The cervical spine is composed of seven vertebrae and five discs. The discs, which are located between each vertebrae, act as shock absorbers, and along with the joints of the cervical spine, allow for motion. As a consequence of aging or injury, the discs can potentially rupture, resulting in a herniated disc, with pinching and inflammation of a cervical nerve. This will result in significant pain down the arm, along with possible numbness and weakness.
Although most cervical disc herniations will heal with time, medications and therapy, a small number of patients will require surgery. During surgery, the disc is removed, along with the disc fragment that is pinching the nerve. Following disc removal, the surgeon must then either fuse the two bones together, resulting in loss of motion at that level, as well as greater stress in the remaining discs. Rather than fusing the bones together, some patients are a candidate for a technology that allows continued motion at the surgical level. This is a cervical disc replacement, also referred to as a total disc replacement or cervical arthroplasty. A cervical arthroplasty allows for continued motion at the surgical level, therefore maintaining range of motion in most patients, as well as protecting the adjacent discs.
Procedure
If a disc replacement is planned, the first part of the procedure is identical to a cervical fusion. Under general anesthesia, a small incision is made over the disc on the front of the neck. The injured disc is located and removed (usually with the assistance of a surgical microscope).
At this point, rather than a fusion, with screws and a plate and bone graft, the arthroplasty device is sized, selected and positioned under X-ray control. The procedure is often followed with an overnight stay, although many patients are allowed to go home the same day as surgery.
Recovery
Recovery after a disc replacement is easier than with a fusion because there is, of course, no fusion to heal. Additionally, most patients note they are more comfortable and have less postoperative pain. Returning to work is earlier than with a fusion.
Not all patients are candidates for cervical arthroplasty. Significant arthritis, poor bone quality, or difficulties obtaining radiographic images of the involved area are all considered contraindications. If you are a candidate, the literature does show excellent long-term results and decreased adjacent segment wear.
James Leipzig, M.D., F.A.C.S. is a fellowship-trained Virginia spine surgeon who offers cervical disc arthroplasty, along with minimally invasive and microsurgical spinal surgery for the Salem and Roanoke communities. Please feel free to contact Dr. Leipzig at the Spine Center in Salem, Virginia today.
