10 things you should know about Cervical Disc Replacement

What is Cervical Disc Replacement?

The latest innovation in surgical management of cervical myelopathy or radiculopathy is cervical disc replacement, a surgical procedure that involves the removal of a damaged or degenerated cervical disc and replacing it with an artificial disc device. Cervical disc replacement, otherwise known as total disc arthroplasty, has been given FDA approval in the management of symptomatic disc disease.

What sort of health conditions are repaired with a cervical artificial disc replacement?

The cervical artificial disc usually repairs degenerated discs or herniated discs in the cervical spine. Some patients with these types of herniated discs will suffer some compression on the spinal cord or on the nerve roots and also some cervical pain (needing a cervical neck surgery) associated to the degenerated disc. The specialised doctor will advise the appropriate treatment regarding to each unique case.

Who is an Ideal Candidate for Cervical Disc Replacement?

Any patient with symptomatic cervical disc disease who fails to improve with conservative therapeutic modalities is an ideal candidate for cervical disc replacement. In the United States, disc replacement is approved for single cervical level and should be avoided if there is an adjoining previous cervical fusion. There a few devices approved in the USA for multilevel cervical disc replacement, though in Europe multilevel cervical disc replacement surgery is commonly performed and approved.

Which material is the artificial disc made of? Is it a material which has been already used in patients before?

The artificial disc is generally made from different types of materials, including a mixture of medical-grade titanium, polyurethane and cobalt chromium. The implants made with these materials have been handled in a safe manner respecting specific and relevant guidelines for many years.

How do you implant an artificial disc? Is the cervical spine surgery a known technique?

The artificial disc is normally implanted through an incision made on the front side of the neck which allows direct access to the space of the disc. This is a routine procedure. This same insertion method is used to perform a cervical disc herniation procedure.

What is the disc replacement surgery step-by-step procedure?

An artificial disc surgery is an artroplasty type of procedure which implies the insertion of an artificial disc in the neck once the damaged cervical disc is removed.
Through a small incision made on the neck (called anterior approach), the surgeon normally does the following:

-Gently separates the soft tissues (skin, fat and muscles) in order to access the anterior part of cervical spine.
-The disc is extracted as well as the bone material surrounding the neural structures in order to acquire more space (discectomy and decompression).
-Exposes all the area where the disc fragments are located or the bone spurs are pressuring against the neural structures (nerve roots and / or spinal cord).
-The defect left behind in between the two vertebrae is filled with a disc replacement device.
The two metallic surfaces within the device slide on each other directly or can be separated by a piece of medical grade plastic. This avoids the need for fusion between the vertebrae and its consequent complication of immobility.
-Seals back the incision.

It is important that the patient is aware of what to expect during the procedure as it helps facing a disk replacement surgery with confidence. The surgeon will inform the patient of all the details of the disc surgery.

What happens after the artificial cervical disc replacement surgery?

In the majority of the cases, immediately after the cervical surgery, doctors will keep on monitoring the pulmonary and cardiac activity. In addition, there is always the possibility that a drainage tube in the wound is necessary, as well as the doctor may prescribe pain killers to control pain and nausea.
In the following day of the surgery, the surgeon will remove the tube (if existent) and the patient may slowly start walking. The patient may experience some difficulty in swallowing which will slowly disappear.
After the second or third day the patient may be discharged from the hospital and return home or to the hotel. It is advisable to use a soft neck collar (reassuring a safe neck surgery recovery) when the patient is outside during the first 10 days post-operation.
Two weeks after the surgery the patients may return to their daily routine however it is highly advisable to avoid carrying heavy items and to undergo minimal physical stress.
During the first month after the surgery, doctors highly recommend walking as it is considered the best exercise for a cervical disc replacement recovery.
By the third month after the intervention, is it advisable to perform some x-rays in order to confirm the correct positioning of the disc as well as to confirm if the disc is working properly. Once all has been positively confirmed, the patient may go back to practice other sport activities such as cycling or running.

It is important to mention that even though the majority of the spinal implants are made from metal, they rarely cause problems with metal detectors. Nonetheless, the patient should always ask the surgeon specific information of the implant that will be inserted.

Risks associated with Cervical Disc Replacement

•Nerve injury, although extremely rare, can result in debilitating consequences.
•Bleeding and infection rates are low with this surgery.
•Self-limited swallowing difficulty is common with all neck surgeries.
•Incorrectly positioned implant and post-surgical displacement of the device might need a revision surgery.
•Spontaneous fusion across the disc replacement level may occur.
•Reaction to anaesthesia and failure to heal.
•Damage to the oesophagus and vocal cords.

Benefits of Cervical Disc Replacement Surgery

•Protective effect on adjacent discs: The use of disc replacement device preserves mobility at the affected level and may, thus protect the adjacent discs from accelerated degeneration.
•No bone grafts: Cervical disc replacement surgery does not require any bone grafting.
•Lower incidence of non-union or pseudoarthrosis: The chances of developing non-union or pseudoarthrosis is rare since the bones are never fused together.
•No spinal plating: It does not require the placement of a plate in front of the spine, with consequent reduction of swallowing difficulty.
•Shortened immobilization: Cervical collar immobilization is needed only for the first few days after surgery unlike the 4 to 6 weeks prescribed after fusion surgery.
•Very short postoperative stay in the hospital: The patient may be discharged on the same day or the next morning after surgery.
•Negligible pain: Pain is usually minimal and disappears within 2 to 3 days after surgery.
•Short recovery period: Post-operatively, most patients can perform light duties within 1 or 2 weeks of surgery and full duty may be performed within 6 weeks following surgery.

How expensive is Cervical Disc Replacement Surgery?

Cervical disc replacement is a major surgery and can be expensive, especially in the United States. This has drawn many patients requiring this surgery to explore the possibility of getting it done in other countries which maintain good standards at reasonable costs. For example in Barcelona, single level cervical disc replacement surgery can only cost 1/3 of USA’s cost.