Cervical Disc Replacement
What is a cervical disc replacement?
Cervical disc replacement is an alternative to anterior cervical discectomy and fusion. It involves the replacement of the degenerated, herniated disc, in the neck region, by an artificial disc. This provides the benefit of maintaining the natural flexibility and motion of the neck, at the level of the replaced disc. It also theoretically allows equal pressure distribution in the cervical spine, between the replaced artificial disc and the discs present above and below it, preventing adjacent segment degeneration. Adjacent segment degeneration is a problem associated with fusion of the vertebrae that results in degeneration of the intervertebral discs, above and below the fused vertebrae.
Who is a candidate for a disc replacement?
Patients who suffer from Cervical Radiculopathy and myelopathy are candidates. A disc replacement is another option for the same patients that would traditional undergo a fusion. There are some patients however that a fusion maybe a better option than a disc replacement. Some reasons include having instability to the spine, considerable joint damage. Please ask Dr Park if a fusion or a disc replacement would be better.
What is an artificial disc made of?
Artificial discs for cervical disc replacement are available in various designs. They usually consist of two metallic endplates with a plastic spacer in between. The endplates can move over the spacer, like the movement of the vertebral body over the disc. Artificial discs with metal on metal design are also available. The artificial disc is fixed to the vertebral body with screws; the endplates of a few artificial discs have spikes which help in attachment of the disc to the vertebral body.
The patient is administered general anesthesia and placed face up on the operating table. An incision is made on the front side of the neck, at the level of the damaged cervical disc. The positioning of the incision is confirmed by real time images from intra-operative imaging. Moreover, the incision is made so that the scar is hidden in the natural skin folds of the neck, after healing. The muscles and the soft tissues are moved to the side to expose the cervical spine. The whole degenerated disc is removed by discectomy and the surface of the vertebral body in the disc space is prepared to receive the artificial disc. The area around the spinal cord and spinal nerves is then completely cleaned and decompressed by carefully removing any soft tissue, bony outgrowths (osteophytes) or thickened ligaments with micro-surgical instruments. The artificial disc is inserted in the disc space and the endplates of the artificial disc are fixed to the surface of the vertebral body guided by the images from intra-operative imaging. The proper position and alignment of the implanted disc is finally confirmed by Xray and the muscles and the soft tissue are repositioned. The incision is then closed.
- The incision should be kept clean and dry till it heals completely. Care should be taken to cover it properly while bathing. Swimming and hot tubs should be completely avoided.
- Medications should be taken regularly, as prescribed.
- A soft collar is usually provided to where. Dr Park advised patients to work on flexion and extension of the spine within the first few days after surgery. Rotation (left and right) should be limited initially.
- Lifting anything heavier than a shoe should be avoided.
- A healthy lifestyle should be followed to promote healing. This may include healthy nutritious food, ample rest and abstinence from smoking. Walking is also encouraged.
Risk and Complications:
The risks and complications of the surgery may include infection, bleeding, nerve injury, or spinal cord injury. Complications due to general anesthesia may also occur.
Benefits of disc replacement:
- Maintains motion
- Theoretically decreases risk of adjacent level degeneration
- Quicker return to activities
What to expect?