Cervical Disk Arthroplasty

For many years patients with cervical radiculopathy, or “pinched nerves” in their neck, have been treated with surgery when other simpler treatments such as medications, physical therapy, or injections fail to help.  Traditional surgical treatments typically involve removing a disc and then fusing the affected vertebrae. Recent studies have shown the patient satisfaction is estimated approximately 70%, usually due to persistent neck pain and stiffness. Surgeons began looking at hip and knee replacement, which demonstrate 90% patient satisfaction rates, for inspiration. Their search for a new treatment led to the development of cervical disc replacement.  This simple idea can achieve big results by preserving joint motion and helping to alleviate pain.

Cervical disc replacement (arthroplasty) surgery was initially developed and tested in Europe.  Using relatively crude devices, the first surgeries demonstrated that disc replacement could be performed safely. Better still, the success rates were similar to fusion surgery, but the patients retained motion at the treated disc level.  This prompted the development of more sophisticated devices designed to accurately reproduce the normal motion of healthy cervical discs.  Improvements in materials have allowed production of devices that can withstand the long-term stresses and strains that occur in the spine.

Two new disc replacement devices have completed rigorous FDA clinical trials in the U.S.  These new devices are the Prestige device manufactured by Medtronics, and the Pro-disc C developed by Synthes. The clinical trials for each device demonstrated superiority of disc replacement compared to fusion surgery.  The speed of improvement, degree of pain relief, and patient satisfaction favored disc replacement. Even with better outcomes, the complication rate stayed as low as traditional disc fusion. Five years ago the FDA approved clinical use of these devices for single disc replacement.

Disc replacement surgery can typically be completed in a 1-1/2 hour procedure under general anesthesia and on an outpatient basis. Surgical scars are limited due to placement of the incision located in the crease on the front of the neck. Patients are allowed to gradually resume normal activities as their comfort allows.  Driving and return to work is allowed when patients achieve a comfortable range of motion and are not taking significant pain medications.  For a short time following surgery it is not unusual for patients to experience mild discomfort in the back of their neck and occasional swallowing discomfort. After two to three weeks patients typically return for a routine follow-up. Six weeks after surgery the surgical site is usually well healed with most patients report minimal residual discomfort.  After six weeks patients typically are released to enjoy full and unrestricted activity with biannual check-ups frequently recommended.

The success of single disc replacement has led to interest in expanding the use of these devices to other applications. These include surgeries for patients who have had previous disc fusion and surgeries that may include both fusion and disc replacement. The benefits of these surgeries, although not studied by the FDA, may actually exceed the benefits demonstrated for single level disc replacement.  The post operative recovery of patients who are treated with these procedures mirror that of the standard procedure though multilevel cases may be kept overnight for observation.

ProDisc -SAS Journal 2010

To view Dr. Tack’s Cervical Disc Replacement Case Studies, please click here.