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In the past, the “gold standard” operation has been to remove the disc via an anterior approach (using an incision in the neck) and fusion of the adjacent segments using bone, bone substitute, or an artificial titanium cage along with a metallic plate (anterior cervical discectomy, fusion, and instrumentation). However, one of the theoretical concerns after fusion surgery is stress at the adjacent levels, leading to a breakdown of the discs above or below the fusion referred to as “adjacent segment disease.” Recent years have seen the development of devices designed to maintain motion at the site of the disc removal (referred to as “total disc replacement” or TDR), theoretically minimizing the development of adjacent segment degeneration.
Anterior-Posterior (Includes ACDs and corpectomies)
252+
99%
Physiologically, the goal of surgery is to achieve segmental stability at the site of the damaged disc while preserving motion across that segment. This theoretically causes less stress at the levels above and below, leading to a lower incidence of degeneration of the discs at the adjacent segments.
The actual ability of an artificial cervical disc to prevent adjacent segment degeneration and the need for additional surgery remains uncertain. Approximately 25% of patients develop degeneration of the disc space adjacent to an anterior cervical fusion over the subsequent 5 years; only some(1.5-4.0% annually) of these become symptomatic. Many factors likely enter into the progressive disc breakdown, including genetics, surgical technique at the time of the original surgery, injuries, as well as the natural history of arthritis affecting the cervical spine. In general, X-ray studies and MRI are not always able to determine which adjacent segment issues are clinically significant. However, recent results have indicated excellent outcomes for one- and two-level artificial cervical disc replacements with good patient satisfaction using a device called the Mobi-C® cervical disc. This device consists of two metallic plates made of chromium, cobalt, and molybdenum designed to adhere to the endplates of the disc sandwiching an ultra-high-molecular-weight polyethylene core attached to the metallic plates that provide movement in a constrained ball-and-socket fashion.
The device is inserted at C3 to C7 via an anterior approach (using a small incision in the neck) with a minimum of pain and disability. Most can be performed as an outpatient without the use of a cervical collar, and patients are generally back to usual activities within 2 weeks. We generally recommend restriction of overhead activities, heavy lifting (> 40 lbs), and repetitive neck movements for 6 weeks after surgery.
Complications associated with cervical TDR are discussed in an additional article on wascherspineinstitute.com.
Cervical disc arthroplasty is becoming more and more common as now multiple studies indicate the tendency for improved outcomes with limiting adjacent segment disease and maintaining the normal biomechanical motion of the cervical spine. If you have arm pain, neck pain, and/or been told you have a pinched nerve or spinal cord in your neck, you might be a candidate for an artificial cervical disc. Call us today at +1-(855)-854-9274 for a free evaluation of your MRI studies as well as education as to whether artificial cervical disc surgery might be the ideal procedure to alleviate your pain.
