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There Are Only 3 Kinds of Spine Surgery - Spinal DISC Center | Kris Radcliff, MD | New Jersey
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There Are Only 3 Kinds of Spine Surgery

Spine operations have dozens of names and abbreviations. Almost every one of them is one of three things, or a mix of them. Once you know which one is being offered, it is much easier to understand it and ask the right questions.

1Decompression
Make room for a nerve
2Fusion
Grow bones together
3Disc replacement
Put in a moving part

1. Decompression: making room

What it is: The surgeon removes whatever is pressing on a nerve or the spinal cord. That might be a piece of herniated disc, a bone spur, or a thick ligament. The goal is to give the nerve room again.

Best for: Pain, numbness or weakness that travels down an arm or a leg (sciatica) from a pinched nerve. Also for spinal stenosis, where there is not enough room for the nerves.

Names you may hear: microdiscectomy, discectomy, laminectomy, laminotomy, foraminotomy, endoscopic discectomy, endoscopic decompression.

What it does not do: It does not stop a bone from moving or sliding. If a bone is unstable, decompression alone may not be enough.

Good to know: Many decompressions can be done through very small cuts, sometimes through a tube or a camera about the width of a pencil (endoscopic surgery). Most people go home the same day.

2. Fusion: growing bones together

What it is: Two or more spine bones are joined so they heal into one solid bone. That painful or wobbly spot stops moving. The surgeon places bone graft, and usually a cage (spacer) between the bones and screws and rods to hold everything still while the bone grows. That healing takes months.

Best for: A bone that has slipped or is unstable (spondylolisthesis), a curve or deformity, a fracture, or a spot that needs a lot of bone removed to free the nerves.

Names you may hear: ACDF (anterior cervical discectomy and fusion), TLIF, PLIF, ALIF, LLIF, XLIF, OLIF (all ways of placing a cage from different directions), posterior spinal fusion, SI joint fusion.

Good to know: Once bones are fused, the levels above and below do a little more work. Over many years, they can wear out faster. Your surgeon should talk with you about this.

3. Disc replacement: keeping motion

What it is: The worn or herniated disc is removed and replaced with an artificial disc that moves. It is like a small joint replacement for the spine. Facet replacement is a newer option that replaces the small joints on the back of the spine instead of fusing them.

Best for: The right patient with a disc problem in the neck or low back who does not have major arthritis or instability. Not everyone is a candidate.

Names you may hear: cervical disc replacement, cervical disc arthroplasty, lumbar disc replacement, total disc replacement, facet replacement.

Good to know: In the neck, disc replacement has been studied for many years and often lets people return to activity quickly. Insurance coverage varies, especially in the low back.

The truth about spacers and cages

A spacer, also called a cage, is a small block placed between two spine bones after the disc is cleaned out. It holds the space open and props open the doorways where nerves exit.

A spacer between two spine bones is part of a fusion. The spacer is there to hold things in place while bone grows across. A spacer does not work by itself. It needs a fusion to support it. If the bone does not grow, the spacer can sink into the bone, shift, come loose or break.

Some small devices are placed between the bony bumps on the back of the spine instead. Some of these are designed to fuse those bones and some are not. If one is offered to you, ask which kind it is, and whether bone needs to grow for it to work.

If you hear “it’s not really a fusion, it’s just a spacer,” ask more questions. A fusion through a small cut is still a fusion.

Ask who can take it out. If a spacer or any other implant causes a problem, it may need to be removed or the surgery redone (revision surgery). Before anyone places an implant, confirm that they can remove or revise it themselves if there is a problem. Be cautious about an implant placed by someone who cannot take it out.

Why it matters who does it

If your doctor can only do one of these three operations, that may be the one you are offered. A spine surgeon who does all three can recommend the one that fits your problem. Read: Who is best positioned to do your surgery?

Questions to ask about any spine operation

  1. Which of the three is it: decompression, fusion or disc replacement?
  2. Will anything be left in my body? What is it called?
  3. Does bone need to grow for this to work? What happens if it does not?
  4. Why this one and not one of the other two?
  5. Who is doing it, and what was their training?
  6. If the implant causes a problem, can you remove it or redo the surgery yourself?
  7. What does recovery look like for someone like me?

Questions about your options? Call 609-800-3472 or send us your MRI for a review.

This page is general information, not medical advice. Talk with your own doctor about your situation.