Patients with symptomatic cervical disc herniation or degenerative disc disease that hasn’t responded to non-surgical treatments (e.g., physical therapy, medications, injections).
Your cervical spine is the structure and support for your neck region. The discs are the cushioning between the bones that allow your neck to move freely. This area of your spine also has a protective tunnel through which your spinal cord can pass. Over time, this space can become too narrow, and the discs can push on your nerves causing severe pain in the shoulders, arms, and hands.
A cervical artificial disc replacement (ADR) is a surgical procedure designed to replace a damaged or degenerated disc in the cervical spine (the neck) with an artificial disc. This procedure aims to relieve neck pain and associated symptoms by restoring normal disc function and maintaining the spine’s natural movement. Cervical ADR is an excellent spine fusion alternative. In fact, recent studies have indicated that an ADR is superior to a neck fusion for the right indicated candidates.
Cervical artificial disc replacement surgery — or cervical total disc arthroplasty — is a solution for the pain and weakness you may experience from this problem. The DISC experts can help at our office in Phoenix, AZ.
Cervical artificial disc replacement (CDR) has been shown in both short-term and long-term clinical studies to have higher success rates compared to anterior cervical discectomy and fusion (ACDF) surgery. Extensive research has established CDR as an effective and safe treatment for cervical disc degeneration presenting with myelopathy or radicular symptoms.
Clinical studies indicate that patient satisfaction and clinical success rates for CDR are comparable to ACDF at one-level surgery and superior at two-level surgery. After seven years, more than 95% of patients who underwent CDR reported being “very satisfied,” compared to 88% of ACDF patients.
The benefits of artificial disc replacement over spinal fusion may include greater postoperative spinal mobility, quicker recovery times, and a reduced incidence of adjacent disc disease necessitating further spinal surgery. However, the success of CDR largely depends on proper patient selection. Candidates with severe degeneration, spinal instability, or significant osteoporosis may be more suitable for ACDF rather than CDR.
Several issues can cause the loss of space between your cervical vertebrae. As you age, your cervical discs may degenerate from general wear and tear in the joints. This phenomenon can also happen from injury.
A candidate for cervical artificial disc replacement (ADR) typically meets specific criteria based on their medical condition, symptoms, and overall health. Here are the key factors that determine candidacy:
Patients with symptomatic cervical disc herniation or degenerative disc disease that hasn’t responded to non-surgical treatments (e.g., physical therapy, medications, injections).
Chronic neck pain that significantly impacts daily activities. Radicular symptoms such as pain, numbness, or weakness in the arms caused by nerve compression. Myelopathy (spinal cord compression) symptoms like difficulty with coordination, balance issues, or fine motor skill problems.
Candidates usually have issues at one or two adjacent cervical disc levels. Multi-level disease may require a different approach.
Non-surgical treatments, such as physical therapy, medications, and lifestyle modifications, have not provided sufficient relief after an adequate trial period.
Generally, patients are adults (ages 18-60) who are in good overall health. Patients should not have severe osteoporosis, as bone density is important for the stability of the artificial disc.
No severe facet joint disease or other spinal conditions that would preclude the use of an artificial disc. No significant spinal deformities or instability.
Our expert surgeons perform cervical artificial disc replacements as a minimally invasive procedure. Here is a quick look at the whole surgical process from start to finish.
During a pre-operative visit, a surgical patient goes through several important steps to ensure they are ready for the upcoming procedure. The healthcare provider will begin with a medical history review, examining any previous surgeries, chronic conditions, allergies, and current medications. A physical examination will follow to assess the patient’s overall health and identify any potential issues that might affect the surgery. Various preoperative tests, such as blood work, electrocardiograms (EKGs), chest X-rays, or other diagnostic tests, may be ordered to evaluate the patient’s health and readiness for surgery. Additionally, the patient will meet with an anesthesiologist to discuss anesthesia options, review any history of anesthesia reactions, and plan for the safest anesthesia approach. The patient will receive instructions on which medications to continue or discontinue before surgery, often including the cessation of blood thinners or NSAIDs that could increase bleeding risk. Patients will be advised to avoid smoking and drinking alcohol before the surgery, as these habits can affect healing. They will also be instructed to fast, typically from midnight before the day of surgery, to ensure an empty stomach during the procedure. The patient will be provided with information about the surgery, including risks, benefits, and what to expect during recovery, and will sign a consent form to acknowledge understanding and agreement to proceed. Finally, logistical planning will be discussed, including arrangements for transportation to and from the hospital and plans for post-operative care, ensuring the patient has the necessary support at home. By the end of the pre-operative visit, the patient should have a clear understanding of the surgical process, be prepared for the day of surgery, and know what steps to take to optimize their recovery.
In the pre-operative area at the hospital, several important steps are taken to prepare the patient for surgery. Upon arrival, the patient will check in, receive a hospital bracelet, and have their identity and surgical details verified. Nurses will then take the patient’s vital signs and conduct an initial assessment, asking about recent health status and any last-minute concerns. An IV line will be inserted to administer fluids, medications, and anesthesia. The surgeon may mark the surgical site to prevent wrong-site surgery, and the patient may receive preoperative medications such as sedatives and antibiotics. The anesthesiologist will review the patient’s medical history, discuss the anesthesia plan, and answer any remaining questions. The surgical team will conduct a final verification process, often referred to as a “time-out,” to confirm the patient’s identity, the correct surgical procedure, and the correct site. The patient will also reconfirm their consent for the surgery. They will change into a hospital gown and remove any personal items. A final preoperative briefing will be given, including post-operative care instructions and what to expect immediately after the surgery. Finally, the patient will be transported to the operating room on a stretcher, where the surgical team will begin the procedure. Throughout this process, the medical team ensures that all necessary precautions are taken to maximize the safety and success of the surgery.
Cervical artificial disc replacement surgery is a minimally invasive procedure that efficiently and safely replaces a damaged disc with an artificial disc. The operation typically takes between one to three hours. First, the patient is prepared by lying on the operating table and receiving anesthesia. Once asleep, the neck area is cleaned and prepped. Next, a 2-inch skin incision is made on the side of the neck, and the surgeon gently retracts the trachea, esophagus, and arteries, lifting the muscles on the front of the spine to access the disc. An x-ray fluoroscope is then used to guide a needle into the disc to confirm the disc level, followed by the insertion of distractor pins into the vertebrae above and below the damaged disc to spread the bones apart.
The disc wall is cut open, and the surgeon removes the disc using small grasping tools, possibly releasing the posterior ligament behind the vertebrae to reach the spinal canal. Bone spurs are removed and the foramen through which the spinal nerves pass is enlarged to give the nerves more room to exit the canal.
The width and depth of the disc space are measured, and a trial size implant is selected and tapped into the empty disc space. An x-ray ensures the size is optimal, with multiple trials placed until a good fit is found. The permanent implant is loaded into the inserter cartridge, tapped into position, and the distractor pins are released. Pressure is applied to set the implant “teeth” into the bony endplates. Finally, the incision is closed by removing the distractor pins, suturing the muscle and skin incisions together, and applying biological skin glue across the incision.
The Cervical Artificial Disc Replacement is used to treat conditions such as:
Following the procedure, you will be moved to a recovery area to be monitored while you come out of anesthesia. In most cases, patients may be discharged on the same day of surgery if they are recovering well, and their pain is managed and tolerated. Recovery can look different for each patient, but you should be able to return to your full activities around four to six weeks after the procedure.
Recovery after cervical artificial disc replacement involves several stages, each with specific care instructions and guidelines to ensure optimal healing and restoration of function:
Post-operative Care: After surgery patients recover from anesthesia for a few hours. During this time, medical staff will monitor vital signs, pain levels, and the overall condition. Most patients go home from the hospital the same day after surgery. Pain Management: Pain is managed with prescribed medications. Some discomfort around the surgical site and in the neck and shoulders is expected. Mobility: Patients are encouraged to start moving the neck around as soon as possible to promote blood flow and reduce the risk of blood clots. Gentle neck movements might be initiated under the guidance of medical staff. No neck bracing is needed as the artificial disc device preserves the neck’s natural motion.
Activity Restrictions: Patients should avoid heavy lifting, strenuous activities, and sudden neck movements. Light activities, such as walking, are encouraged. Wound Care: Proper care of the surgical incision is essential to prevent infection. Patients should keep the area clean and dry, following the surgeon’s instructions. Physical Therapy: Physical therapy may begin a few weeks after surgery to help improve neck strength, flexibility, and overall mobility. The therapy regimen is typically customized to each patient’s needs.
Gradual Return to Activities: Most patients can gradually return to their normal activities over the first few months. However, activities that place stress on the neck should be resumed only after receiving clearance from the surgeon. Follow-Up Appointments: Regular follow-up appointments with the surgeon are crucial to monitor the progress of recovery, check for any complications, and make any necessary adjustments to the recovery plan.
Full Recovery: Full recovery can take several months. Patients can expect to regain most, if not all, of their normal neck function and return to regular activities, including work and exercise, typically within three to six months. Lifestyle Adjustments: Patients may need to make lifestyle adjustments to avoid activities that could place excessive strain on the neck. Maintaining good posture, using ergonomic workstations, and avoiding high-impact sports can help preserve the benefits of the surgery.
Monitoring for Complications: While complications are rare, patients should be aware of signs such as increased pain, swelling, redness at the incision site, fever, or any neurological symptoms like numbness or weakness. These should be reported to the surgeon immediately. By adhering to these guidelines and maintaining regular communication with their healthcare team, patients can expect a successful recovery and a significant improvement in neck pain and function after cervical artificial disc replacement.
The surgeons at DISC have the technology and expertise to relieve your neck and back pain through cervical artificial disc replacement surgery. Contact us today with any questions or to schedule a consultation appointment.
