Is Spinal Fusion the Only Option? What Your Surgeon Might Not Tell You

During a spinal fusion procedure, surgeons access the spine through various approaches. They remove the damaged disc material, prepare the vertebral surfaces, place bone graft material between the vertebrae, and secure everything with metal hardware to hold the vertebrae in position while the bone graft heals and forms a solid bony bridge.

The fusion process takes approximately 3–6 months, during which the vertebrae gradually grow together. Once complete, these vertebrae function as a single, solid bone segment, permanently eliminating motion at that level.

Once fused, the vertebrae no longer move independently. This loss of natural motion can limit flexibility and affect posture and overall biomechanics. The spine is designed to move, and eliminating motion at one segment places additional stress on the remaining mobile segments.

For patients who undergo multi-level fusions, the loss of flexibility can be significant, affecting their ability to bend, twist, and perform everyday movements that were once taken for granted.

Perhaps the most significant long-term complication of spinal fusion is adjacent segment disease (ASD), in which the spinal levels above and below the fusion deteriorate faster than they would naturally.

Recent Research on Adjacent Segment Disease

A comprehensive 2025 systematic review published in PMC reported that adjacent segment degeneration occurs in 36% of patients, while adjacent segment disease requiring treatment occurs in 11% of patients within two to seven years post-operation. ¹ This means more than one in three patients will experience accelerated degeneration at levels next to their fusion.

A 2024 meta-analysis examining cervical fusion found that the incidence of symptomatic adjacent segment disease following anterior cervical discectomy and fusion was 11%, while radiographic adjacent segment degeneration was present in 30% of patients.² The study identified older age, preoperative adjacent segment degeneration, developmental spinal stenosis, and postoperative reductions in cervical lordosis as significant risk factors.

Most concerning, a 2025 study analyzing temporal patterns of ASD found that risk factors differ depending on when ASD develops. Early ASD (within five years) was associated with different predictors than late ASD, suggesting the condition is not simply a result of aging but a direct consequence of fusion biomechanics. ³

A 2023 study on reoperation rates found that patients who underwent multilevel fusions had significantly higher odds of requiring reoperation due to symptomatic adjacent segment disease. Younger patients were also at increased risk, likely due to more vigorous and prolonged use of their adjacent segments. ⁴

Why This Happens

Fusion transfers stress to the spinal levels above and below the fused area, leading to accelerated degeneration. The spine functions as an interconnected chain of motion segments. When one segment is locked in place, the segments around it must compensate by moving more than they were designed to. This excessive motion accelerates wear and tear, causing disc degeneration, facet joint arthritis, and eventually new pain.

Many patients return years later with symptoms caused by adjacent segments breaking down. Sometimes requiring additional surgery to fuse those levels as well. This can create a domino effect in which each fusion leads to problems at the next level.

Screws, rods, and cages can fail, shift, loosen, or even cause allergic reactions in some patients. Hardware complications include:

Screw loosening or pullout: The screws anchoring the construct can loosen from the bone, causing pain and instability

Rod fracture: The metal rods connecting the screws can break under stress, particularly in long fusions

Cage subsidence: The interbody cages placed between vertebrae can sink into the vertebral body, losing height and potentially compressing nerves

Hardware prominence: Screws or rods can become prominent under the skin, causing discomfort and sometimes requiring removal

Allergic reactions: Though rare, some patients develop metal sensitivity or allergic reactions to titanium or other hardware materials

A 2023 study examining the influence of screw positioning found that proper hardware placement is critical for preventing cage subsidence and maintaining fusion integrity.

Additional surgeries may be needed to correct hardware issues, revise failed fusions, or address adjacent segment problems.

Fusion is an invasive surgery with a lengthy recovery period that can take several months. The typical recovery timeline includes:

Hospital stay: 2-4 days for single-level fusion, longer for multi-level procedures

Restricted activities: 6-12 weeks of limited bending, lifting, and twisting

Fusion healing time: 3-6 months for the bone graft to solidify

Full recovery: 6-12 months before returning to all normal activities

Physical therapy is usually required throughout this period, and returning to work or daily activities can be significantly delayed. For patients with physically demanding jobs, the recovery period may extend even longer.

Perhaps most concerning of all, many patients report no significant improvement in their pain even after a “successful” fusion. The surgery treats the structure—by eliminating motion—but does not always address the root cause of discomfort.

What the Research Shows

A 2025 study on patient satisfaction following lumbar fusion found that 81% of patients were satisfied with their overall outcomes. However, the study revealed something critical: current pain and function were independent predictors of satisfaction, while reaching the minimal clinically important difference was not. ⁵

This means patients care far more about genuinely feeling better than about meeting statistical benchmarks. Yet traditional outcome studies often focus on whether patients meet these thresholds rather than on real-world pain relief and function.

A 2025 ten-year study examining long-term outcomes after lumbar fusion found that 80% of patients perceived improvement at one year. This increased to 85% at two years but then declined, dropping to 68% at the ten-year mark. ⁶ The study also documented significant fluctuation in outcomes over time, with many patients experiencing a recurrence of symptoms years after initially successful results.

Another 2025 comparative study reported that spinal fusion had a higher “total effective rate” than non-surgical treatment (97.87% vs. lower conservative rates). However, this metric does not account for the substantial subset of patients who continue to experience persistent or recurrent pain. ⁷

Traditional spine surgery requires a specific skill set focused on open surgical approaches and fusion techniques. Some surgeons may not be familiar with newer, less invasive techniques because these methods weren't part of their training.

Endoscopic spine surgery, laser disc repair, and other motion-preserving procedures require specialized training beyond a standard spine surgery fellowship. Mastering these techniques takes years of dedicated practice and investment in specialized equipment.

Spinal fusion is a high-revenue procedure, and it may be prioritized by hospitals and surgical practices because of its reimbursement rates. A fusion procedure typically generates significantly more revenue than a minimally invasive disc repair.

Hospital systems often pressure surgeons to perform procedures that maximize revenue. Fusion requires longer operating room time, hospital stays, extensive follow-up care, and the use of hardware from manufacturers with whom hospitals often maintain profitable relationships.

Large academic medical centers and established spine practices have been slow to adopt newer motion-preserving techniques. Many institutions continue teaching and performing traditional fusion simply because it is what they know, despite growing evidence supporting less invasive alternatives.

Many spine care providers simply have not kept pace with evolving technologies and treatments like Deuk Laser Disc Repair®. If a surgeon only knows how to perform fusion, then fusion is what they will recommend. Regardless of whether it is the best option for your specific condition.

Whatever the reason, the result is the same: patients are often steered toward an outdated treatment that may not be in their best interest.

Using live imaging, the surgeon guides a small tube into the damaged disc through a tiny 4–7 mm incision (about the size of a pencil eraser). Through this tube, a high-definition endoscopic camera and laser are inserted.

The Holmium:YAG laser precisely removes only the damaged portion of the disc—the part causing herniation and inflammation—while leaving healthy tissue completely intact. The laser also debrides the annular tear, which is the source of discogenic pain that fusion does not address.

The disc is repaired without affecting nearby muscles, bones, or nerves. Because the approach is entirely endoscopic, there is no muscle stripping, no bone removal, and no hardware placement.

Preserves Natural Mobility:
Unlike spinal fusion, Deuk Laser Disc Repair® allows your spine to move naturally. Nothing is fused, so you’re free to bend, twist, and move as before. Your spine maintains its full range of motion permanently.

Truly Minimally Invasive:
The procedure is performed through a 4–7 mm incision, which is smaller than most “minimally invasive” fusion procedures that use 1-inch or larger incisions. There is no cutting of bone or muscle, leading to dramatically faster healing.

No Hardware:
There are no screws, rods, plates, or cages used, eliminating hardware-related complications entirely. You won’t set off metal detectors, won’t need hardware removal surgery, and won’t face risks of screw loosening or rod fracture.

Rapid Recovery:
Most patients walk out of the surgery center within an hour and return to daily activities in just a few days. Many return to desk work within 3–5 days and resume full activities within 2–3 weeks.

Exceptional Success Rate:
This procedure has a 99.6% success rate in eliminating back and neck pain caused by damaged discs, with zero complications across more than 2,000 procedures performed over 15 years.

Performed by a Specialized Expert:
Doctor Ara Deukmedjian, a board-certified neurosurgeon who pioneered this technique and has published peer-reviewed research documenting its safety and effectiveness.

This procedure is unique because it has been peer-reviewed, published in medical literature, and proven effective in clinical settings. It is FDA-approved (using FDA-cleared technology) and performed in a world-class, fully accredited surgical facility.

Deuk Laser Disc Repair is also revolutionary because it:

Treats the disc without removing it entirely: Unlike discectomy procedures that remove large portions of the disc, DLDR removes only the damaged 5-10% that's causing symptoms

Targets inflammation with pinpoint precision: The laser debrides the annular tear that generates inflammatory chemicals, addressing the source of discogenic pain

Avoids damage to nearby tissues: The endoscopic approach protects surrounding muscles, nerves, and bone structures

Addresses both herniation and discogenic pain: Traditional surgery addresses nerve compression from herniation but often doesn't resolve the deep, achy pain from the damaged disc itself

This comprehensive approach ensures better long-term outcomes and a dramatically reduced risk of recurrence or adjacent segment problems. ⁸

Deuk Laser Disc Repair is effective for a range of painful spinal conditions, including:

• Herniated or bulging discs
• Degenerative disc disease
• Sciatica and radiculopathy (pinched nerves)
• Annular tears (the source of discogenic pain)
• Disc-related chronic back or neck pain
• Failed previous fusion (in select cases)

If you're experiencing chronic back or neck pain, numbness, tingling, or weakness in your arms or legs, this could be the solution you've been looking for.

“Do I have actual spinal instability, or is my pain from disc damage?”
Fusion is designed to treat instability. If your pain is caused by a damaged disc, motion-preserving options may be more appropriate.

“Have you confirmed that my disc is the source of my pain, or could it be my facet joints or another structure?”
Accurate diagnosis is essential. Fusing the wrong level, or addressing the wrong pain generator; often leads to failed surgery.

“Would I be a candidate for Deuk Laser Disc Repair® or other motion-preserving procedures?”
If your surgeon says no, ask why. Get specific, medically grounded reasons—not vague dismissals.

"How many levels are you proposing to fuse, and why?"
More levels fused means more motion lost and higher risk of adjacent segment disease.

"What is your complication rate for this specific procedure?"
Surgeons should be able to provide their personal complication rates, not just general statistics.

"What is your reoperation rate for adjacent segment disease?"
This reveals the long-term track record of their fusion technique.

"What percentage of your fusion patients require additional surgery within 5-10 years?"
This question uncovers the reality of adjacent segment problems.

"Have you personally trained in endoscopic spine surgery or laser disc repair?"
If not, they may not be qualified to evaluate whether you're a candidate for these alternatives.

"Why isn't a motion-preserving procedure appropriate for my case?"
The answer should be specific to your anatomy and condition, not "that's experimental" or "insurance won't cover it."

"Can I get a second opinion from a surgeon who specializes in motion-preserving techniques?"
Any surgeon who discourages second opinions should raise red flags.

If your surgeon becomes defensive, provides vague answers, or dismisses alternatives without specific reasons, that's a significant red flag warranting a second opinion.

• Confirmation your diagnosis is correct: Second opinions often reveal misdiagnoses or incomplete evaluations.
• Understanding all available treatment options: Including alternatives your first surgeon may not have mentioned.
• Honest assessment of whether fusion is truly necessary: Especially from a surgeon trained in both fusion and motion-preserving techniques.
• Perspective from a different training background: Different surgical training often leads to different approaches and solutions.

At Deuk Spine Institute, we offer a free virtual consultation and MRI review. During this consultation:

Dr. Ara Deukmedjian will personally review your MRI images.

You perform movement tests via video to assist in diagnosis.

He provides an honest assessment of whether you’re a candidate for laser disc repair.

He will recommend his technique, other surgical approaches, or even conservative pain management if surgery is not necessary.

This consultation provides valuable insight from a surgeon who has published peer-reviewed research on his laser technique and has performed more than 2,000 of these procedures with documented outcomes.

A: Adjacent segment disease is remarkably common. Recent 2025 research shows that radiographic adjacent segment degeneration occurs in 36% of patients, while symptomatic adjacent segment disease requiring treatment develops in 11% of patients within two to seven years after fusion. Risk is higher in patients who undergo multilevel fusions and in younger individuals.
The condition occurs because fusion eliminates motion at one level, forcing the adjacent levels to compensate by moving more than they were designed to—accelerating wear and tear over time.

A: Success rates vary significantly depending on how “success” is defined. A 2025 study found that 81% of patients reported satisfaction with their fusion outcomes, but satisfaction correlated more with actual pain relief and functional improvement than with meeting statistical benchmarks.

Long-term outcomes are less encouraging. A 10-year study found that while 80 –85% of patients felt improved within the first two years, only 68% still felt improved at the 10-year mark.

Overall success depends heavily on proper patient selection, surgical technique, and most importantly whether the fused level was truly the source of pain.

A: Traditional spinal fusion recovery is measured in months, not weeks. The typical timeline includes: a 2–4 day hospital stay, 6–12 weeks of restricted activities (no bending, lifting, or twisting), 3–6 months for the bone graft to solidify and create a stable fusion, and 6–12 months before returning to all normal activities. Physical therapy is required throughout recovery.

In contrast, motion-preserving procedures like Deuk Laser Disc Repair allow patients to walk within an hour, go home the same day, and return to most activities within 2–3 weeks.

A: In many cases, yes. Fusion is necessary for specific conditions involving structural instability, severe deformity, or fractures. However, if your pain is caused by disc herniations, annular tears, or degenerative disc disease without significant instability, motion-preserving alternatives such as Deuk Laser Disc Repair may be appropriate. The key is getting an evaluation from a surgeon trained in both fusion and motion-preserving techniques who can objectively assess which approach is best for your specific condition.

A: Deuk Laser Disc Repair is fundamentally different from both traditional fusion and most “minimally invasive” procedures. Unlike fusion, it preserves natural motion and avoids hardware entirely. Unlike many procedures marketed as “minimally invasive,” it uses a truly small incision (4–7 mm versus 1 inch or larger), employs a surgical laser as the primary tool, and treats both the herniation and the annular tear the true source of discogenic pain.

The procedure has been published in peer-reviewed medical journals with a documented 99.6% success rate and zero complications across more than 2,000 cases.