminates movement at the treated level
  • Pseudoarthrosis: Incomplete fusion may occur and could require additional surgery
  • Longer Recovery: Bone healing may prolong recovery compared to motion-preserving options

SUMMARY

• Motion Preservation:LDR preserves motion at the treated level vs ALIF which eliminates motion through fusion.
• Indications: LDR is best suited for carefully selected patients seeking motion preservation vs ALIF is preferred when stability, alignment correction, or facet disease is present.
• Recovery: LDR often allows for faster recovery and improved flexibility vs ALIF may require longer recovery due to bone fusion

Choosing the Right Procedure

The decision between lumbar disc replacement and ALIF depends on multiple factors, including the source of pain, spinal alignment, facet joint health, bone quality, activity level, and individual goals. A thorough evaluation by a fellowship-trained orthopaedic spine surgeon like Dr. Brandon A. Ortega, is essential to determine the most appropriate surgical option for each patient.