Pain in and around the neck area is a common problem for many people. If the pain extends down into the shoulder or arm, or if any weakness or numbness results, the source of the problem is often due to compression on a spinal nerve or nerve root by a herniated disc or a bone spur. If conservative methods such as rehabilitation and over the counter medications fail, surgery may be the best option for some patients to restore function and relieve symptoms. Stated simply, cervical disc replacement surgery is a procedure where an affected, painful disc in the neck is removed and replaced with a new, artificial one. During the procedure the surgeon can also remove any bone spurs and elongate the disc space, further relieving pressure on the nerves and nerve roots. Generally, the surgeon will use an anterior approach to reach the cervical spine, allowing for greater visibility of the problem area. This approach is similar to the spinal discectomy and fusion procedure. The new artificial disc was developed to function similar to a natural disc, and thus it can to maintain close to normal mobility while also acting as a buffer between the two adjacent vertebrae. Because these characteristics are preserved, the chance of degeneration is greatly reduced in the vertebrae above and below the surgical site.
To restore function and relieve symptoms of compressed spinal nerve(s).
Disc replacement improves function after surgery. Because the disc replacement devices preserves more normal neck motion, patients are able to reclaim a wider range of head and neck movement after surgery. Increased movement means increased day-to-day function and better quality of life. Motion preservation reduces stress on the spine. Traditional fusion surgery locks the treated vertebrae in place. The loss of motion can put stress on adjacent vertebrae and cause further degeneration in the future. Because disc replacement surgery maintains motion and prevents increased stress, it may help protect the adjacent vertebrae from additional degeneration over time. Minimally invasive surgery offers a faster recovery. After fusion surgery, patients must be immobilized for a period of time while the fused vertebrae heal. Recovery from disc replacement surgery is much faster; patients have returned to work within four days of surgery. Disc replacement surgery also means that patients don’t have to worry about some of the potential complications of fusion surgery.
Possible risks and complications - can be reduced by following the surgeon's instructions before and after the neck surgery.
The actual procedure may last a few hours. This is what may happen once the procedure begins: Monitors are placed to check your heart, blood pressure, and oxygen level. The area of your neck where the incision will be made is cleaned with a special solution to kill germs on the skin. A one- to two-inch incision (surgical cut) is made on the side or front of your neck. The important structures of the neck are carefully moved to the side until the surgeon can see the bones of the vertebrae and the cervical disk. The cervical disk that is being replaced is removed. The artificial disk is secured into the empty disk space. The incision is closed using absorbable sutures (stitches) under the skin. The skin is then carefully closed with sutures that minimize any scarring. A small dressing is applied over the incision, a rigid or soft neck collar may be put on your neck to restrict motion, and you will be taken to the recovery area. Some steps might be slightly different from those outlined above. Talk with your health care provider about what might happen during your procedure.
Tell your surgeon about any medications you take at home including herbal supplements and over-the-counter medications. You may be asked to stop taking aspirin or other medications that thin your blood and may increase bleeding. Tell your surgeon if you or someone in your family has any history of reaction to general anesthesia. If you smoke, you may be asked to stop smoking well before surgery and avoid smoking for a time after surgery. Before surgery you will probably be given instructions on when to stop eating and drinking. It’s common to have nothing to eat or drink after midnight on the night before the procedure.
Recovery after a cervical disc replacement is relatively quick. Most patients can stand and walk a few hours after the procedure, and can even return home on the same day or following morning. There may be minimal activity restrictions for a short period of time; however, most patients return to their regular activities within a few days or weeks. There may be some mild pain near the incision site, but this will decrease with time.
Reactions to the anesthesia Bleeding Infection Nerve injury Spinal fluid leak Voice change Stroke Difficulty breathing Difficulty swallowing Failure to relieve symptoms Broken or loosened artificial disk Need for further surgery There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your surgeon before the procedure.
Who is a suitable candidate for the procedure?
Most patients with cervical disc disease do not need surgery to manage their symptoms. To be considered, candidates must demonstrate severe neck pain or severe pain, numbness, or weakness that radiates down the shoulder and arm. In almost all cases, patients must have tried conservative treatments such as anti-inflammatory medications, physical therapy, spinal interventions, etc. for at least 4-6 weeks without seeing significant results.
What are the advantages of artificial disc replacement over spinal fusion for neck conditions?
-Preserves natural range of motion in the neck -Decreases stress on adjacent levels above and below -Quicker return to everyday life, activities, work, and sports/exercise An Artificial Disc Replacement is a suitable option for patients with prominence of arm symptoms (radiating, burning, tingling and numbness) over isolated neck pain, where their hinges or facet joints in their neck are healthy.
What kinds of patients will benefit from this procedure?
The indications for a cervical disc replacement are generally the same as for a cervical discectomy and fusion. A person must have symptoms from a cervical disc problem. Symptoms include neck and/or arm pain, arm weakness, or arm and hand numbness. These symptoms may be due to a herniated disc and/or bone spurs called osteophytes pressing on adjacent nerves or the spinal cord. This condition typically occurs at cervical spine levels C4-5, C5-6, or C6-7. Artificial disc replacement is still somewhat new in the United States. In the United States, surgeons are currently only replacing one cervical disc in a patient's cervical spine at this time. In Europe, surgeons are replacing more than one disc. More surgeons in the United States will probably start replacing more than one cervical disc in the near future. Cervical artificial disc replacement is indicated for the treatment of radiculopathy (pressure on the spinal nerve) and myelopathy (pressure on the spinal cord) at one or two levels. In the future, it may be used for the treatment of three or more symptomatic levels or levels adjacent to a cervical spine fusion. This use is still under investigation. More data is needed before the uses of cervical artificial disc replacements are expanded to other problems in the cervical spine. Cervical artificial disc replacement is not advised when there is cervical spine instability, significant facet joint damage, or infection.