Cervical Disc Replacement from a Spine Surgeon in New Jersey
Cervical disc replacement is a surgical procedure that involves removal of a damaged or degenerated cervical disc and replacing it with an artificial disc device. Cervical discs are the cushions or shock absorbers between the bones (vertebra) of the neck (cervical spine). Discs that become damaged either through trauma or degeneration can be a source of pain. If part of a disc displaces out of its normal position it can cause pressure either on the central spinal cord or on the individual nerve roots that exit from the spinal canal at each vertebral level. Over time, the body’s reaction to a disrupted disc is the formation of bone spurs called osteophytes that can also cause pressure on the spinal cord or nerve roots. Pressure on the spinal nerves from a disc or bone spur can cause neurologic symptoms which may include numbness, weakness, or pain that radiates from the neck into one or both arms. Disc disruption and degeneration can be a source of neck pain as well.
The standard initial treatment for symptomatic cervical disc disease typically involves physical therapy, medications, and occasionally spinal injection procedures that involve injecting anti-inflammatory medications directly around the spinal nerves. If the symptoms persist and are very bothersome for more than 6-12 weeks, surgical treatment can be considered. While a small portion of patients with a disc herniation in a specific location can be managed with a procedure performed on the back of the neck called a “posterior discectomy” or “lamino-foraminotomy,” the most common and traditional operation for symptomatic cervical disc disease involves an anterior cervical discectomy and fusion surgery, sometimes called an “ACDF”.
With the anterior cervical discectomy and fusion technique, an incision is made in the front of the neck following which the surgeon removes the damaged and protruding disc and associated bone spurs in order to relieve any pressure on the spinal cord and nerve roots. After the disc is removed, the gap that has been created between the two bones is then typically filled with a piece of bone graft (obtained from a cadaver or from the patient’s pelvis) or with a synthetic (titanium or medical grade plastic) cage device. Once the pressure on the nerves has been relieved, the goal of the procedure is to cause the two bones to grow together (called a fusion), resulting in a complete loss of motion at the surgical level. In the anterior cervical discectomy and fusion procedure, a plate with screws is frequently applied to the front of the spine to provide initial stability, which assists in achieving a solid fusion. Following the fusion, patients are often immobilized for up to six weeks in a specialized neck brace called a cervical collar. X-rays are also obtained at different time points after the surgery to determine whether the fusion has healed.
More recently, cervical disc replacement, also known as total disc arthroplasty, has become an FDA-approved option for surgically treating symptomatic cervical disc disease. This procedure is similar to the anterior cervical discectomy and fusion, except that the gap that is created by removing the disc from between the two vertebrae is filled with a disc replacement device. A disc replacement device is typically composed of two metallic surfaces, one of which is attached to the upper vertebra and the other to the lower vertebra at the affected disc level. These metal implants can then slide on each other directly or slide on medical grade plastic sandwiched between. The device allows for motion between the two vertebrae to be maintained and avoids the need for a fusion. The disc replacement device can be secured in place with screws or it may have an anchor that holds the implant to the bones with a tight fit (Figures 1 and 2).
We provide surgical treatment for the excision and reconstruction of vertebral tumors and complex cervical trauma, depending on the type and severity of the condition. Our doctors are specially trained in treating all cervical spine conditions with care and precision.
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It is important to understand that disc replacement surgery is a newer procedure with a shorter track record than the more traditional anterior cervical discectomy and fusion surgery. Cervical disc replacement has only been available in the United States for the past several years, though the procedure has been performed in Europe for almost 20 years. The randomized FDA trials evaluating cervical disc replacement in the United States found clinical results that were equivalent, and perhaps slightly superior in some ways, to anterior cervical discectomy and fusion. More data on disc replacement is being generated every year, but both patients and physicians must understand that this is a newer surgical option whose longer-term results will need to be watched closely.
Cervical disc replacement does offer several potential benefits over more traditional fusion surgery. Using a disc replacement device preserves motion at the affected level, which may potentially protect against increased stress on the discs above and below the disc replacement. This increased stress is thought to be a factor in damage of discs above and below that can be seen later after a fusion. While the goal of protecting of the adjacent disc levels is very important, it is not fully known exactly how much a fusion causes accelerated degeneration of the surrounding discs. It should also be noted that the protective effect of a disc replacement on the remaining discs has not yet been definitively proven. Another potential benefit of disc replacement is that disc replacement surgery does not require any bone grafting. Additionally, since the bones are not being fused together, the possibility of a non-healed spinal fusion (called a non-union or pseudarthosis) is also eliminated. Moreover, with disc arthroplasty there is no need for a plate to be placed on the front of the spine. Avoiding the need for a plate may potentially lessen irritation of the esophagus (throat) and reduce the swallowing difficulty that sometimes occurs following anterior cervical surgery. Finally, with disc replacement surgery, immobilization in a cervical collar is also generally less than the customary 4 to 6 weeks of immobilization typically prescribed after fusion surgery.
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