Who is a candidate for cervical disc replacement spine surgery and what are the risks?
As noted above, cervical disc replacement is used to treat symptomatic cervical disc disease that has not improved with non-operative care. While in some cases disc replacement (arthroplasty) can be used instead of an anterior cervical discectomy and fusion, there are situations where arthroplasty is not an option. In the United States, disc replacement was initially FDA-approved for use at one cervical disc level, though two level disc replacement was recently FDA-approved using one specific company’s device. Cervical disc replacement is not approved for use at the disc level above or below a previous fusion procedure. The procedure should also not be performed in children or when there is abnormal motion or instability at the affected level. Patients with advanced degenerative or arthritic changes, known as spondylosis, affecting the small facet joints along the back of the spine are not candidates for a disc replacement procedure. A disc replacement device should also not be used in the presence of significant osteoporosis or an active infection. It is important to note that cervical arthroplasty is a newer and technically challenging procedure whose exact indications for use continue to evolve. Patients will need to see a qualified spine surgeon to discuss whether disc replacement is an option for their specific condition.
The risks associated with cervical disc replacement surgery are very similar to those associated with an anterior cervical discectomy and fusion. Spinal nerve injury is extremely rare, but is a potentially catastrophic complication of this and most other spinal surgeries. Bleeding is usually very limited with a cervical disc replacement and the risk of infection is also low. Swallowing difficulty is common with any anterior cervical surgery, but in most cases is self-limited. Hoarseness of the voice either due to irritation of the structures of the throat or due to irritation of a nerve may occasionally be seen in either a fusion procedure or a disc replacement surgery; this can improve with time. Technical difficulties related to placement of the disc replacement device, including an incorrectly positioned implant or movement of the device following implantation, are possible and could require revision surgery. Spontaneous fusion across the disc replacement level has been reported, but does not typically require treatment.
Many physicians and patients have expressed concern over whether a disc replacement device will wear out over time. Fortunately, unlike hip and knee replacements, this has not been found to be the case with cervical arthroplasty devices, both when they are tested in a laboratory setting and in reviews of patients who have had this procedure in the past. This is likely because the stresses applied to these implants are significantly less than those seen in other joints such as the hip and knee. Additionally, the biologic environment of the disc space is quite different than that of the joints found in the extremities. Many other potential complications to the procedure do exist, however, and a thorough discussion with your surgeon is mandatory before considering this or any other surgical procedure.
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