Artificial Cervical Disc Replacement
The Spine or backbone provides support and stability to the body and helps to maintain body posture. The cervical or neck area is the upper part of the spine and is comprised of 7 vertebrae, the bones that make up the spinal column. These vertebrae are separated from one another by shock absorbing pads called intervertebral discs. Over time, the discs can wear out resulting in neck pain. Most of us, at some time in our lives, suffer from neck, shoulder, or arm pain. These disorders often occur as a result of disc abnormalities in the neck.
In the initial stages, conservative treatment options such as anti-inflammatory medications, physical therapy, and cold or heat therapy may be beneficial.
Surgery may be considered if the pain does not respond to conservative treatment.
Anterior cervical discectomy is one of the most common surgical procedures for the management of cervical spine disorders. In this procedure the herniated or degenerative disc in the cervical spine is removed and replaced by a bone graft. The discectomy is usually combined with an anterior spinal fusion, where the vertebrae are fixed together with metal plates and screws. Spinal fusion, however, is associated with several complications, including those related to bone graft harvesting and adjacent-segment disc degeneration.
Artificial cervical disc replacement is a relatively new procedure developed as an alternative to spinal fusion to provide pain relief, stability, and movement to the cervical spine with fewer complications.
Artificial cervical discs have emerged as an alternative to bone grafts, plates and screws used with spinal fusion that abolish movement at the operated vertebral segment.
Artificial cervical disc replacement is usually indicated if:
- You have a symptomatic cervical disc at a single level
- Neck pain is associated with pain, weakness or numbness of the arm
- Your symptomatic cervical disc disease does not improve after conservative treatment
Artificial cervical disc replacement is contraindicated in the presence of severe facet arthritis, cervical kyphosis, severe cervical stenosis, and primary bone pathology such as infection.
Your doctor may recommend a few diagnostic imaging tests such as x-rays, magnetic resonance imaging (MRI) and computed tomography (CT or CAT scan) to confirm your diagnosis. Your physician may also perform a discography, a procedure to determine which intervertebral disc is the cause of pain. During discography, a special dye is injected into the disc; the affected disc is identified with the help of X-rays and CT scans.
In artificial cervical disc replacement surgery the damaged disc is removed and replaced with a prosthetic device inserted between the two cervical vertebrae. The artificial disc is designed to preserve mobility within the disc space.
The surgery is performed under general anaesthesia in a sterile operating room. Your surgeon approaches the cervical spine from the front of your neck. A small incision is made in the front of the neck and the soft tissues are gently pulled apart to access the cervical spine. Then the damaged disc along with any loose disc fragments or bone spurs are removed. After the disc is removed, the disc space is rectified to its normal disc height in order to relieve any pressure on the nerves. The artificial disc device is then placed in the prepared disc space, under fluoroscopic x-ray guidance. The soft tissues are then repositioned and the incisions are closed.
Post operative Care
Following the surgery, you will be monitored at the hospital for 24-48 hours. You may be advised to wear a cervical collar for a week to immobilize the cervical spine. Your pain will gradually resolve within a day or two after surgery. Other symptoms such as numbness and weakness usually improve within a few hours of surgery. However, in some cases recovery may take a few weeks to a few months. You will usually be able to return to light work within a week or two of the surgery and gradually resume regular work by 6 weeks.
Benefits of cervical artificial disc replacement surgery over spinal fusion include:
- Bone graft and the associated complications is not needed
- Reduction in the risk of adjacent-segment disc degeneration
- Lower risk of infection
- Earlier return to normal activities
- Restoration of the normal mobility of your neck
- Fewer postoperative activity restrictions
Risks and Complications
The potential complications associated with cervical artificial disc replacement include:
- Nerve injury
- Implant failure or misplacement requiring another surgery
Long term wear of the implant
Artificial cervical disc replacement surgery, an alternative to spinal fusion surgery, is where the damaged disc in the neck is removed and replaced with a disc implant. This surgery relieves neck pain as well as restores the normal range of motion of the neck.