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Spine Treatments

Cervical Disc Replacement

Cervical disc replacement, also known as cervical total disc replacement (c-TDR), is a state-of -the- art surgical procedure designed to replace a damaged or degenerated cervical disc with an artificial disc. This procedure is an alternative to traditional spinal fusion surgery and aims to maintain motion at the disc space. Success rates for cervical disc replacement are greater than 90% in providing relief from neck pain, preserving neck motion, resolving neurologic pain symptoms, and improving quality of life. Another key advantage is avoiding cervical spinal fusion which limits movement and can negatively affect adjoining cervical vertebrae.

Cervical disc replacement is the surgical removal of a damaged cervical disc and the implantation of an artificial disc. The artificial disc is designed to mimic the natural movements of a healthy disc, allowing for motion in the neck. This procedure is performed to relieve symptoms caused by disc degeneration or injury, such as chronic neck pain, arm pain, and neurological deficits like numbness or weakness.

Many disc problems can be treated with conservative measures such as rest, lifestyle modifications and changes in your habits or routines. Additionally, non-steroidal anti-inflammatory medication, injections of corticosteroids, and physical therapy can provide direct pain relief from a damaged disc by reducing inflammation and promoting healing.

Cervical disc replacement may be recommended for patients who have not found relief from conservative treatments such as physical therapy, medications, or injections. Specific indications for cervical disc replacement include the following conditions, found at 1 or 2 levels (more than 2 level disease is not FDA approved and outcomes are not well studied).

  1. Cervical Disc Degeneration: When the cervical discs degenerate due to wear and tear, leading to neck pain and other symptoms.
  2. Herniated Disc: When the disc material protrudes and compresses the spinal cord or nerve roots, causing pain, numbness, or weakness.
  3. Radiculopathy: Pain, numbness, or weakness radiating from the neck to the arms due to nerve root compression.
  4. Myelopathy: Compression of the spinal cord causing more severe neurological symptoms such as difficulty walking, coordination problems, or bladder dysfunction.

c-TDA is an excellent option for many patients. However, if you have one of these conditions or factors, your outcome may be unreliable and you may be a better candidate for fusion or other procedure.

  1. Advanced disc degeneration with disc height collapse more than 50%
  2. Advanced facet arthritis and/or severe extension-based neck pain
  3. Osteoporosis
  4. Cervical instability
  5. Cervical deformity
  6. Global inflammatory arthritis such as rheumatoid arthritis

Many different artificial disc implants are available, and are typically made from a combination of titanium, polymer, or ceramic materials. No one implant has risen as the industry standard, but there are differences between implants with regard to design and level of constraint (ability to move in different planes). Dr. Colman is involved with and continues to participate in FDA trials surrounding c-TDA implants and may be able to offer cutting-edge devices not yet widely commercially available. Additionally, Dr. Colman performs original research looking at optimizing outcomes in c-TDA.

Cervical disc replacement, also called cervical disc arthroplasty, involves an incision in the front of the neck, protection of the blood vessels, trachea, and esophagus, and exposure / removal of the damaged disc. Dr. Colman then inserts the artificial disc and secures it in place. Most discs have a polymer center that allows for gliding, tilting and rotating motions.

Recovery time varies but many patients find significant improvement in symptoms within the first few weeks. Full recovery can take up to 2-3 months. If nerve compression is severe, it can take up to a year or more for the nerves themselves to heal.

Generally, risks for anterior cervical surgery are low. Commonly cited risks include dysphagia (difficulty swallowing), dysphonia (hoarse voice), or failure to heal after surgery. Fortunately, these risks are either rare (<5%) or are transient, meaning they are self-limited and resolve within the first 4-6 weeks.

Adjacent segment disease (breakdown of discs above or below the surgery) can still occur with c-TDA but is thought to be less than with fusion given the motion preservation of disc replacement.

More serious risks such as bleeding, swelling, blood vessel injury, holes in the trachea (wind pipe) or esophagus (food pipe), spinal cord injury, persistent neck or arm pain, and medical risks of anesthesia and surgery are exceedingly rare, fortunately.

Over more than 20 years, multiple clinical trials have shown cervical disc replacement to be safe and effective treatment for degenerative disc disease preserving spinal motion and reducing degeneration in the neck vertebrae. Cervical disc replacement is a motion preserving technique that has been shown to be equal to and superior to cervical fusion. It can be used to treat single level and two-level disease.

Learn more about cervical disc replacement by scheduling a consultation with Dr. Matthew Colman at Northwestern Medicine in Chicago, Illinois. He specializes in degenerative spine conditions, spine trauma, spinal deformities and spine oncology. His patients find him to be a kind, caring, and thorough surgeon, who has a wonderful bedside manner, and is knowledgeable and trustworthy. They note that he takes time to listen to his patients, explains conditions well and answers their questions.

Dr. Colman’s care philosophy is that surgery should be a last resort. He feels strongly that conservative treatments including physical therapy and anti-inflammatory medications and injections should be pursed to their fullest extent before entertaining surgery. However, he knowns that certain orthopedic conditions require immediate surgical intervention for the best possible outcomes. Contact him at Northwestern Medicine in Chicago, Illinois to schedule a consultation to receive the correct diagnosis and all your treatment options today.

References

  • https://www.orthobullets.com/spine/12279/cervical-disc-arthroplasty
  • https://www.spine-health.com/treatment/artificial-disc-replacement/postoperative-care-cervical-artificial-disc-replacement
  • Nunley PD, Hisey M, et al. Cervical Disc Arthroplasty vs Anterior Cervical Discectomy and Fusion at 10 Years: Results From a Prospective, Randomized Clinical Trial at 3 Sites. Int J Spine Surg. 2023 Apr;17(2):230-240. doi: 10.14444/8431. Epub 2023 Apr 6. PMID: 37028803; PMCID: PMC10165661.
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Dr. Matthew Colman

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