Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
When chronic back pain persists despite medication, physiotherapy or other conservative treatments, two surgical options are often explored: spinal fusion and artificial disc replacement (ADR). Both procedures are designed to relieve pain and restore spinal stability, but they differ in technique, purpose and suitability depending on each patient’s condition.
However, how do you know which procedure is more suitable for you? Let us explore their differences and suitability.
What Is Spinal Fusion?
Spinal fusion is a surgical procedure that permanently connects two or more vertebrae to eliminate movement between them and reduce pain. The surgeon places bone graft material, taken from the patient, a donor or a synthetic source, between the affected vertebrae. To stabilise the spine during healing, metal plates, screws or rods may also be used. Over time, the graft helps the bones fuse into a single, solid structure, restoring stability and reducing pain.
Spinal fusion is considered for conditions such as:
- Spinal instability from spondylolisthesis
- Severe degenerative disc disease
- Spinal deformities like scoliosis
- Fractures that compromise stability
- Certain tumours or infections in the spine
While potential risks include infection, bleeding, blood clots or complications with bone healing and hardware, these are uncommon when the procedure is performed by an experienced spine surgeon. With proper care and rehabilitation, most patients achieve significant pain relief and improved spinal stability.
What Is Artificial Disc Replacement?
Artificial disc replacement (ADR), also called disc arthroplasty, is a procedure in which a damaged spinal disc is removed and replaced with an artificial implant. The prosthetic disc is designed to replicate the movement and cushioning of a healthy disc, helping to preserve natural motion at the treated spinal level.
Disc replacement is typically considered for:
- Patients with degenerative disc disease affecting a single spinal level
- Individuals without severe facet joint disease or spinal instability
- Patients who have not undergone major spinal surgery at the same level
Unlike fusion, ADR is designed to preserve natural motion in the treated segment, which may help reduce stress on nearby discs and maintain overall spinal flexibility. While potential risks include implant wear, dislocation, infection or residual pain, these are uncommon with proper patient selection and expert surgical care. Most patients experience lasting pain relief and improved mobility following recovery.
Key Differences Between Spinal Fusion and Artificial Disc Replacement
Spinal fusion and artificial disc replacement (ADR) both aim to relieve disc-related pain. However, each procedure works distinctly and carries its own benefits, limitations and long-term considerations.
- Motion: In spinal fusion, movement at the treated segment is eliminated to stabilise the spine, while ADR maintains natural motion by replacing the damaged disc with a mobile implant.
- Indications: Fusion is typically recommended for spinal instability, deformities or multiple affected levels. ADR is more suitable for single-level degeneration in patients with healthy bone quality and minimal joint damage.
- Long-Term Effects: By restricting movement, fusion may place additional stress on nearby segments, which can lead to future wear and tear. ADR helps preserve spinal mechanics and may reduce the risk of adjacent segment degeneration.
- Surgical Technique: Fusion uses bone grafts and metal implants to permanently stabilise the spine, whereas ADR involves placing a prosthetic disc that mimics the cushioning and movement of a natural disc.
What Are the Factors to Determine the Right Option?
Choosing between spinal fusion and disc replacement depends on several key factors. Imaging tests such as X-rays, MRI and CT scans help assess spinal alignment, disc condition and bone quality. Patients with active infections, uncontrolled chronic illnesses or poor overall health may not be suitable for surgery.
- Age: Younger patients often benefit from motion-preserving disc replacement, while older individuals with widespread degeneration may be better suited for fusion.
- Activity Level: Those seeking to maintain an active lifestyle typically prefer disc replacement; fusion may be more reliable for lower activity levels.
- Spine Condition: Disc replacement may not be ideal for patients with severe facet arthritis, instability, deformity or osteoporosis. Fusion offers greater stability in such cases.
- Previous Surgery: For patients with prior fusions, disc replacement can help preserve motion, whereas multiple-level degeneration often calls for fusion.
If you are considering spine surgery, whether spinal fusion or artificial disc replacement, scheduling a consultation with an experienced neurosurgeon is the best next step. A specialist can provide a thorough assessment of your spine, explain the benefits and risks of each procedure, and help determine which option best fits your condition and lifestyle goals. To learn more, book an appointment or contact us at info@oxfordspineneuro.sg.
Our Spine Specialist in Singapore
Dr Colum Nolan
Senior Consultant Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Dr Colum Nolan is a Senior Consultant Neurosurgeon and the Medical Director of Oxford Spine & Neurosurgery Centre. He undertook specialist neurosurgery training in Ireland and Australia, and later on completed a complex spine surgery fellowship at Addenbrooke’s Hospital in Cambridge, UK.
Dr Column held key leadership roles including Director of the Spine and Spinal Disorders Programme at the National Neuroscience Institute (NNI), as well as the Head of Neurosurgery Service at Sengkang General Hospital.
With his depth of experience, Dr Colum is committed to guiding each patient towards the safest and most effective treatment for their needs.
