Motion Preservation & Spine Arthroplasty

Full Spine Replacement: What’s Real, What’s Hype, and What Naples Patients Need to Know

By Dr. Mark Frenkel, MD, MA, FAANS, FCNS  |  Board-Certified Neurosurgeon & Spine Surgeon, Naples, Florida

“Can’t you just replace the whole thing?” A patient asked me that last month after years of neck and back pain. She’d had a knee replacement and a hip replacement, both successful, and reasonably assumed the spine worked the same way.

Here’s the honest answer: full spine replacement does not exist. No surgeon can swap out your entire spinal column the way an orthopedic surgeon replaces a hip. But specific parts of the spine can be replaced, and some of those options have excellent long-term data.

In this article, I’ll explain what can and can’t be replaced, where artificial disc replacement and joint replacement genuinely outperform fusion, when fusion is still the right answer, and the marketing claims I’d steer you away from.

Is Full Spine Replacement Real? The Short Answer

No. Your spine isn’t a single joint. It’s a column of 33 vertebrae, more than 20 discs, dozens of small facet joints, ligaments, muscles, and, running through the center, the spinal cord and nerve roots. There is no implant that replaces that system, and there is no realistic prospect of one in the near future.

The spinal cord is the core reason. Unlike the bone and cartilage of a hip, nervous tissue cannot be removed and swapped. Any spine operation has to work around the cord and nerves with great precision, which is why spine “replacement” will always mean replacing specific parts, not the whole.

What people usually mean by “full spine replacement”

When patients search for this term, they are usually looking for one of these:

• Artificial disc replacement, also called total disc replacement or arthroplasty.
• Posterior joint replacement, such as the TOPS™ system, which some coverage has called a “posterior spine replacement.”
• Multilevel reconstruction for scoliosis or deformity, which rebuilds alignment but fuses rather than replaces.
• Vertebral body replacement after a severe fracture or tumor.

Each of these is a real procedure with real indications. The key is matching the right one to your problem, and recognizing that “replacement” isn’t automatically better than other approaches.

What Parts of the Spine Can Actually Be Replaced

Here’s the practical map I walk patients through in my office.

A note on vertebral body replacement

When a vertebra is crushed by a fracture or destroyed by a tumor, I can remove part of it and rebuild the space with a metal or expandable cage. That’s called a corpectomy. It restores support, but it works more like a structural fusion than a joint replacement. The cage doesn’t move, and the goal is for bone to heal around it.

Cervical Disc Replacement: The Best-Proven Spine Replacement

If any part of the spine has earned the word “replacement,” it’s the cervical disc. For the right patient, anterior cervical disc arthroplasty removes the damaged disc, decompresses the nerves or spinal cord, and inserts a motion-preserving artificial disc.

What the long-term research shows

A randomized FDA trial published in the Journal of Neurosurgery: Spine followed patients who had two-level cervical disc replacement or two-level fusion. At ten years, the disc replacement group had higher overall success and roughly a quarter of the index-level reoperation rate. Adjacent-level surgery was also about half as common.

That last point matters. When you fuse a neck segment, the levels above and below take on more motion. Preserving motion appears to reduce that extra stress over time.

Who is a candidate

Cervical disc replacement works best for patients with disc herniation or disc-level spurs, preserved disc height, and healthy facet joints. It’s not right for patients with severe arthritis of the facet joints, instability, significant osteoporosis, or certain deformities. For those patients, anterior cervical discectomy and fusion remains an excellent, time-tested operation.

In my practice, I evaluate every cervical patient for disc replacement candidacy first. I’d rather preserve motion when the anatomy allows it.

Lumbar Motion Preservation: Discs and Facet Joints

In the lower back, the story is more complicated. The lumbar spine carries far more load, and pain often comes from several structures at once: the disc, the facet joints, and nerve compression. Replacing only one of those rarely fixes everything.

Lumbar disc replacement

Lumbar total disc replacement is FDA-approved for narrowly defined patients, generally younger adults with pain clearly coming from a limited number of degenerated discs in the lower lumbar spine, healthy facet joints, good bone quality, and no significant slippage. Within those limits, results can be very good. Outside them, results tend to disappoint.

Many older patients, who make up much of my Naples practice, aren’t candidates because their facet joints are already arthritic. That’s not a failure of the patient. It’s simply where the evidence points.

Posterior facet replacement: TOPS™

For patients with lumbar stenosis and mild degenerative slippage, the traditional answer has been decompression plus fusion. The TOPS™ Posterior Arthroplasty System offers a motion-preserving alternative. After a full decompression, the implant replaces the function of the facet joints and stabilizes the segment while allowing controlled movement.

TOPS™ received FDA approval in 2023 after a randomized trial against fusion. In that trial, reported composite clinical success was substantially higher with TOPS™ than with fusion, and the manufacturer reports that the device was approved with a superiority-to-fusion label. Candidacy is strict, and I evaluate each patient’s anatomy carefully, but for the right person it can be an excellent option.

When Replacement Isn’t the Answer, and Fusion Is

I’m a strong advocate for motion preservation, but I want to push back on a growing myth: that fusion is outdated and replacement is always better. That’s not what the evidence says.

Fusion is still the right call when

• The spine is unstable or has meaningful slippage, as in many cases of spondylolisthesis.
• The facet joints are severely arthritic, which undermines motion-preserving implants.
• There’s a deformity such as adult degenerative scoliosis that needs realignment.
• Bone quality is too poor to anchor a moving implant.
• A previous disc replacement or fusion has failed.

Rethinking how we fuse

What I do believe is that fusion itself can be done better. Traditional lumbar fusion relies on rods and pedicle screws, and screws are a common point of failure, especially in osteoporotic bone. That’s why I developed the CemLIF™ procedure, a rod-less, screw-less lumbar fusion technique. Not every patient is a candidate, but for those who are, it offers a way to stabilize the spine without the hardware burden of a traditional fusion.

The real goal isn’t replacement versus fusion. It’s choosing the least disruptive operation that fully addresses the problem. Sometimes that’s an artificial disc. Sometimes it’s TOPS™. Sometimes it’s a simple decompression with no implant at all.

Red Flags in Spine Replacement Marketing

I’ve written before about procedures sold with more confidence than evidence, including ultrasonic spine surgery. The spine replacement space has its own share of hype, and patients searching for “full spine replacement” are exactly who it targets.

Claims I’d be skeptical of

• “Total” or “complete” spine replacement. As explained above, it doesn’t exist. Ask exactly which structure is being replaced.
• Multilevel lumbar disc replacements far beyond approved indications, especially when offered abroad without long-term data.
• “Regrow your discs” with stem cells. Regenerative approaches are an active research area, but no stem cell treatment has proven it can rebuild a degenerated disc. Expensive cash-pay injections marketed as disc regeneration deserve real skepticism.
• Promises of “no recovery” or guaranteed results. Every spine operation carries risk and requires healing.

Why motion preservation is a judgment call, not a product

The best implant in the world fails in the wrong patient. Excellent outcomes come from selection: the right diagnosis, the right anatomy, and an honest discussion of trade-offs. That’s why other spine surgeons send me their complex and revision cases. Many of those patients had a procedure that sounded modern but didn’t match their spine.

Questions to Ask About Spine Replacement Surgery

If a surgeon recommends any kind of spinal replacement, these questions will help you understand whether it’s the right fit:

1. Exactly which structure are you replacing, and why is that the source of my symptoms?
2. Is this device FDA-approved for my level and number of levels?
3. What does my facet joint health and bone density look like? Both affect whether a moving implant will last.
4. What are the alternatives? Decompression alone, fusion, or continued conservative care.
5. What is the long-term data for this specific implant?
6. If the implant fails, what is the revision plan?
7. How many of these procedures do you perform?

Considering surgery from out of state?

Patients often travel for motion-preserving surgery because not every surgeon offers it. Through our Concierge Spinal Surgery Program, you can start with a telehealth review of your imaging. My team coordinates testing, insurance verification, scheduling, and travel to Naples if surgery is the right step.

Conclusion: Replace What Needs Replacing, Nothing More

Full spine replacement makes for a compelling search term, but it isn’t a real operation. What’s real is a set of precise, evidence-based tools: artificial discs, posterior joint replacement, decompression, and modern fusion. The art is choosing the one that fits your anatomy.

If you’re researching spine replacement and want a clear answer about which option fits you, I’d encourage you to schedule a consultation. You can reach my Naples office at (239) 649-1662. If you’re traveling from out of state, inquire about our concierge program. We’ll start with telehealth and handle the logistics from there.

The information in this article is for educational purposes only and does not constitute medical advice. Surgical decisions are made on an individualized basis following a thorough consultation. Results may vary. Always consult a qualified physician before pursuing any surgical or medical treatment.

References

1. Two-level cervical disc arthroplasty versus anterior cervical discectomy and fusion: 10-year outcomes of a prospective, randomized investigational device exemption clinical trial. J Neurosurg Spine. 2019;31(4):508. Journal
2. Prospective, randomized, multicenter FDA trial of the TOPS™ System versus lumbar fusion for stenosis with degenerative spondylolisthesis. J Neurosurg Spine. 2023;38(1):115. Journal