Cervical Artificial Disc Replacement Surgery
MANY AMERICANS ARE FAMILIAR with surgery for replacing arthritic joints that have become painful. In the US, approximately one million worn-out knees and hips are replaced by artificial joints every year. Overall, results for these procedures are excellent, allowing patients to return to active lifestyles.
Joints in the spine, called intervertebral discs, can also become painful, similar to knees and hips when they become arthritic. This is a common condition, affecting up to 80% of adults as they get older. For a small subset of these patients, the pain may become so severe that surgery is required.
It is only recently, however, that artificial joint replacement technology has been perfected for these cervical discs in the spine. Previously, the only treatment for rebuilding a damaged disc was to remove the entire cervical disc and replace it with a fixed, immovable cage (spinal fusion surgery). When performed in the cervical spine (neck), this operation was called Anterior Cervical Discectomy and Fusion (ACDF).
ACDF, though very effective at relieving pain and dysfunction caused by a damaged intervertebral disc, has a drawback: fusion leads to decreased neck range of motion. More importantly, fusing a joint in the neck can lead to accelerated wear and tear on the joints nearby. This process, known as adjacent segment disease, can create additional problems for the patient many years after a successful spinal fusion procedure.
Cervical artificial disc replacement surgery solves this problem by preserving motion in the treated joint. As a result, spine patients can now experience the same motion-preserving benefits that hip and knee patients have enjoyed for decades.
Why Is Cervical Disc Replacement Needed?
Patients who are experiencing arm, shoulder, and neck pain (cervical radiculopathy, pinched nerve, or cervical stenosis), and who have not improved with conservative care, can be considered for surgical intervention. Historically, anterior cervical discectomy and fusion was the surgical treatment of choice for these patients. Cervical artificial disc replacement is now an excellent alternative to ACDF.
Do All Surgical Candidates Qualify For Cervical Disc Replacement?
Currently, the FDA approves disc replacement for the treatment of only one or two intervertebral discs. Patients who need more levels treated may need ACDF. In addition, disc replacement requires certain ligaments in the spine to be intact, along with normal bone alignment. By closely studying an MRI or CAT scan, a doctor can decide whether a patient qualifies for cervical disc replacement.
How Is Cervical Disc Replacement Performed?
Surgery for disc replacement is very similar to ACDF and takes between 60 and 90 minutes to perform by an experienced CNSO surgeon. Surgery can be performed in a hospital or ambulatory surgery center.
After general anesthesia is given, an incision is made on the front of the neck. The windpipe (trachea) and food pipe (esophagus) are then carefully moved to the side and protected, allowing direct visualization of the spinal column (typically an inch or two under the skin). The damaged disc is then removed, and all loose disc fragments are taken off the spinal cord and nerves. An artificial disc, made from metal and medical-grade plastic, is then custom fitted into this space.
How Long Does It Take To Recover From Cervical Disc Replacement?
Cervical disc replacement is typically an outpatient procedure. Patients are usually discharged home the same day or the next day after the procedure. A cervical collar for immobilization may be required for one or two weeks depending on the neurosurgeon’s preference. Postoperative discomfort from the procedure is tolerable and usually limited to two to three days and can be controlled with oral pain medications. Preoperative symptoms such as pain, numbness, tingling, and weakness are often markedly improved within hours of the procedure. However, full recovery may take up to weeks or even months.
Postoperative office follow-ups are usually done at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year. X-rays are routinely performed to check for proper positioning and functioning of the artificial disc replacement. Most patients are back to work on light duty in one to two weeks and full duty in about 6 weeks after disc surgery.
How Does Cervical Disc Replacement Compare to ACDF?
Cervical disc replacements are proving to be equal or superior to anterior cervical discectomy and fusion in terms of surgical outcomes. In 2016, a randomized controlled trial with 2300 patients compared disc surgery to anterior cervical discectomy and fusion, with at least 4 years of follow-up. This study found that cervical disc replacements led to significantly higher rates of success and lower rates of complication.
What Are The Advantages of Disc Replacement Surgery Over ACDF)?
Motion preservation at the replacement level, reducing chances of adjacent segment disease development.
Reduced postoperative pain and recovery. With a cervical disc replacement, the need for any cervical immobilization lessens to a week or less as compared to 6 weeks with an anterior cervical discectomy and fusion.
No need for an anterior plate placement. Consequently, there is less irritation to the esophagus, and less swelling, both of which may cause difficulty swallowing and hoarseness.
Factors To Consider When Choosing A Spine Doctor
- Experience: The most important factor to consider is experience. There is no substitute. Repetition yields excellence in results. When choosing a surgeon to treat the cervical spine, ask how many of these procedures he or she performs on a routine basis, and what are the outcomes. In addition, ask whether prior patients would be willing to discuss their pre and post-operative journeys.
- Judgment: While experience does lead to technical expertise and improved outcomes, it also leads to better clinical judgment. In many ways, a doctor’s judgment is even more important than his or her technical skill, because a great deal of consideration goes into deciding whether a patient even needs surgery, and if so, what type of surgery. This careful consideration cannot be rushed, and cannot be made with a cookie-cutter approach. A surgical decision can never be made based on MRI findings alone (beware of doctors who offer free MRI reviews, without an evaluation or examination). Rather, MRI findings must be interpreted within the context of what the patient reports to the doctor, and what the doctor finds on a careful examination. It is only when the patient’s symptoms, findings on exam, and MRI results closely correlate can a surgical decision be made. Furthermore, this decision can only be made after all conservative options have been exhausted.
- Conservative Approach: When choosing a spine doctor, make sure he or she has a very conservative approach to care, offering surgery only as a last resort. The vast majority of patients (>95%) who suffer from spine ailments do not require surgery, even if their MRIs look severely abnormal. The human body has a tremendous capacity to heal itself, and it is the spine doctor’s job to show how that can be achieved. Surgery should be reserved only for those rare cases where this healing process is not possible.
- Breadth of knowledge and skills: There are over 200 distinct types of operations that can be offered for the treatment of spine conditions. Some can be performed via same-day, minimally invasive approaches, while others require large incisions with titanium hardware for complex reconstructions. Every one of these operations represents a tool in the surgeon’s armamentarium, uniquely suited to address a specific surgical need. Unfortunately, not all surgeons have a broad range of surgical skills. Some may limit themselves to the simpler procedures, that are only effective for more routine conditions. However, if a condition is more complex, they may be out of their comfort zone, or they may offer surgical solutions that are not appropriate for a unique circumstance. Ask the surgeon about the range of spine conditions he or she treats, from simple disc herniation to scoliotic deformities. Is the surgeon equally comfortable with a multi-level deformity correction as with a microdiscectomy? Can the surgeon explain the difference between cervical disc replacement versus spinal fusion, and offer either technique if appropriate? Many surgeons will offer cervical fusion simply because they lack qualifications for disc replacement.
- Time spent listening and educating: Many surgeons rush to diagnose off an MRI scan. This is the primary reason that so many patients feel dissatisfied with the results of their spine surgery. The surgery may have been performed well, but there continues to be severe pain and dysfunction, causing many to wish they had never undergone surgery to begin with. Why does this happen so often? Because most spine surgery is performed for something that cannot be measured – i.e. pain. Pain is not like temperature or blood pressure, which can be objectively quantified and treated if too high. Rather, pain is very subjective; something that causes misery to one person may be minimally bothersome to another. To further complicate matters, pain is difficult to localize. Many things in the spine can cause pain, such as herniated discs, unstable facet joints, SI joints, or compressed nerve roots. Unfortunately, these can be packed very close together anatomically, and can all cause pain in the same general area. Finally, a joint or disc can look abnormal on X-Ray or MRI, but not cause pain.
Considering all these factors, it can be very difficult to accurately identify the pain generator in any particular patient. If the original diagnosis is inaccurate, then even well-executed spine surgery can leave the patient in pain, because the true source of pain was never accurately identified. Worse, there may be unnecessary complications from surgery, and scar tissue formation, that creates even more pain.
How CNSO Can Alleviate Disc Pain
The only way to overcome the difficult problem of accurate diagnosis in spine care is this – the doctor must spend enough time listening to the patient and asking a lot of questions. With enough time, important clues in the patient’s story can help a doctor identify the underlying problem. The doctor must also perform a thorough and detailed examination searching for all of the signs that lead to a proper diagnosis. All of the findings then will be correlated with imaging study results and the correct pain generator will be identified.
The CNSO philosophy is to treat the patient, not the MRI. Patients receive comprehensive and coordinated care so they can resume a healthy, pain-free lifestyle by working with the CNSO leading board-certified neurosurgeons, orthopedic spine surgeons, interventional pain management physicians, physiatrists, rehabilitation specialists, and certified physical therapists. CNSO offers multiple convenient locations spanning northern New Jersey, including Bergen, Passaic, Essex, Morris, and Hudson counties. Learn how the doctors at CNSO can alleviate pain with cervical disc replacement surgery by contacting them today.