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For many years, the gold standard for surgical treatment of certain painful neck conditions has been a procedure called anterior cervical discectomy and fusion. This surgery can effectively relieve pain, but it limits the patient’s range of motion and places more stress on the discs above and below the fusion.
Fortunately, today we have the technology to perform cervical disc arthroplasty (replacement)–placing an artificial disc between two vertebrae in the neck. This procedure allows people to retain their range of motion and recover in just days, and not the weeks needed after fusion surgery.
LISTEN: Dr. Tannous’ full podcast on the latest advances in spine surgery including cervical disc replacement.
Not all spine surgeons have adopted this technology. Those of us who have find it to be a phenomenal treatment option for some patients with painful neck conditions such as cervical disc herniation. Let’s discuss how it works.
“We can treat some neck-related arm pain with disc replacement. It can avoid a spine fusion.” via @MedStarWHC
How does cervical disc arthroplasty work?
The cervical spine is the portion of the spine in the neck. There are six discs in the cervical spine that rest between the vertebrae, the bones that make up the spinal column. The discs are spongy and act as shock absorbers.
When there’s a problem with a disc, the spinal cord or nerves can be compressed or pinched. This can cause neck pain, along with arm pain, numbness or weakness.
Traditionally, when physical therapy and medication didn’t relieve the pain, the main surgical option was anterior cervical discectomy and fusion. We would take the disc out and replace it with a piece of bone, a metal plate and screws that over time would fuse the vertebrae and stabilize that part of the cervical spine. The surgery relieves pain, but you lose some range of motion because there is no longer movement between the fused vertebrae.
In cervical disc arthroplasty, instead of fusing vertebrae together, we replace the disc with an implant that mimics your normal disc motion. It basically functions as a joint that allows normal range of motion and reduces stress on the discs above and below.
The FDA approved the first cervical disc implant in the U.S. in 2007. This allowed us to replace one problematic disc. In 2013, the first device was approved to replace two adjacent problematic discs.
Who might benefit from this technique?
Cervical disc replacement can help people with conditions such as these if non-surgical treatments did not work:
- Cervical disc herniation
- Cervical radiculopathy
- Cervical spinal stenosis
- Degenerative disc disease
We typically use this procedure on patients younger than 60. The main reason for this is because most people 60 and older have a fair amount of arthritis in the neck. Cervical arthroplasty doesn’t cure the arthritis, so the neck pain can remain. In these cases, we recommend traditional surgery.
Find out if you are a candidate for cervical arthroplasty.
Recovery takes days, not weeks
The most amazing part about this technique other than sparing your range of motion is the short recovery period.
When we do a traditional fusion, you may be in a brace up to 12 weeks. This immobilizes the neck to allow the fusion to take place.
But when we do a disc replacement, we don’t want to lock up your motion for very long. I usually put my patients in a brace for a couple days to help with the swelling, but then I want them out of the brace and going about their normal activities.
We’ve had patients who had surgery on Friday and were back to work on Monday. I tell people to do what they can tolerate. I don’t restrict activity too much. Don’t engage in extreme ranges of motion or participate in contact sports right away, but go about your daily activities.
If you’re experiencing neck and arm pain due to disc herniation or cervical spinal stenosis, you may not need surgery at all. About 75 percent of our patients get better using physical therapy, anti-inflammatory medications or steroid injections. It’s only after we’ve exhausted those options that we talk about surgery.
If you’re in that small group who needs surgery, ask your doctor if you’re a candidate for cervical arthroplasty. You may be able to find pain relief without the frustration of losing range of motion in your neck.
Brian Paul, DMD was a perfect candidate for cervical disc replacement. Read his story here.