Joey Wahler (Host): For those with severe back or
neck pain, there are two viable surgery alternatives. So, we're discussing
artificial disc replacement versus spinal fusion. Our guest, Dr. Dami Oluyede.
He's an Orthopedic Spine Surgeon with Dignity Health. This is Hello Healthy, a
podcast from Dignity Health. Thanks for listening. I'm Joey Wahler. Hi, Dr. Oluyede.
Thanks for joining us.

Dami Oluyede, MD: Thank you for having me. This is
a great topic to talk about.

Host: Absolutely. Great to have you on board for it. So first, why
might someone need artificial disc replacement or spinal fusion?

Dami Oluyede, MD: So, generally the main reasons we
intervene for spine is when you have what we call a radiculopathy, which is a
fancy way of saying pressure on nerves causing pain, numbness, tingling, or
some level of dysfunction to your extremity. Oftentimes that also comes with
neck pain, if the pathology is in the neck or, low back pain if the pathology
is in the low back. But generally some kind of nerve issue, that creates
dysfunction that needs to be fixed.

Host: And what typically causes that?

Dami Oluyede, MD: So that varies based on the
number of things. You can have pathology from soft tissues, most commonly a
disc, that can occur from an injury, that can occur from repetitive work. It
can occur from genetic component. It can occur most commonly from wear and tear.
Basically, we don't think about this much when we don't have pain, but as we
use our backs, our necks, our bodies in general, it's basically that they're
working every day. You know, it's like you have a whole bunch of employers in
your body. They're all trying to keep up with the workload you give them. So
just wear and tear can also cause the same thing.

Host: Great analogy there. So what symptoms specifically may mean it's
time to have back pain looked into? What's sort of the line between bearable back
pain that would likely not mean there's a spinal issue and something more
serious like what you were just alluding to?

Dami Oluyede, MD: So in people that have what I
call actual back pain or actual neck pain, meaning that the pain is primarily
in the neck or the back, if there was an injury or something that occurred, you
know, I usually say give time. So I look at the trend. So let's say your pain
started off. And we like to use pain scales. So let's say the first day you
have a pain, the pain was about an eight, and two weeks later you can look at
me and say it was a five and two weeks later it's a three. The trend is
basically telling me that it's getting better and it doesn't really necessarily
need my help or anyone's help to help it along.

Some people, their pain will be associated with some of those
radicular symptoms or nerve mediated symptoms I was referring to, namely the
burning sensation, the tingling sensation, the numbness, the weakness; that is
more concerning. And I would say you should at least see someone to investigate
to make sure there's not a more serious issue. Cause that might mean there's a
nerve component to it.

Host: Gotcha. So what are the basic differences between disc
replacement and spinal fusion?

Dami Oluyede, MD: In terms of what people care
about, the biggest difference is the implant that's going in. And when I say
implant, I mean the tool that's being used to repair that disc space. In a
fusion, the implant we're putting in is a non mobile, meaning it's a static,
does not move tool and in a replacement, it's a mobile tool to try to replicate
what your disc was doing before.

Now, the biggest misconception that I see in my practice is people
think one is better than the other. And I think that's a misconception. They're
both great options. They both work very well, and the indications for one over
the other, varies based on the patient. Cervical disc replacement were made for
a very, very tight group of people that had purely disc issues without any
other bony issues to address them or give them the option to address without
fusing them. So they're both great options, but the biggest difference is the
disc replacement still has a mobile implant.

Host: And so in terms of, to use your terminology what the average
patient would care about; what are the benefits of the one procedure versus the
other?

Dami Oluyede, MD: So the biggest benefit of a
fusion is it's tried and true. I mean, we've been doing fusion since quite
literally the early 19 hundreds. It's been around for a while. It works very
well for decompressing and stabilizing the spine, and the biggest disadvantage
of a fusion is that over time it can put a little bit more stress and strain on
the levels that are next to it. We call it adjacent segment disease. The way I explain
it to my patients is, for example, in the neck, you have seven vertebral
bodies. So I say you have seven workers, and let's say one of them gets sick,
and due to that, the factory stops working cause everyone is paying attention
to that worker.

You have the option of shutting down the factory and letting the
person recover. Or you can send that person home and the other six people get
back to work, which means your factory keeps running. Now obviously those six
people are carrying the workload of seven, so they do get a little bit more
stress and strain to them.

That's kind of what I liken a fusion to, is it gets you back
functioning, but the work that needs to be done, namely the movement that your
neck did before is shared by six instead of seven people. With a disc
replacement, the biggest advantage is that last point I just brought up is in
theory, you're putting a mobile segment back in and that allows seven people to
keep functioning in your neck. And obviously that sounds great at face value, but
again, the key to remember is the right indications. Are you a right person for
a disc fusion or are you a right person for a disc replacement?

Host: And so speaking of which, what more than anything makes you
diagnose one as being better than the other for a given patient? Who's a
candidate for one versus the other?

Dami Oluyede, MD: I think some people have put it
together from some of the things I'm saying. So, if you come in with a purely
disc issue, meaning that, at the level of your neck we're talking about,
there's no arthritis, meaning that your facet, your bones, everything is lining
up appropriately, there's no major issue in the bony aspect itself, and it's
purely a soft tissue, AKA, a disc issue; then I'll say a disc replacement or
fusion, either or is a candidate, and in that situation, I would lean more
towards a disc replacement because you do get the added benefit of retaining a
mobile segment.

And there's been a lot of research that shows in terms of the goal
of surgeries, of decompressing a nerve, both a fusion and a disc replacement
achieve that and achieve that successfully. And the other extreme would be
someone that has a lot of degenerative changes, which is a fancy way of saying
wear and tear and arthritis.

In that picture, usually there's some bony component to what's
creating pressure on the nerve. So if I was to take just the disc out and put a
new disc in, that doesn't give me the opportunity to address the bony
component, which means you might still have some residual pressure on the
nerves. So someone that has a lot of arthritis or a lot of bony disease, I
would recommend a fusion because that allows us the opportunity to address both
the disc and the bony component of the pressure.

The other things to think about is in people that have a lot of
arthritis, when you put in a disc replacement, that segment still moves, and a
lot of people don't think of it like this. What causes pain in arthritis is
when the bones are rubbing together, basically you've lost the cushion that was
there, protecting those bone ends.

It's worn away or it's gone for some reason or the other. So the
bones are rubbing. So if you have a lot of arthritis and someone puts in a disc
replacement, your facets, which are the names of the bone, can still move and
rub and create a lot of neck pain. So in people that have both a disc issue and
a degenerative or arthritic issue, I tend to go towards a fusion because
there's that component of arthritis that can still create pain after the disc
replacement.

Host: So what's meant when it's said that there are various levels of
the spine and can discs be replaced at any of those levels?

Dami Oluyede, MD: We can talk till we're blue in
the face as to the history of disc replacements. We've tried them of various
sorts in various parts of the world, in Europe and in the states in the neck
and the low back primarily, very little indication to no indications to do a
disc replacement in the thoracic spine, which is the mid-back because your
ribcage stops you from any significant motion there.

So, it doesn't apply generally. In the neck we talk about the sub
actual neck, meaning from level C three, which stands for cervical level three
to C7, and in the low back lumber spine from L2 to S1. So could you put a disc
replacement anywhere in the back in theory? Yes. Where is it indicated for?
From C3 to C7 in the neck and from L2 to S1 in the low back.

Host: Couple of other things. First, can a previous fusion be revised
or reversed by replacing a disc?

Dami Oluyede, MD: So in life and in medicine, you
never say never. So I'll say yes, it can be, but the indications for that is
extremely, extremely, extremely, extremely rare. And part of what I said
earlier, should kind of explain this. Let me elaborate. Is it's more common to
see people go from a disc replacement to a fusion.

So it's more common to have a disc replacement be revised to a
fusion. It's very rare to have a disc fusion be revised to a replacement for
two reasons. The first being, if you were to have a fusion in the first place,
you most likely had some kind of degenerative condition or arthritic condition
that led to your surgeon choosing a fusion over a replacement.

Let's say you're the person that didn't have a lot of that and
someone does fuses you, by definition, the bone ends are now fused or very
close to being together, cause to achieve a fusion, those bone ends have to
basically touch and become one. Can I go back in there and break it apart? Yes.
And put a disc in? Yes. But then you have bone ends that are not congruent,
meaning that they're not perfectly aligned anymore, that are rubbing together
and could then cause the same neck pain or back pain in that patient. So I
would advise against it. It's possible, but there will be very, very rare
indications. It's more likely to go from a disc replacement to a fusion.

Host: So be it replacement or fusion, what quality of life benefits,
improvements can patients expect after the procedure?

Dami Oluyede, MD: The biggest thing to know is
they're both great options and it just has to be patient selection, meaning
that if a fusion is done for the right reasons, patients will love it. What do
I mean by that is if you have nerve mediated symptoms, meaning you have
pressure on the nerve causing numbness, tingling, weakness or some sort of
dysfunction; when you decompress, which both those surgeries do; when you do a
disc fusion or a disc replacement, part of the surgery is to decompress the
nerves. So by doing that, there's usually significant improvement in the level
of pain, numb, tingling a patient has.

Some people will make an argument that a fusion has a little bit
better tendency to help with neck pain because you're stopping the components
from moving. But disc replacement can also do the same thing because you're
creating a congruent alignment of those joints. So generally, the one thing I
tell my patients is nerve mediated symptoms are the most reliable to change because
that's the main goal of the surgery, to decompress nerves.

Then neck pain, depending on the reason you're having the neck
pain is also a good expected thing to change, but apart from the disc and the
bones that we talk about, the ignored aspect are the muscles and the way we use
those muscles. So another thing I coach my patients on and irrelevant of which
you choose, there's a muscular component that you also have to pay attention to
and rehab to get the best prognosis.

Host: Gotcha. Well, folks, we trust you are now more familiar with
artificial disc replacement versus spinal fusion. Dr. Dami Oluyede, thanks so
much again.

Dami Oluyede, MD: Thank you for having me.

Host: Thanks for being here. And for more information, please visit
Dignityhealth.org/bakersfield/ortho. Again,
dignityhealth.org/bakersfield/o-r-t-h-o. Now, if you found this podcast
helpful, please share it on your social media and thanks for listening to Hello
Healthy, a podcast from Dignity Health.

Hoping your health is good health. I'm Joey Wahler.