A Patients' Guide to Outpatient Surgery

Cervical Disc Replacement Surgery at an Outpatient Spine Center

Minimally invasive approach to total disc replacement to relieve neck pain

Your intervertebral discs—the cushion-like structures between the bones of your spine—are essential to spinal function and mobility. You won’t notice when your discs are healthy, but you will experience considerable pain if a disc is damaged by trauma or deteriorates due to age. If a damaged disc is the source of your neck pain, and you’ve exhausted nonsurgical therapies, you may be a candidate for cervical disc replacement surgery. The procedure involves removing the damaged disc and replacing it with an artificial disc device. If you are a candidate, your procedure may be performed using minimally invasive techniques in an outpatient setting.

cervical artificial disc; postoperative lateral x-rayUnderstanding Minimally Invasive Cervical Disc Replacement
Two of the most common neck surgeries to correct disc-related pain—anterior cervical discectomy and fusion (ACDF) and cervical disc replacement—may both be performed minimally invasively. While ACDF has a longer history in the United States, cervical disc replacement is gaining popularity for its favorable patient outcomes.

The minimally invasive approach to neck surgery uses a small incision compared to traditional open neck surgery. Often, the incision is made in a natural skin fold at the front of the neck, which is virtually invisible in most patients when healed.

Furthermore, minimally invasive spine surgery (MISS) utilizes smaller instruments, which means the size of the surgical field (known as exposure) is reduced. Overall, this lessens the amount of healing you have to do. Also, MISS uses specialized surgical instruments allowing the surgeon to avoid disrupting (eg, cutting) soft tissues in the cervical spine, resulting in less pain.

Benefits of MISS include:

  • Smaller incision(s)
  • Less blood loss
  • Lower risk of muscle and soft-tissue damage
  • Lower risk of infection
  • Reduced postoperative pain
  • Reduced pain medication use
  • Faster recovery

While MISS often focuses on the size of the incision, it’s really a larger concept of being minimally traumatic to the body—in this case, the neck structures. The advances in MISS techniques have given spine surgeons a new way to perform cervical disc replacement enabling the surgery to be performed in an outpatient setting. After a postoperative period of recovery in the outpatient recovery area, patients are discharged home the same day of their surgery.

Conditions Treated with Minimally Invasive Cervical Disc Replacement
Cervical disc replacement may be recommended to treat many neck problems, including:

  • Disc disorder pressing on a nerve root (ie, radiculopathy)
  • Disc problem pressing on the spinal cord (ie, myelopathy)
  • Degenerative disc disease
  • Herniated disc
  • Loss of disc height

Minimally Invasive Surgery to Implant a Cervical Artificial Disc
The beauty of an artificial disc is it preserves neck motion at the level where the disc is replaced (eg, C3-C4, C4-C5). The results are completely different from a spinal fusion where movement at a level in the spine is stopped. Artificial disc replacement devices are typically constructed of metal or a combination of metal and a high density plastic (eg, medical grade polyethylene).
cervical TDR xray The surgical procedure is similar to ACDF wherein a discectomy is performed to remove the damaged disc. The empty disc space is prepared for implantation of the cervical artificial disc, instead of an interbody device filled with bone graft (spinal fusion).

Prior to surgery, you are positioned on the operating table face-up. You are placed under general anesthesia, so you will be asleep during the entire procedure.

The surgeon makes a small incision near the front of your neck, usually in a natural skin fold. The soft tissues and muscles are gently retracted to expose the appropriate level (eg, C4-C5) of the cervical spine. The surgeon performs a microdiscectomy—surgical removal of the damaged or herniated disc. A surgical microscope is utilized to see small structures that the surgeon’s attention, such as removal of bone or soft tissue pressing on a spinal nerve root. The empty disc space is prepared to accept the appropriately sized artificial disc, and then it is implanted.

After the cervical artificial disc is implanted, the soft tissues and muscles return to their normal position, and the surgeon closes the incision using suture that dissolves within 2-4 weeks. The closed incision is covered with a small dressing/bandage.

From start to finish, a cervical disc replacement procedure in an outpatient spine center takes approximately 30 to 45 minutes. Then, you are moved to the recovery area where the medical staff closely monitors your vital signs, including postoperative pain management. Prior to discharge home, your surgeon may provide a cervical collar to wear to help reduce pain and aid your recovery. Though pain tends to improve significantly within three days of the operation, your surgeon may recommend you wear a cervical collar to aid your recovery and limit your pain.

Minimally Invasive Cervical Disc Replacement Considerations
Minimally invasive cervical total disc replacement offers patients many potential benefits compared to traditional open neck surgery: namely, a smaller incision and faster recovery time. However, not everyone is a candidate for this procedure in an outpatient setting.

Some cervical conditions are best treated with a traditional open approach, so your particular diagnosis will be taken into account when weighing whether MISS is right for you. Also, patients with other serious health problems, such as a heart condition, may be suited for minimally invasive cervical disc replacement, but the surgery should be performed in a hospital in case unexpected treatment for their co-existing medical condition is warranted.

Cervical disc replacement has similar potential risks as ACDF, though these complications are rare:

  • Swallowing difficulty
  • Incorrect placement of the disc implant
  • Hoarseness of voice or other voice changes
  • Throat soreness

Your surgeon will review all risks related to minimally invasive cervical disc replacement with you before your surgery.

Conclusion
When you learn you need neck surgery, you may feel scared, anxious, and worried about recovering from such a significant procedure. Fortunately, many spine surgeries—including cervical disc replacement—can be performed using minimally invasive techniques that deliver small incisions and quicker recovery times compared to traditional neck surgery. Adding to the list of benefits, you can have a minimally invasive cervical disc replacement surgery in an outpatient spine clinic and go home same day.

Updated on: 02/28/17
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Learn more about the specifics of what to expect Immediately following your outpatient spine surgery, including coming out of anesthesia, pain management and discharge instructions.
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