For patients whose pain does not improve with non-surgical treatments, surgery may be necessary. Cervical artificial disc replacement is an alternative to fusion that places a device inside the disc space to restore height and remove pressure on the pinched nerves. The artificial disc is designed to allow the neck to maintain normal motion and potentially prevent the adjacent levels from degenerating. Replacing a damaged disc with an artificial disc is a newer type of treatment than a bone fusion, and may have the advantage of allowing more neck movement and placing less stress on the other cervical vertebrae.
The typical patient will have neck pain caused by one or two discs, and nerve pain going down the arms. The damaged disc may cause a pins and needles feeling in their hands, or weakness in their shoulders, arms, hands and even legs. The best candidates are of healthy weight, don’t have scoliosis or other spinal deformities, don’t suffer from significant compression on spinal nerves and haven’t had previous major spinal surgeries.
The procedure
The surgical team will insert an intravenous line in the patient’s hand or arm to deliver fluids and general anesthesia. They might also insert a breathing tube down the patient’s throat to protect the airway and supplement breathing.
The surgeon cuts a one- to two-inch incision in the side or front of the patient’s neck. The team retracts muscles and blood vessels so the surgeon gets a clear view of the vertebrae. He or she then removes the problem disc and replaces it with the artificial disc.
The surgeon uses absorbable stitches under the skin to close the incision, and another layer of sutures on the outer skin. The surgical team applies a small dressing over the incision. They may decide the patient needs to wear a rigid or soft neck collar to restrict motion.
Recovery
Patients usually spend a day or two in the hospital after a cervical artificial disc replacement. They continue to get liquids through an IV until they’re able to drink normally. The hospital staff will encourage the patient to get up and gently move around as soon as possible, but they might require a support collar to stabilize the neck. Pain medicine is often necessary during the hospital and physical therapy will be advised afterward. Patients vary, but usually they’re able to resume their normal activities in four to six weeks.
Risks
Cervical artificial disc replacement is considered a relatively safe procedure. Since it’s a new type of surgery, there’s not much data on long-term outcomes. Like all surgeries, it carries risks. The surgery might not resolve the condition. The artificial disc could become loose, break or cause an infection. Since this surgery happens in the neck, it’s possible that it will change the patient’s voice or lead to difficulty in breathing or swallowing. Nerve injury, spinal fluid leak, stroke, bleeding and adverse reactions to anesthesia are other possible risks.
The term “decompression” means releasing pressure on the nerves or spinal cord. There are both non-operative ways and several surgical ways to do this. Spinal decompression surgeries can relieve pain caused by collapsed or bulging discs, loosened ligaments, thickened joints or bony growths, all of which narrow your spinal canal and cause pain and irritation.
Patients with spinal nerve compression report feelings of pain, weakness, tingling, numbness and unsteadiness. Occasionally the pressure on the nerves is so bad it interferes with bladder or bowel function, or even causes paralysis. Microdiscectomy, laminectomy and foraminotomy are three surgeries a spine specialist might recommend if non-operative approaches fail.
