Cervical disc replacement doesn't have to be a pain in the neck
Written in association with:Anterior cervical disc replacement (ACDR) is a surgery to treat diseased discs – such as herniated discs, or discopathy – in the spine that are causing neck or arm pain. In this article, Mr Neil Dorward, a consultant neurosurgeon, explains this procedure.
Where are the cervical discs and when is a replacement needed?
The cervical discs make up the cervical spine of the neck, and act as shock absorption cushions between the bones (vertebrae). The spine is the scaffolding that holds up the head and the chest, but also protects the spinal cord and nerves. As we age or due to disease, these discs become dehydrated and shrink, losing height. This contraction of the cervical spine causes the spaces between the vertebrae to narrow, pinching the nerves or spinal cord. This is the source of the pain and can also cause weakness and numbness in the arms and legs.
Not every patient with a cervical disc issue is suitable for this procedure. Those who have severe osteoporosis, a kyphotic or scoliotic deformity, metal or plastic allergies, or are younger than 20 years old are not recommended to undergo this procedure
Other symptoms of a cervical disc problem include headaches, stiffness, numbness, weakness, and pain that travels down from the neck and into the shoulders or arms.
These symptoms can sometimes be managed with medications, but in the case that the medications are not helping or the pain is too severe, then the CDR surgery is recommended.
What does a cervical disc replacement entail?
ACDR is a complex spinal procedure that can provide relief from pain and restore functionality and movement, as well as protect other discs from future degeneration. It involves the removal of the defective disc that is causing the issues, and implanting a replacement artificial disc.
The procedure is conducted with a general anaesthetic and can last 1-2 hours. During the procedure, an incision is made on the front of the patient’s neck and all structures are moved aside so that the neurosurgeon can access the spine, at which point they will remove the disc and place the implant, made of metal and secured to the vertebrae by keels tapped into a sut in the bone. The incision site is closed with absorbable sutures, staples, and dressed. Patients tend to stay a 1-2 nights in the hospital to recover a bit and for monitoring.
After the procedure, patients are given painkillers to help with any pain from the incision site.
Before the replacement technique, the only procedure available for cervical disc issues was a cervical fusion, where the offending disc was removed and the vertebrae below and above were fused using bone graft; however, this greatly reduced mobility, leads to increased wear in the next disc, and is no longer the preferred technique.
What happens after a cervical disc replacement?
After surgery, recovery time is around six weeks, and in the first two weeks, the patient will need to wear a soft collar to protect the wound and also provide some comfort. After four weeks, patients can start physiotherapy and swimming.
There are significant potential risks that patients should keep in mind. Patients may have difficulty swallowing and a hoarse voice after surgery; these are expected temporarily, but can become permanent. There is a low risk of the implant shifting which could put pressure on the airway or the spinal cord. Bleeding can cause a haematoma and any operation can become infected. The frequency of any such complication in this type of surgery is fortunately very low and the efficacy of the procedure is high.
If you are experiencing spinal pain, you can consult with Mr Dorward via his Top Doctors profile.
