Spinal Fusion vs. Disc Replacement: To Fuse or Not to Fuse

Fact: Making decisions as a doctor is never black-and-white. Ideally, when there is no clear-cut diagnosis or treatment, the decision ultimately rests on a doctor's ability to synthesize information from peer-reviewed research. However, sometimes personal opinion, experience, conflicts of interest (we're looking at you, medical device companies), or lack of research get in the way of making the better choice. The latter problem is currently a hot issue in the world of spinal surgery. Upstate Medical is looking to remediate the problem, but the poor patients really have no idea what to expect in this single-blind study. Excerpt from The Post-Standard:

How would you like heading into surgery, not knowing if the vertebrae in your neck were going to be fused together, or if the disc between your vertebrae was going to be replaced? And, knowing that your surgeons didn't know, either?

That's what happened with Auburn's Jim Traver, 48, who hurt his neck when he fell 15 feet from a building where he was working construction.

Surgeons opened an envelope the day he had his operation in October at Upstate Medical University. Instructions inside told them Traver would get the Porous Coated Motion cervical artificial disc, a new device under FDA study. Upstate is one of 20 sites in the country participating in the study for the Food and Drug Administration.

Patients in the study randomly receive either fusion or the replacement disc. "It's the only way of lowering the bias," explains Dr. Amir Fayyazi, an associate professor and one of Traver's surgeons. Scientists want to determine whether disc replacement is more effective than spinal fusion. Letting surgeons pick which patients get what surgery would, potentially, taint the results.

Replacement discs are a new concept.

"This is relatively early in motion preservation of the cervical spine," says Fayyazi. "We've been doing cervical fusion for over 50 years."