Cervical Disc Replacement for Neck or Arm Pain

Cervical disc replacement may be a treatment option for you instead of a traditional Anterior Cervical Discectomy and Fusion surgery.

Many different non-spinal disorders may cause or contribute to arm and neck pain, such as a rotator cuff problem, tennis elbow or carpal tunnel. For these patients, the problem is often with the spinal column and nerves in the neck, known as the cervical spine. One of the most common problems is with a herniated or bulging disc that presses on these spinal nerves. In the past, the only operation to fix this is to remove the cervical disc and fuse vertebrae in the neck together. This was often performed with bone from the “hip” or iliac crest. This left patients with an extra operation, often more painful than the neck surgery.

Cervical (neck) disc herniation is shown  Cervical (neck) disc herniation is shown in the above MRI.
Reprinted with permission © bjerkespine.com

Cervical Disc Replacement
In the last twenty years, newer technology and materials have made replacement of cervical discs possible and even preferable over a fusion for many patients. Like hip and knee joint replacement, modern spinal disc replacement devices are made of high-grade metals and plastic and help maintain the neck’s natural motion. The largest studies on cervical disc replacements have reviewed thousands of patients with over seven years of clinical follow-up for those patients.

CDR Adopted by Spine Surgeons Worldwide
Today, cervical disc replacement is considered an option for some patients with neck problems involving one or two cervical discs. CDR is no longer an experimental technique, and has been adopted worldwide. For the modern spine surgeon trained with motion-preserving techniques, a one- or two-level cervical disc replacement is an excellent option for properly selected patients.

CDR Surgical Summary
Through an incision of about an inch and a half or less, the target cervical disc is safely accessed using specialized tools. Using a high-powered surgical microscope, the disc is seen and removed, and nerves are freed of any bone spurs or herniated disc material that may be causing pain or weakness (decompression). Unlike cervical fusion surgery, the patient does not need to wear a neck brace until fusion is evidenced on x-ray, and movement is encouraged.

The advantages of a cervical disc replacement over a fusion have been well studied. For appropriately selected patients, CDR:

  • Maintains range of motion
  • Has a lower rate of additional surgery
  • Less wear and tear at adjacent spinal levels*

*Fusion of even one level (eg, C4-C5) in the cervical spine causes stress to the adjacent levels above and below the fusion. The adjacent levels in the neck are susceptible to more stress and are at risk to wear out faster.

Post-operative x-ray shows the disc replacement device in the patient’s neckPost-operative x-ray shows the disc replacement device in the patient’s neck.
Reprinted with permission ©  bjerkespine.com

Why can’t all patients receive a disc replacement?
Disc replacement is only proven to work in one or two levels of the neck. For patients with more extensive problems, a replacement may not be a good option. For patients with more neck pain and arthritis than arm pain or weakness, a disc replacement may leave patients with persistent pain from neck motion.

Do disc replacements work for the lower back?
There have been many attempts in artificial disc replacement for the low back; the lumbar spine. Unfortunately, the medical evidence supporting the effectiveness is not as robust as for CDR.

The lower back undergoes much more stress and body weight, and is at greater risk for osteoarthritis and degeneration. Lumbar disc replacement has not been shown in studies to be better, and many patients will have persistent pain from arthritis. Many surgeons do not perform lumbar disc replacements at all, and most consider it a controversial operation.

Conclusion
Not all spine surgeons have training in cervical disc replacement, and do not offer disc replacement for this reason alone. Patients who have been offered a cervical fusion (also known as an Anterior Cervical Discectomy and Fusion, or “ACDF”) should ask if they are a candidate for a cervical disc replacement, and explore reasons why that may or may not be an option with their surgeon.

Cervical disc replacement is a focus of Dr. Bjerke's practice. Dr. Bjerke trained with the combined Neurosurgery and Orthopedic Surgery Fellowship at Mayo Clinic and is a spine surgeon for Reno Orthopedic Clinic.

Updated on: 06/06/17
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Minimally Invasive Spine Surgery

For some patients who have spinal instability or have been recommended spinal fusion, it is important to understand what minimally invasive options may be available.
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