Alternative treatments to spinal fusion

What is spinal fusion?

Spinal fusion is a surgical procedure in which an upper and a lower vertebra of the spine are fused together with the use of tools such as plates, screws, rods, and spacers.
This surgical operation is performed for various back pain conditions such as lumbar disc herniation, lumbar spinal canal stenosis, lumbar spondylolisthesis, lumbar degenerative spondylolisthesis, and other spine instabilities caused by disc degeneration following aging or heavy work.
Compression of a nerve root can cause pain, numbness, and other severe pain in the lower back, and this procedure is also used when the cause of the symptoms is a compressed nerve, in order to relieve numbness and pain by alleviating the pressure on that specific nerve.

How is the surgical procedure performed?

There are three surgical methods available for spinal fusion


  • 1) Posterior lumbar fusion

    This is a surgical method to hold the vertebrae together that is performed from the posterior side of the back. Access from the posterior side is often preferred when treating lumbar spinal canal stenosis, lumbar disc herniation, lumbar spondylolisthesis, lumbar spondylolisthesis, and lumbar degenerative spondylolisthesis. First, it involves removing a part of the vertebrae called the vertebral arch and the spinous process from the lumbar vertebrae, as well as the intervertebral discs and ligamentum flavum. Next a spacer is inserted in place of the intervertebral disc between the upper and lower vertebrae so as not to damage the nerve, and a metal plate is set on the vertebral bodies and secured by means of rods and screws.

  • 2) Lateral lumbar interbody fusion

    This is a surgical procedure similar to the posterior vertebral fusion that fuses vertebral bodies from the backbone. The posterior vertebral arch is removed, and the posterior vertebrae are held together using the patient's own bone material as well as metal devices to prevent injury to the nerve. This method does not involve the removal of the disc or ligamentum flavum.

  • 3) Anterior lumbar fusion

    This surgical procedure is performed when vertebrae in the lower back (the spine) have been fractured. During the anterior vertebral fusion, an incision is made from the side of the abdomen, and the intervertebral discs around the fractured vertebrae and the remnants of vertebral bodies are removed. The patient's own bone matter (bone graft) or bonelike material is used to replace the vertebrae or intervertebral discs and are held in place using fixation devices.

It is said that these techniques, by creating a space between the spinal canal and the nerve, can relieve the pressure on the nerve that is the cause of pain and numbness. However, in the event of a surgical procedure, the relapse rate is said to be generally around 30 to 45% (*1), and depending on the physical condition of the patient, the surgery itself may pose a risk. On some occasions, the patients may not be permitted to have surgery even if they wish to undergo it.

Potential risks posed by the spinal fusion procedure

The surgical procedure may damage nerves and blood vessels and may cause bacterial contamination and suppuration in the operated area, resulting in complications and infections.
In the case of a spinal fusion procedure, the lumbar spine may shift in place if damage to the fixation device or some loosening of the screws occur. Alternatively, there is a risk that the patient's exact physical condition may not be asserted correctly prior to the procedure due to poor communication with the doctor beforehand, or an allergic reaction due to metal or artificial components may also occur after the surgery. In addition, attaching a fixation device may cause discomfort, fatigue, and persistent pain in the lower back, with symptoms lasting for as long as a year in some cases. The vertebrae also become permanently immobilized after the operation, which translates into a limited use of the body, so the patient will have to bend and twist at the waist instead, making some movements difficult.
At our hospital, we are providing low back pain treatment, with release from the clinic on the same day, to treat patients whose old age would pose high risks during surgery, or who suffered a relapse of their condition in the wake of their previous surgery.

Alternative treatment to spinal fusion

DST(Discseel) is one of the most effective minimally invasive treatment procedures provided in our clinic as an alternative to spinal fusion. This regenerative spine procedure is used mainly as a treatment option for lumbar disc herniation, lumbar spinal canal stenosis, lumbar spondylolisthesis, lumbar degenerative spondylolisthesis, disc degeneration, and lumbar instability. Since the intervertebral disc is approached with a single needle, there is no need to make any incisions and unnecessary damage to the bones ligaments and surrounding tissues is avoided. The treatment involves injecting a medicine into the cracked disc that repairs it and allows it to regenerate. Repairing the damaged disc prevents the nucleus pulposus from leaking and as a result the inflammation that causes pain and numbness disappears. Hospitalization is not necessary, so patients can return home within the same day after the treatment. Being a minimally invasive outpatient procedure, DST(Discseel) is less physically demanding which makes it suitable for elderly high-risk surgical patients or patients who experience pain and numbness after undergoing a spinal fusion surgery.

  • DST (Discseel) treatment

    DST (Discseel) treatment

  • Lumbar spinal fusion

    Lumbar spinal fusion

Differences between the DST procedure and spinal fusion

  • Duration of treatment

    Spinal fusion is performed under general anesthesia, and a scalpel is used to make a skin incision to remove the vertebral arch, spinous process, and intervertebral joints in the back. The surgery takes approximatively 2 hours.

    The DST procedure is performed using a thin needle after local anesthesia.
    This method of treatment puts less strain on the body since no incision is required, the wound is small and minimally invasive, and the operation time is minimal (as short as 25 minutes).

  • Duration of treatment

    The skin incision made with a scalpel has the average length of 15 cm and may carry a risk of postoperative complications and infection.
    In addition, spinal fusion surgery may cause nerve damage and metal allergic reactions to the fixation device.
    The DST procedure does not involve any skin incision, but instead uses a needle for treatment, which results in a small dermal puncture of approximately 1.0 to 0.8 mm, so it is less likely to cause nerve damage and has a very low risk of infection and complications.

  • Recurrence rate.

    The recurrence rate for spinal fusion surgery is said to be between 30 and 45% (*1). Many patients also undergo revision surgery.
    The DST procedure repairs the disc and prevents the nucleus pulposus from leaking through the disc, so the recurrence rate is extremely low.

  • Going back to normal life

    If you undergo a spinal fusion, you will need to stay in the hospital for about two weeks and take rehabilitation sessions for about a month.
    No hospitalization is needed for our method of treatment, simply the patient must rest in bed for approximately an hour after the after DST procedure is performed. The patient can then go home on the same day and is able to do desk work on the following day.

1 "Pain Medicine 12. Review article failed back syndrome," 2011.
British Journal of Pain6. "Whose failure Time to discard a redundant term. 2012
Tatsuro Yamamoto, Keiichi Omote, Tatsuro Yamamoto, Masako Izeki, and Kihito Kawamada: “The Science of Low Back Pain”, Kobundo, May 2014.
Multiple research reviews referenced

Treatment flow

  • 01 Consultation with one of our doctors

    An MRI and x-ray will be taken, and the doctor will then make a diagnosis.
    If the diagnosis indicates that DST is suitable, you can start the procedure on the afternoon of the same day.

  • 02 Before the procedure

    A local anesthetic is administered to the lower back in the operating room and a needle is inserted into the lumbar disc(s) identified during the examination.
    An examination using a contrast agent is performed to pinpoint the location of the damaged disc.

  • 03 The procedure

    Fluoroscope guidance is then used to locate the disc and administer the drug to the damaged area. Once the drug has penetrated the zone, the needle is removed, and the bleeding is controlled.

  • 04 Going home

    The patient can go home upon completion of the treatment, after resting in a private room for about an hour and a final routine examination by the doctor.
    *The time of release depends on the patient's symptoms and condition.

Treatment cost of the DST procedure

Locations Treated 1 2 3 4 5
Cost of Treatment 1,320,000 Japanese Yen (JPY) 1,430,000 Japanese Yen (JPY) 1,540,000 Japanese Yen (JPY) 1,650,000 Japanese Yen (JPY) 1,760,000 Japanese Yen (JPY)
Notes
*If the procedure is performed in our hospital, all the costs of consultation, diagnosis, MRI and other tests will be included in the costs listed above.
*If the same treatment is performed again within 3 years of the first treatment, the treatment fees will be reduced by half.
*All prices are before tax.
*Since this method of treatment is not covered by health insurance, the patient must bear the entire cost of the treatment.
*In case of treatment only (one day treatment), We accept payment by credit card (VISA, MasterCard, China UnionPay).
*If you wish to request rehabilitation (specialized for back pain), bank transfer by credit card is also accepted.
*You can receive a tax refund at the time of filing your tax return for medical expenses.

Frequently Asked Questions

  • question

    I have been experiencing pain and numbness for quite a long time now. Should I see a doctor?

    answer

    If the pain or numbness persists for more than a month, we recommend that you consult a doctor. X-rays and MRIs will be performed to determine the cause of the pain and numbness, and a diagnosis will be made.

  • question

    Is it possible to treat spondylolisthesis using the DST procedure?

    answer

    We can also treat spondylolisthesis if the procedure is deemed suitable for your pathology. Please contact us for a consultation so that we can determine if you are eligible for treatment.

  • question

    I am experiencing continuous pain and numbness after undergoing spinal fusion surgery previously. Is there any way to improve my condition?

    answer

    If lumbar disc herniation, lumbar spinal canal stenosis, lumbar spondylolisthesis, or a lumbar degenerative spondylolisthesis are confirmed, conservative treatments will usually be performed according to the doctor's instructions.
    Or, the DST procedure can also be applied as a minimally invasive treatment alternative to spinal fusions that cannot be re-operated.

  • question

    Is the DST procedure only available at the ILC International Lumbago Clinic?

    answer

    Yes, we are currently the only hospital in Japan that is fully accredited to perform the DST procedure. In addition to being a minimally invasive treatment, we also provide a one-day treatment.

  • question

    Should I continue rehabilitation after leaving the hospital?

    answer

    Yes, it is important to continue rehabilitation to prevent recurrence of the pathology.
    It is necessary to avoid heavy labor as much as possible and try to perform movements without putting a strain on your lower back.
    If you are experiencing severe pain or numbness, you should consult with a doctor to discuss the appropriate exercises.
    Since we are operating in coordination with a rehabilitation facility, we can also provide exercise guidance and training.

    Click here to access a rehabilitation facility that specializes in low back pain:
    ILM International Lumbago Medical Fitness

5 Types of Outpatient Treatment for Low Back Pain

  • The DST Method (Discseel™)

    An intervertebral disc treatment that began in the United States in the 2010s. Can be suitable for a wide range of conditions, including problems in patients after surgery. It is the only (※2)treatment that can repair and regenerate intervertebral discs.
    ※2 According to research by Operation Japan (Ltd.)

    Click here for details.
  • The PIDD Method (Implant)

    An implant intervertebral disc treatment that has been conducted since the 2000s. As with PLDD, results without injury to intervertebral discs can be anticipated. This treatment is suitable for herniated discs only.

    Click here for details.
  • Hybrid Laser Treatment

    A treatment that combines the benefits of PLDD and PODD. This treatment is suitable for herniated discs only.

    Click here for details.
  • The PODD Method (Ozone)

    An ozone intervertebral disc treatment that has been conducted mainly in Europe since the 1990s. It can be suitable for a wide range of conditions.

    Click here for details.
  • The PLDD Method (Laser)

    An outpatient, laser intervertebral disc treatment that has been well known worldwide since the 1980s. This treatment is suitable for herniated discs only.

    Click here for details.