What is a Cervical Disc Replacement?
Cervical disc replacement surgery is a procedure that involves removing a diseased or degenerated disc in the neck and replacing it with an artificial disc.
The indications for this procedure are somewhat similar to that for an anterior cervical discectomy and fusion, or ACDF.
However, not every patient is a candidate for a cervical disc replacement.
Cervical disc replacement is an excellent procedure to relieve the symptoms of cervical radiculopathy, or severe pain, numbness, or weakness radiating down the arm. This can be caused by a herniated disc or degenerative disc disease.
Patients with severe degenerative disc disease and collapse of the disc space will usually get better results with an ACDF while those with milder degenerative disc disease may be candidates for cervical disc replacement surgery.
The main benefit of a cervical disc replacement is that no spinal fusion is performed, and that the motion between the bones is preserved.
Cervical Disc Replacement Procedure
During a cervical disc replacement surgery, the patient is positioned on their back on the operating room table.
The procedure is performed under general anesthesia. After a sterile preparation of the skin and placing drapes, a small incision is made on the left or right side of the neck. The structures of the front of the neck including the trachea, esophagus, and arteries and veins are moved gently to the side to access the front of the spine. Specialized retractors are then placed to protect the structures of the neck and to allow access to the spine and disc space.
Using a microscope, the disc is completely removed. Bone spurs are also removed using a high-speed burr and small biting instruments.
The ligament that covers the spinal canal is then carefully removed to visualize the spinal cord and remove any disc fragments that are putting pressure on the spinal cord or nerves. At this point the empty disc space is measured carefully and the appropriate size disc replacement is selected and implanted in the disc space. Final x-rays are taken to confirm good position of the disc replacement, and then the retractors are removed and the incision is closed.
What To Expect After Cervical Disc Replacement Surgery?
Cervical disc replacement surgery in most cases leads to excellent relief of neck and arm pain caused by degenerative disc disease or a herniated disc. Typically this relief is almost immediate, with patients waking up from surgery noticing right away that they pain they had before surgery is gone. If a drain is used after surgery to remove bleeding from the surgical site it is removed on the same day or the following morning after surgery. A brace after surgery is not required after cervical disc replacement surgery.
Cervical Disc Replacement Surgery Recovery
Cervical disc replacement recovery time is typically fairly rapid and without much post-operative pain. Patients usually go home either on the same day of surgery or the next morning.
Strong pain medications are needed only for a day or two after surgery, and many patients don’t require strong pain medications at all.
Cervical radiculopathy pain is usually improved immediately after surgery. If numbness or weakness was present before surgery, this can take weeks to months to fully resolve as the nerves recover. Rarely these symptoms may not recover completely if there was pre-existing damage to the nerves or spinal cord prior to cervical disc replacement surgery.
Post-operative visits are recommended at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and then every other year after cervical disc replacement surgery.
For the first 6 weeks, patients are restricted to lifting no more than 10-15 lbs, and no overhead activities, to allow the initial phases of healing of the implant to the bony surfaces of the spine to occur. After the first 6 weeks, patients can gradually return back to their normal activities without restrictions.
Walking daily and low-impact exercise such as elliptical machine or riding a stationary bike is recommended after cervical disc replacement surgery. This can be restarted within a day or two after surgery.
Tylenol or anti-inflammatory medication such as ibuprofen or naproxen can be used as needed for pain during the recovery process but most patients find that they do not require any pain medication after the first week after surgery.
Cervical Disc Replacement Surgery Risks
While all spinal operations carry some risks, the risks of cervical disc replacement surgery are quite low.
The most common risks after cervical disc replacement surgery include:
Dysphagia - this refers to swallowing difficulty after surgery. Every patient will have minor discomfort swallowing after surgery which is typically temporary and resolves over the course of 1-2 weeks. Rarely after cervical disc replacement surgery patients will develop persistent dysphagia that lasts longer than 3 months.
Dysphonia - this refers to an effect on speech, and can result in hoarseness or an inability speak over a whisper. This can occur if there is a stretch injury to the nerves that control the vocal cords. This is a rare complication and if it occurs usually resolves over several weeks, but even more rarely can be permanent.
Adjacent level degeneration. This means that the spinal level above or below the operated level can develop a problem such as degenerative disc disease. This is believed to be less common after cervical disc replacement surgery than after anterior cervical discectomy and fusion.
Displacement or failure of the disc replacement device. Because the disc replacement can move, the parts and bearing surfaces can wear out over time or it could theoretically become dislodged from its proper position in the spine. Since the most modern disc replacement implants have only been available for approximately 10 years, we are not sure how long the disc replacement devices will last and if they will eventually have to be revised or replaced with a new disc replacement years later.
Other risks that are very rare after cervical disc replacement surgery include:
The possibility of injury to the nerves or spinal cord
Possible injury to the vertebral arteries or carotid arteries that could result in stroke or death
Injury to the other structures of the neck such as the esophagus or trachea
If you have more questions or would like to schedule an appointment with Dr. Nemani to see if you are a candidate for a cervical disc replacement, please call 919-781-5600 or book an appointment online.