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Cervical Total Disc Replacement
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Procedure description
Cervical total disc replacement is a surgical procedure that involves removing a damaged or compromised cervical disc and replacing it with a prosthesis to add support and structure in between the cervical vertebral segments while still maintaining range of motion. Typically, a cervical total disc replacement is done through an anterior approach which means the surgeon will make incision from the front and side of the neck. This gives the surgeon the working window to remove the damaged disk safely without having to navigate around the spinal cord or nerve root branches as is necessary with a posterior approach.
Total disc replacement has become more common recently as a better option for some patients versus a typical Anterior Cervical Diskectomy and Fusion (ACDF). One of the primary disadvantages of an ACDF procedure is the loss of range of motion. When the cervical vertebral segments are fixated through fusion with instrumentation they will naturally lose the ability to flex and extend at that particular segment. Additionally, because that segment is now rigid, the segments above and below can over time become compromised because they are having to absorb more load. With that said, an ACDF is still is very viable option in many cases and in some cases will be a better option as compared to a total disc replacement. There are many factors that go into whether or not a total disc replacement or an ACDF would be the best option for a patient’s case.
When to Consider
As with any surgery, conservative treatment measures should be exhausted before considering spinal surgery. There are many effective non-invasive options that can treat cervical spine related neck pain such as chiropractic, traction, physical therapy, and massage. Typically plans of care include 6 weeks minimum of conservative treatment that has been strictly adhered to. If symptoms persist or worsen than patients may be considered for treatments like epidural steroid injections or radiofrequency ablations. If those therapies fail that surgery may be considered
Symptoms a patient may experience that may indicate candidacy for a total disc replacement can include:
- Pain that is local to the head, neck, and shoulders
- Radiating symptoms that extend from the neck into the upper extremities (shoulders, arms, hands, and digits)
- Gait abnormalities, difficulty walking, and trouble balancing
Recovery from cervical total disc replacement
Many times, cervical total disc replacement can be done outpatient through minimally invasive techniques. One of the main advantages of minimally invasive surgery is that it offers small incisions that ultimately lead to significantly less post-operative pain. Less post-operative pain is definitely a good thing, however, sometimes it can lead patients to believes they can get back to their normal day to day activities faster than they should. It is vitally important when post-op from cervical total disc replacement to play close attention to the guidelines and restrictions set forth by your surgeon. Most patients can return to light-duty work and activities within 1 to 2 weeks from surgery. Lifting restrictions will be places and gradually allow more and more over time. Range of motion should be preserved and when fully recovered most patients should be able to return to the active lifestyle they had before their symptoms started.
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