How is Cervical Disc Replacement Performed (A Step by Step Guide)

Cervical disc replacement is a type of spine surgery in which a worn or damaged cervical disc in the neck is replaced by an artificial disc device.

The cervical spine has seven bones, known as cervical vertebrae, which are stacked on top of each other. The cervical discs act like shock absorbers in between the vertebrae and enable the neck to move freely.

Disc replacement surgery can relieve nerve-related pain and other symptoms, while maintaining motion in that part of the spine.

Brief history of cervical disc replacement

Swedish surgeon Ulf Fernstrom implanted the first artificial cervical disc in the 1960s. This ball-shaped stainless steel device was also used in the lower back, or lumbar spine. In the cervical spine, though, the devices tended to shift position and offered too much movement.

In the late 1980s, surgeons in the United Kingdom designed another type of cervical disc. This had a ball-and-socket design, with an upper and lower metal plate that attached to the adjacent vertebrae.

This device was redesigned and eventually released as Medtronic’s Prestige Disc . A in 2007 found that cervical disc replacement with this device maintained motion in that part of the spine with fewer complications.

Choosing a surgeon for cervical disc replacement

Cervical disc replacement is a specialized surgery, so you want to choose a surgeon who has a strong combination of training and experience to perform this procedure well.

If you are considering a cervical disc replacement, first check with your health insurance company to make sure that your health plan covers this procedure and to find out which surgeons are in your plan’s network.

When choosing a spine surgeon, look for a surgeon who:

Is Board-certified and fellowship-trained

Look for a surgeon who is board-certified or has done a dedicated fellowship in spinal surgery, in addition to having done their primary residency in orthopedic surgery or neurosurgery. These qualifications show that a surgeon has a high level of experience, knowledge, and competency.

Dr. Benjamin Bjerke, a spine surgeon with Capital Orthopaedics in Des Moines, Iowa says that “surgical knowledge and techniques have become so advanced that it’s impossible for a surgeon to be an expert in all subspecialties of his or her training.” Except in rural and underserved areas, the majority of spine surgeons are dedicated to spine care because of the pace of innovation in the field.

“In addition, most companies that manufacture cervical artificial disc replacement devices require the surgeon to complete one or two training courses,” added Dr. Khawar Siddique, a neurospine surgeon at DOCS Spine + Orthopedics in Los Angeles.

Has a strong record of performing successful cervical disc replacements

Dr. Siddique says experience is key to a surgeon’s success with this procedure. “Even though there is no national standard for the minimum number of cases to be considered ‘experienced,’” he says, “I would argue that a surgeon needs to do at least 25 cases a year.”

When meeting with a potential spine surgeon, ask them about their experience, such as:

• How many cervical disc replacements have they performed in the past year?
• What percentage of these procedures had a positive outcome?
• Did any of the cervical disc replacements fail or need to be corrected?

Routinely performs other types of spine surgery

Look for a spine surgeon who is well-versed in a number of treatments for disc-related pain in the cervical spine, including cervical disc replacement and spinal fusion. This enables them to recommend the best treatment for your condition, rather than choosing the procedure they are most comfortable performing.

Is a good fit for you

It’s important that you find a surgeon you feel comfortable with. You should also look for one that understands your treatment needs and your goals for after surgery, whether it is to be able to sit without pain or to resume playing golf.

How do patients qualify to receive the procedure?

“Cervical artificial disc replacement surgery has been shown to be a better option than fusion in multiple studies, which is why we strongly recommend cervical disc replacement over fusion surgery for most patients,” says Dr. Siddique.

However, he says cervical disc replacement is not a good option for people with any of the following:

• severe disease or degeneration of the joints on the back of the vertebrae in the neck (facet joints)
• instability of the neck
• infection — either throughout the body, such as pneumonia; or a local infection in the skin or tissue at the surgical location
• tumor
• known allergy to metal or other components used in the artificial disc device
• damaged cervical vertebrae due to trauma
• severe deformity or scoliosis in the neck
• low bone density (osteopenia or osteoporosis)

In addition, not all insurance companies will cover this procedure. “For years, insurers considered artificial disc replacement ‘investigational’ even though it was FDA-approved,” says Dr. Siddique. “Most have finally realized that cervical artificial disc replacement is a better option than fusion, but some still refuse to cover it.”

Insurers may also not cover this procedure until after you have tried at least six months of conservative treatment with no improvement such as physical therapy, home exercise, and core strengthening programs, anti-inflammatory or other medications, or chiropractic care.

Dr. Bjerke adds that “a cervical disc replacement isn’t for everyone, but it’s worth asking your surgeon if he or she feels it is an option for you. There are some cases where advantages exist for both a fusion and a replacement, and most surgeons will be glad to discuss those with an informed patient.”

Patient surgical prep protocol

Ask your surgeon what steps you should do before your surgery. You may be asked to:

• Have X-rays, an MRI or CT scan, or blood tests done.
• Continue to eat healthily and stay physically active, as much as possible.
• Tell your surgeon about any prescription or over-the-counter medications or herbal supplements that you are taking. Your surgeon may ask you to stop taking aspirin or other medications that increase your risk of bleeding.
• If you smoke, you may be asked to consider stopping smoking before surgery and avoid smoking during your recovery period.
• Arrange for someone such as a family member to help take care of you after surgery. You will also want to find someone to take care of your children or other people who depend on you.
• Prepare for recovery after surgery by cleaning your house, stocking up on groceries, and running any errands that cannot be postponed.
• Not eat or drink anything for several hours before your surgery.
• If you take medications regularly, ask your surgeon if you should take them on the day of your surgery.

The surgical process step by step

Cervical disc replacement surgery takes about two to three hours, although some procedures may last longer. During this surgery, the following steps are typically done:

• You will be given a medication to put you into a deep sleep and keep you from feeling pain during the surgery.
• The surgeon will make a small cut (incision) on the side or front of your neck.
• The surgeon will carefully move aside the important structures of the neck until they can see the vertebrae and the cervical disc.
• The surgeon will remove the damaged cervical disc, including the soft tissue and cartilage. This is called a discectomy.
• After choosing the best size artificial disc device, the surgeon will implant the device into the spine. They will then check the position of the implant using X-ray imaging.
• Once the implant is in place, the surgeon will put the neck structures back in place and close the incision. The incision will be covered with a small dressing.
• You will be taken to a recovery area and will be monitored here until you are fully awake.
• You will remain in the hospital for one to three days, depending on your level of pain and how quickly you regain functioning.

Summary

Cervical disc replacement is surgery to replace a worn or damaged disc in the neck or cervical spine. In many cases, it is a better option than spinal fusion. However, this procedure is not a good choice for everyone.

When choosing a surgeon to perform your cervical disc replacement, look for one with the right combination of experience and training. Many surgeons who have been involved for some time in research studies of new cervical disc devices have extensive experience with this procedure.

Cervical artificial disc devices have greatly improved since the first-generation devices. The technology continues to advance, with companies developing more options for fitting the devices to the patient, as well as building devices that better mimic the natural movements of the spine.

“As with any product, innovation continues to improve quality,” says Dr. Siddique. “There are a number of clinical trials underway that seek to improve cervical artificial disc replacement. Having said that, the current cervical artificial discs on the market are very effective. If you need the surgery, don’t wait for a revolutionary product that may or may not come.”

Dr. Bjerke adds “when my patients see that they retain cervical spine motion after surgery, they can both see and feel that their neck functions normally. I show them that if the implant alone is covered up on the X-rays, it looks no different than a normal spine.”

Originally published at https://spinenation.com.