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If your spine surgeon has recommended fusion surgery, you are not alone. Spinal fusion is one of the most commonly performed procedures in the country. But it is also one of the most misunderstood — and for many patients, it may not be the only option.

As a spine surgeon in Westchester, NY who specializes in motion-preserving procedures including disc replacement and endoscopic spine surgery, I want to make sure every patient is fully informed before they make a decision that permanently changes their spine. Here are five questions I encourage every patient to ask before saying yes to fusion.

1. Is my diagnosis one that actually requires fusion?

Fusion is appropriate for certain conditions — spinal instability, deformity correction, and some fractures. But for many patients with herniated discs, degenerative disc disease, or stenosis, fusion is not the only answer. Disc replacement surgery, for example, can address many of the same problems while preserving natural motion at that level of the spine.

2. Am I a candidate for disc replacement instead?

Cervical and lumbar disc replacement surgeries have outcomes equivalent to — and in some studies, superior to — fusion for appropriate candidates. The key difference: disc replacement preserves motion and reduces stress on neighboring vertebrae, potentially avoiding future surgeries at adjacent levels.

3. Can this be done minimally invasively or endoscopically?

Traditional open spine surgery involves significant muscle dissection and longer recovery. Endoscopic spine surgery achieves the same surgical goals through incisions sometimes smaller than a centimeter. Patients typically return to daily activity significantly faster and with less postoperative pain.

4. What is the surgeon's specific experience with this procedure?

Not all spine surgeons perform disc replacement or endoscopic procedures. These are specialized techniques that require advanced training. When evaluating a surgeon, ask specifically how many disc replacements and endoscopic cases they have performed — and whether they are involved in teaching or advancing these techniques.

5. What does recovery look like compared to fusion?

Fusion recovery typically involves weeks of restricted activity and a longer rehabilitation process as the bone graft heals. Minimally invasive and disc replacement approaches often allow patients to return to light activity within days and normal function within weeks — not months.

When most people picture spine surgery, they imagine a long incision, a hospital stay of several days, and weeks of recovery. That picture is outdated. Endoscopic spine surgery has changed what is possible — and most patients in the New York area have never even heard of it.

What Is Endoscopic Spine Surgery?

Endoscopic spine surgery uses a tiny camera (an endoscope) and specialized instruments to treat spinal conditions through very small incisions — sometimes less than a centimeter. The surgeon watches the procedure on a high-definition monitor and works with precision tools designed specifically for this technique. Compare that to traditional open surgery, which requires a much larger incision and separation of the surrounding muscles — causing significant tissue trauma that the patient then has to recover from.

Uniportal vs. Biportal: What is the Difference?

There are two main endoscopic approaches I use at Somers Orthopaedics:

• Uniportal endoscopic surgery uses a single small entry point. Both the camera and surgical instruments work through the same port. It is highly efficient and well-suited for targeted procedures like disc herniations.
• Biportal endoscopic surgery uses two separate entry points — one for the camera and one for the instruments. This separation gives the surgeon more freedom of movement and is well-suited for more complex decompressions, including stenosis surgery.

Conditions Treated Endoscopically

• Lumbar and cervical disc herniation
• Spinal stenosis (narrowing of the spinal canal)
• Foraminal stenosis (nerve root compression)
• Recurrent disc herniations
• Facet joint pathology

The Advantages

• Incisions often under 1 cm — smaller than a pencil eraser
• Less blood loss during surgery
• Significantly less postoperative pain
• Faster return to daily activities — often days, not weeks
• Frequently performed as an outpatient procedure — home the same day
• Lower risk of infection and complications compared to open surgery

Neck pain, arm pain, and numbness from a cervical disc problem can be debilitating. When conservative treatment stops working, surgery becomes the conversation. And for most patients, the first option they hear about is anterior cervical discectomy and fusion, or ACDF. But there is another option that many patients never get told about: cervical disc replacement.

What Is Cervical Disc Replacement?

Cervical disc replacement (CDR) removes the damaged disc and replaces it with an artificial implant that preserves motion at that segment of the spine. Unlike fusion, which permanently locks two vertebrae together, a disc replacement allows the neck to continue moving naturally at the treated level. Dr. Perfetti uses FDA-approved, extensively studied implant systems for cervical arthroplasty.

How Does It Compare to Fusion?

Both procedures address the same underlying problem: a damaged disc that is compressing the spinal cord or nerve roots. The difference is in what happens after. Fusion eliminates motion at the treated level. Over time, this can transfer additional stress to the discs above and below — a condition called adjacent segment disease — which sometimes requires additional surgery years later. Disc replacement preserves motion and may reduce that adjacent segment stress. Multiple randomized controlled trials have shown that cervical disc replacement produces outcomes equivalent to or superior to fusion, with lower rates of requiring additional surgery at adjacent levels.

Who Is a Good Candidate?

• Single or two-level disc disease (herniation or degenerative disc disease)
• Nerve root compression causing arm pain, weakness, or numbness
• No significant instability or deformity
• Adequate bone quality
• Failed a trial of conservative care

What Is Recovery Like?

Most patients undergoing cervical disc replacement go home the same day or after a one-night stay. Neck pain and arm symptoms typically improve quickly. Patients are usually back to desk work within one to two weeks and more physical activity within four to six weeks.

Low back pain is among the most common reasons people visit a doctor in the United States. For patients whose pain comes from degenerative disc disease, surgery is sometimes necessary when all else has failed. Most patients are offered one option: lumbar spinal fusion. But there is another procedure with strong clinical evidence that far fewer surgeons are trained to perform: lumbar total disc replacement.

What Is Lumbar Total Disc Replacement?

Lumbar total disc replacement (TDR) removes the damaged spinal disc and replaces it with an artificial implant that mimics the natural disc's function — including shock absorption and motion. Dr. Perfetti uses FDA-approved implant systems with long-term outcome data spanning over 15 years.

Why Isn't Everyone Offering This?

Lumbar total disc replacement is technically demanding. It is performed through an anterior (front) approach, which requires specialized training in both the approach and the implant positioning. Not all spine surgeons have this training, which is why many patients are simply never told it exists. I pursued advanced training in this technique and have been nominated as one of the upcoming arthroplasty leaders in my field because of my commitment to offering patients the full spectrum of modern spine surgery options.

How Does It Compare to Lumbar Fusion?

Like cervical disc replacement, the key difference is motion. Fusion eliminates motion at the treated level and can accelerate degeneration at adjacent segments. Disc replacement preserves motion and aims to reduce that adjacent-level stress. Clinical studies have shown lumbar total disc replacement produces comparable or superior outcomes to fusion for appropriate candidates.

Who Is a Candidate?

• Single-level degenerative disc disease at L4-5 or L5-S1
• Primarily discogenic low back pain
• No significant facet arthritis
• No significant instability or deformity
• Failed at least 6 months of conservative treatment

When I trained in orthopedic spine surgery, I made a deliberate decision: I wanted to offer my patients every modern option available — not just the procedures that have been done the same way for decades. That commitment led me to pursue advanced training in endoscopic spine surgery, including both uniportal and biportal techniques. It led me to become proficient in both cervical and lumbar total disc replacement using FDA-approved motion-preserving implant systems. And it led to my nomination as one of the emerging arthroplasty leaders at the Advancing Spine Arthroplasty Meeting.

What It Means for Your Care

When you come to see me at Somers Orthopaedics in Westchester, I am not going to recommend the procedure I am most comfortable with. I am going to recommend the procedure that is right for you. Sometimes that is fusion. Sometimes that is disc replacement. Sometimes that is a minimally invasive endoscopic decompression with no implant at all. The difference between a surgeon who has one technique and a surgeon who has many is that the latter can actually individualize your care.

Who I See

• Patients with herniated discs in the neck or back causing arm or leg pain
• Patients who have been recommended fusion and want to understand all options
• Patients who are active and want the fastest, least disruptive recovery possible
• Patients who have had prior spine surgery and need revision care
• Patients from throughout Westchester, Rockland, Putnam, and the New York metro area

What to Expect at a Consultation

I review all relevant imaging and take a thorough history. I explain your diagnosis in plain English. I walk through every surgical option you qualify for — and the reasons I might recommend one over another. I answer every question you have. There is no pressure. The goal of a consultation is information. What you do with it is entirely your decision.

Not every spine problem needs surgery — and I believe it is just as important for a spine surgeon to know when not to operate as when to operate. For patients with back or neck pain who want to start with conservative care, the American Academy of Orthopaedic Surgeons (AAOS) offers a free, evidence-based Spine Conditioning Program that I recommend to appropriate patients.

What the Program Includes

The AAOS Spine Conditioning Program is a structured exercise protocol designed to strengthen the muscles that support the spine, improve flexibility, and reduce pain — without surgery. It covers stretching, core strengthening, and posture guidance appropriate for a range of common spine conditions including degenerative disc disease, herniated discs, and mechanical low back pain.

Who It Is For

• Patients with new-onset back or neck pain who have not yet tried structured physical therapy
• Patients managing chronic spine pain who want a home exercise foundation
• Post-operative patients looking to maintain spine health after recovery
• Patients who want to delay or avoid surgery and commit to a conservative approach first

When Surgery Becomes the Right Conversation

Conservative care — including physical therapy, anti-inflammatory medications, and activity modification — is the appropriate first step for most spine conditions. Surgery becomes the right conversation when conservative treatment has been tried for an adequate period and symptoms persist, when there is progressive neurological weakness, or when imaging shows a problem that is unlikely to resolve without surgical correction.