Fusion or disc replacement L4-L5?

@brycek112 I'm with the second surgeon because the disc replacement preserves the motion, which in turns elimates the transfer of stress to other segments. https://www.spine.md/artificial-disc-replacement/disc-replacement-vs-spinal-fusion/
Young or old I'd think disc replacement a better choice, but I'd want a surgeon with a lot of experience.

Spinal fusion surgery is a surgical procedure to fuse the spinal bones together with a bone graft. There are many variations on this theme, but once the spine has healed, two or more vertebral bones will be fused together like a single bone.
Artificial disc replacement surgery, on the other hand, is a surgical procedure to replace the problem vertebral disc or discs with a prosthesis or artificial joint. The main difference between disc replacement and spinal fusion is the mobility of the spine after the surgery. After fusion surgery, the treated area is less flexible and mobile because the vertebral bones of the spine no longer move independently. After disc replacement surgery, the prosthesis mimics the natural joint, so the spine is able to bend, flex, and rotate as it did when the disc was healthy.
Talk to your Doctor to see if you
qualify for a (SCS)
Spinal cord stimulator
Hope this helps

@brycek112
Did they say what is causing your DDD at such a young age? Did you have an accident or play sports that caused serious compression of your L4-L5 disc? Were you told you have a congenitally narrow spinal canal?

I am 55 and just had L3-L5 decompression and fusion surgery in August 2024 due to severe central spinal canal stenosis, DDD and neurogenic claudication. You could not even see my spinal canal/cord on MRI because it was so severely compressed by disc bulge plus arthritis bone growth. Many symptoms are improved while in the healing process. There is some restriction in movement but I was restricted before due to pain. My L4 vertebrae was slipping over L5 (spondylolisthesis) so they needed to use hardware to stabilize my spine to prevent movement and support fusion plus they removed lamina bone to give space for spinal cord.

Depending on the cause of your DDD and compression of L4-L5 disc, disc replacement may be okay but if you have instability in your spine, the fusion would help to limit the movement which could cause issues with a disc replacement (may slip/move again requiring another surgery). It would be good to ask both surgeons questions as to pros and cons and maybe get a 3rd opinion one you get more answers and information. Have you seen neurosurgeons or orthopedic spine specialists? I had my surgery done by an orthopedic surgeon ( he also did my cervical spine surgery).

wow… too young. my son injured his spine at 18 … 20 years ago. Disc replacement was not available. He is fine and has not needed further surgery. I would opt for disc replacement that is IF it is best choice.

I am looking at a fusion from S1-T12 to avoid a 2nd surgery from most likely adjacent spine problems in my future. I have a lot more going on and am 67.

However, I have consulted with 6 surgeons over the past 2 years to help make this determination. Keep asking questions and doing your research till you are comfortable with your decision for yourself.

This site has been helpful and while no one has the exact situation as mine, I have learned a lot from these posts.

I wish you well and relief from the pain!
T

@brycek112 Welcome to Connect. Deciding on spine surgery is always difficult and you have one chance to get it right. There isn't a perfect solution that will return you to pre-injury status, and each procedure has it's own risks and limitations, so you have to choose what you think is best with the advice of your surgeon. There are differences in manufacturers of artificial disks with different engineered designs. There are different cages and spacers if a fusion is performed as well as just a bone disc spacer. One consideration is that foreign materials and metal that will be introduced with hardware. Hardware is held in by screws which can pull out. Bone quality is important to stand up to pressure from screws which must be placed at the correct angle and depth, and there is a lot of pressure from body weight at the lower end of of the spine. As a younger person, bone quality may not be a limiting factor. You also have to consider what happens as you age. Some hardware can fail, and you may want to research any manufacturer for literature about failed devices. If you have instability with vertebrae that slip past each other, that may limit you to a fusion. There are defined standards for when an artificial disc is acceptable. I'm not saying this to worry you, but you need to understand what you are getting into. If no surgery is done, and a disc has collapsed enough, the bones of the vertebrae above and below that may start to automatically fuse. There is a window of time in which surgery may be more successful, and that also depends of what other health issues you have. Often surgeons make smokers quit before they will operate because it affects the ability to heal.

Having spine surgery in your 20's of course will change your life, and you won't want to be doing sports that will add extra pressure to the spine. Once your spine has been re-engineered with surgery, you'll want to be gentle with it so as not to cause other discs to wear out because they will get added pressure. Adjacent segment disease happens with both artificial discs and fusions. Ask the surgeon for statistics. Typically, they say motion preserving artificial discs have a better track record on that, but nothing is guaranteed. Your results will be different than other patients, so do the best you can to figure out what solution fits you best. Different surgeons choose different spine hardware and will have had a training from the manufacturer specific to the devices they implant. This is why you should get several surgical opinions before deciding on a surgeon and sign up for a procedure. Ask why a surgeon prefers a device. There may be pros and cons, and the surgeon may not look for other solutions if they are comfortable with the way they do things. There is always new hardware in clinical trials. That decision is permanent and there are no do overs once surgery has been done. There can be revision surgery if something fails, but the first surgery sets the stage for what is compatible for spine surgery going forward if more surgery is warranted in your future.

If you think of questions to ask a surgeon, you are welcome to post them here and get responses from other patients about why they chose something or what worked for them. No one here can advise you, and that can only come from a surgeon who has examined your condition, but there is a lot to learn.

Do some research into the average success rates for each type of surgery, And the biggest risks of each. I wish I had been knowledgeable enough to have done this. I would not have consented quite so easily. Also, check out very carefully the doctors. Like their success rates, recommendations from past patients, etc. Look them up on castleconnelly.com. This is the group that rates only the very best doctors for U.S. News and World Reports. I have NEVER had a problem with one of their doctors, ever. Because I did not do these things with my fusion, I ended up with a spinal cord injury, and not much quality of life.

At 24 years of age I would do try any appropriate option besides fusion surgery. As I was told at Mayo, you need to put off fusion as long as you can. It’s not that you’re putting off the fusion now but the fusion you will need after the first fusion. I’ve had L4, L5 and S1 fused and told I need additional fusing. If your doctors tell you that repairing the disc could be an answer. I would certainly recommend it over fusion. There is a place for fusion, but my fear is at 24. You’ll be looking at many more possible fusions. My cousin has had six different surgeries. I trust this is helpful and pray that you will make the best decision for you.

Go to 2 more doctors and then decide!

I am 73 years old, soon to be 74.
My surgeon is going to check my Bone health before talking about Spinal Fussion Surgery.
In April of this year, he thought my Bones would not stand up to Spinal Fusion Surgery.
Now after 7 months of Envinity im having another CT Scan to look at my Bone Density Increase? I hope!
Any sugestions on how to approach this or if there are any alternatives? I have scoliosis also- ( hoping this would straighten my posture)
Thank You-Joe

My double spinal fusion did not help my scoliosis or give me back the 3 inches I lost that he promised. I didn't have scoliosis before I broke my back, I had very bad osteoporosis but they were able to do the fusion. It definitely helped my broken back. I still have constant lower back pain that can't be fixed with surgery. Good luck with whatever you decide.