Spine Fusion Alternatives (Fusion vs. Replacement)

Spine Fusion Alternatives (Fusion vs. Replacement)

If you are suffering from pain, numbness, weakness, or tingling in your arms and have been told a fusion might be necessary, we urge you to consider this information carefully. In many cases, Dr. Johans can show patients how a disc replacement is much better for them than a disc fusion. Disc replacement surgery has numerous advantages over traditional fusion surgery and can provide patients with greater long-term relief from their pain and discomfort, a much faster return to full activity, and decreased chance of further neck surgery in the future.

Dr. Johans is highly experienced in disc fusions and replacements and will work closely with each patient to develop the best treatment plan for their individual needs. Our team takes great pride in helping our patients recover from their neurological pain issues so they can return to living active lives free from pain and discomfort.

What Are The Symptoms That You May Need Spine Surgery?

The most common symptom that can indicate the need for spine surgery is pain, numbness, weakness, or tingling in your hands, arms, legs, or feet. If these symptoms continue despite non-surgical remedies and lifestyle changes, it may be a sign that surgery is required.

Other signs include:

  • Chronic back pain or neck pain
  • Sciatica
  • Loss of bladder or bowel control due to nerve compression
  • Difficulty standing up straight
  • Trouble walking due to instability in the spine

These issues sometimes become so severe that they affect daily activities and limit mobility. If any of these symptoms describe your current condition, it is important to talk to Dr. Johans immediately. He can explain exactly what treatment or procedure might be needed and how long recovery may take.

What is the Difference Between Disc Fusion and Replacement?

Disc fusion is a surgical procedure that connects two or more vertebral bones in any part of the spine. Dr. Johans will replace the degenerated disc with a titanium cage filled with your bone marrow and secured with a plate and screws that fuse the two adjacent bones together, eliminating all motion between them. A fusion can help relieve chronic pain caused by damaged spinal discs and joints that no longer provide adequate support for the spine.

Alternatively, disc replacement is a less invasive (compared to disc fusion) spine surgery that replaces a damaged and degenerated disc with an artificial implant designed to replicate its natural function and restore mobility to the surrounding area. Unlike disc fusion surgeries, this operation preserves the range of motion in the spine because it does not permanently connect any vertebrae. The implant used in disc replacement surgery is typically made from metal, such as titanium. It is designed to move like a normal spinal disc, allowing for greater flexibility and improved stability for patients who have previously suffered from chronic pain due to spinal instability or damage.

Fusion is a long-term solution for relieving pain and restoring mobility caused by damaged discs. It is permanent, with a titanium cage held in place with screws and plates. The success rate of disc fusion varies depending on the patient's age and health condition at the time of surgery. Most people who have had this procedure remain pain-free for many years after their surgery; however, there are cases where further operations may be necessary due to the fusion breakdown or a burden placed on the nearby discs. Studies show that approximately 25% of patients may require additional disc fusion within ten years after surgery.

The longevity of disc replacement can vary greatly from person to person. Some people experience relief from symptoms for up to 10 years or more, while others may find lasting relief that lasts them throughout their entire life. The success rates also depend on individual factors such as age, health condition at the time of surgery, and how well postoperative care is maintained over time.


  1. If your symptoms of tolerable neck pain, stiffness, or tingling alone have been present for less than six months, then disc surgery is not recommended, as there may still be other treatments that can help alleviate the symptoms.
  2. Spinal damage at multiple points is a sign that surgery is not recommended, as it would be unable to address all of the areas affected adequately.
  3. Too much spinal instability due to excessively damaged vertebrae could cause a fused spine to tilt, putting excessive pressure on other vertebrae, making fusion a poor option.

Disc Replacement

  1. Patients with facet joint syndrome, bony compression on spinal nerves, scoliosis, or weakened bones from osteoporosis may not be viable candidates for disc replacement surgery.
  2. If a patient has advanced spinal deterioration caused by aging, disease, or trauma, a disc replacement may not ease any pain, numbness, or weakness caused by it.
  3. An inflammatory condition called Ankylosing spondylitis will affect the results of a disc replacement, making it ineffective.

  • Those who have failed to find relief with non-surgical treatments, medications, and physical therapy
  • People who experience severe pain or numbness in the arms
  • Individuals who need to maintain their mobility and stay active due to their occupation or lifestyle
  • Patients whose quality of life has been greatly diminished due to neck caused by a degenerative disc condition
  • Someone who has neck and arm pain, numbness, or weakness that is progressive despite conservative treatments
  • The spinal facet joints are in good condition

Depending on the severity of the condition, both operations may involve a period of recovery. However, recovery from disc fusion typically takes several months, whereas disc replacement only takes a few weeks.

During this recovery period, it is likely that a patient will have to wear a brace after a fusion surgery during their healing process to provide extra support and stability. Disc replacement patients do not need to wear a brace. In addition, Dr. Johans might recommend physical therapy following surgery to help the affected area recover its full range of motion and strengthen arm muscles. While physical therapy is beneficial for both surgeries, it can be even more important after a fusion since patients may lose some of their original mobility when the vertebrae are fused together and must learn new ways to move. Patients who receive a cervical fusion will be able to return to full work duties after 3 months, but disc replacement patients can return to duty just 1 month after the surgery.

General Risks with Disc Surgery

  • Pain: Disc surgery is an attempt to reduce pain but is not 100% guaranteed.
  • Bleeding: Any surgery carries a risk of excessive bleeding during and after the procedure due to the location of the surgery. Dr. Johans typically loses less than 1 oz of blood and has never had to give a blood transfusion, even after many thousands of neck surgeries.
  • Infection: Surgery always carries a risk of infection due to the invasive nature of any procedure. Dr. Johans takes careful precautions, and he has never had a patient develop a deep infection in 30 years of being a surgeon.
  • Nerve Damage: Disc surgery carries a risk of nerve damage due to its proximity to delicate anatomical structures and nerves within the spine.
  • Spinal Cord Injury: The risk of quadraplegia is possible. Dr. Johans has never injured a spinal cord despite *touching it many hundreds of times during previous neck surgeries.

Risk of Disc Fusion

  • Risk of Secondary Surgery: Disc fusions are generally successful procedures; however, a second procedure might be necessary in some cases to address ongoing pain or other complications. Additionally, a second surgery might be needed when the discs above and below the first fusion work overtime and deteriorate.
  • Fusion May Not Be Successful: While the fusion process can often be successful after a single disc fusion procedure, the spine may not fuse properly due to age, pre-existing conditions, or other factors.
  • Swallowing Difficulty: Usually only causes minor disruption to swallowing and will not last very long.
  • Lack of Fusion: A lack of fusion is when the fusion weld does not take and there is a lack of union. This complication is largely dependant on a patients smoking history, medications, age, and if they are experiencing osteoporosis.
  • Voice Damage: Damage to the vocal cords is very rare.

Fusion can do more harm than good in some cases. Joining two or more vertebrae together during the fusion process can cause damage to discs adjacent to the fused vertebrae by applying extra pressure on them. This could lead to further spinal degeneration in those areas down the line. Spinal fusions often last less than someone may expect; sometimes, they will only last around ten years or less before another surgery or fusion becomes necessary.

Undergoing a spinal fusion limits a person's ability to move freely because it decreases their range of motion and flexibility in that particular area of their spine. This means that the life of someone who underwent a spinal fusion will never be quite the same again.

Disc replacement is an increasingly popular option for addressing many spine-related issues. Unlike spinal fusion, disc replacement allows the patient to retain their mobility while achieving the desired outcome of pain relief or stability. Mobility following a disc replacement is typically very high, with most motions returning to pre-pain levels. This is the same reason why surgeons will no longer fuse shoulders, elbows, hips, or knees, because joint replacement leads to a much better functional outcome.

Recovery time is often faster following a disc replacement. Patients can usually expect to get back up on their feet sooner. Disc replacements also tend to last longer than fusions since they don’t require permanent changes or large alterations to the spine.

Disc Replacement Surgery by Dr. Johans

Dr. Johans is a highly experienced, board-certified neurosurgeon and pain management specialist with exceptional expertise in neck pain, lower back pain, carpal tunnel syndrome, and cervical arthroplasty. He is a Diplomat of the American Board of Neurological Surgeons and Pain Management and a Fellow of the American College of Surgeons and the American Board of Neurological Surgeons.

If you have any of these conditions or suspect that you may be suffering from any other neurological disorder, please get in touch with Dr. Johans at 208-327-5600 for a consultation to discuss which treatment plan may be right for you.

Dr. Johans is committed to providing personalized care tailored to meet the needs and effective treatment options to achieve maximum relief from discomfort. With over 30 years of experience in neurological surgery and pain management treatments, patients can trust that he will provide the highest standard of care available so they can get back on track with life as quickly as possible!