Why Isn’t Disc Replacement the Standard by Now?
- Kingsley R Chin MD MBA
- 6 days ago
- 3 min read
An opinion piece by Dr. Kingsley R. Chin, MD, MBA
A colleague recently asked me a question every spine surgeon should have to answer:
“Why isn’t disc replacement the default treatment for spine conditions by now?”
We have decades of evidence.We have better biomechanics.We even have 50-year durability data for viscoelastic discs that behave almost exactly like the natural disc.
So why is the field still stuck?
The truth is uncomfortable:
The barrier isn’t clinical.
It’s cultural, economic, and leadership-driven.
1. Surgeons are trained to fuse — not preserve.
From day one of residency, the entire ecosystem reinforces fusion:
Fusion is the academic standard.
Fusion is reimbursed consistently.
Fusion fits hospital workflows.
Fusion becomes the identity of the spine surgeon.
Disc replacement is rarely taught, and motion preservation is not embedded in the curriculum.
We created a generation of surgeons who treat fusion as default and preservation as optional.
2. Surgeons don’t own innovation — they just use it.
Here’s the part most surgeons don’t want to hear:
Surgeons behave like employees of the system, not owners of their future.
They align with:
a rep
a distributor
a company
a hospital
a reimbursement code
…instead of aligning with the future of spine care.
They wait until technology reaches “safe” consensus before they follow it.
By the time a breakthrough disc gets acquired:
surgeons have no seat at the table,
no influence on pricing or strategy,
no say in development,
no ownership in what happens next.
Surgeons follow.Investors decide.And fusion — not preservation — keeps winning.
3. Fusion economics reward more hardware, not better outcomes.
Let’s be honest.
A three-level fusion pays more than a single-level disc replacement.Hospitals are built for fusion.Insurers pay fusion predictably.Device companies profit most from fusion implants.
So multilevel fusion becomes “expertise.”Disc replacement becomes “interesting.”And the patient pays the price — with a rigid spine and a revision waiting down the line.
This is not a science issue.It’s an incentive issue.
4. The science behind motion preservation is now overwhelming.
Zigler et al., Global Spine Journal (2018) — 5-Year Randomized Controlled Trial Meta-Analysis.
A high-quality meta-analysis of 5-year outcomes found that lumbar total disc replacement:
leads to significantly greater ODI success
improves patient satisfaction
cuts the risk of reoperation nearly in half
is at least as safe as fusion
🟨 Read article here:
2025 AxioMed Study — Natural Disc Mechanics Restored
A new peer-reviewed study confirms that newer viscoelastic discs can:
mimic the natural disc’s viscoelastic cushioning
restore near-normal physiological motion
last 50+ years based on durability testing
🟨 Read article here:
This is the evidence surgeons claim they’ve been “waiting for.”Well — it’s here.
5. Interventional spine is quietly shifting the entire patient pipeline.
While spine surgeons debate fusion vs. ADR, Interventional Pain physicians are:
treating patients earlier
adopting anatomy-preserving outpatient techniques
owning ASCs
reducing referrals for big instrumented fusions
A new specialty — interventional spine surgery — is rising.
Patients are gravitating to practitioners who preserve anatomy, not remove it.
Surgeons risk losing leadership of the future if they remain passive adopters.
So why isn’t motion preservation the default?
Because surgeons still act like participants in someone else’s system.
This is not a clinical problem.
This is a leadership problem.
Disc replacement will continue to lag until surgeons:
invest in preservation-focused innovations
demand alignment in training and reimbursement
lead adoption instead of waiting for consensus
stop defining expertise by the number of screws placed
reclaim ownership of their specialty
The shift has begun — but it needs leaders, not followers.
A Message to Patients
If a surgeon only offers you a pedicle screw and cage fusion — ask them:
“Why aren’t you offering me a disc replacement like Tiger Woods had?”“What other anatomy-preserving options exist before fusion?”
There will come a day when patients routinely demand viscoelastic disc replacements and LESS-anatomy-preserving procedures instead of multilevel fusion.
When that day comes, the system will finally align around preservation, and more physicians will choose to own the technologies shaping the future rather than being handed whatever the system gives them.
⭐ Fusion is the present.
Preserving anatomy — through viscoelastic disc replacement and LESS-invasive innovations — is the future.And that future is moving fast toward becoming the new standard.
The question is no longer if the shift is coming.It’s whether surgeons want to shape it…—or be shaped by it.
— Kingsley R. Chin, MD, MBA
Orthopedic Spine Surgeon
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