Cervical Disc Replacement
Posted in: Orthopedics Sunday, 11 September 2011
For many years patients with cervical radiculopathy, or "pinched nerves" in their neck, have been treated with surgery when other simpler treatments such as medications, physical therapy, or injections fail to help. Traditional surgical treatments typically involve removing a disc and then fusing the affected vertebrae. Recent studies have shown the patient satisfaction is estimated approximately 70%, usually due to persistent neck pain and stiffness. Surgeons began looking at hip and knee replacement, which demonstrate 90% patient satisfaction rates, for inspiration. Their search for a new treatment led to the development of cervical disc replacement. This simple idea can achieve big results by preserving joint motion and helping to alleviate pain.
Cervical disc replacement (arthroplasty) surgery was initially developed and tested in Europe. Using relatively crude devices, the first surgeries demonstrated that disc replacement could be performed safely. Better still, the success rates were similar to fusion surgery, but the patients retained motion at the treated disc level. This prompted the development of more sophisticated devices designed to accurately reproduce the normal motion of healthy cervical discs. Improvements in materials have allowed production of devices that can withstand the long-term stresses and strains that occur in the spine.
Two new disc replacement devices have completed rigorous FDA clinical trials in the U.S. These new devices are the Prestige device manufactured by Medtronics, and the Pro-disc C developed by Synthes. The clinical trials for each device demonstrated superiority of disc replacement compared to fusion surgery. The speed of improvement, degree of pain relief, and patient satisfaction favored disc replacement. Even with better outcomes, the complication rate stayed as low as traditional disc fusion. Five years ago the FDA approved clinical use of these devices for single disc replacement.
Disc replacement surgery can typically be completed in a 1-1/2 hour procedure under general anesthesia and on an outpatient basis. Surgical scars are limited due to placement of the incision located in the crease on the front of the neck. Patients are allowed to gradually resume normal activities as their comfort allows. Driving and return to work is allowed when patients achieve a comfortable range of motion and are not taking significant pain medications. For a short time following surgery it is not unusual for patients to experience mild discomfort in the back of their neck and occasional swallowing discomfort. After two to three weeks patients typically return for a routine follow-up. Six weeks after surgery the surgical site is usually well healed with most patients report minimal residual discomfort. After six weeks patients typically are released to enjoy full and unrestricted activity with biannual check-ups frequently recommended.
The success of single disc replacement has led to interest in expanding the use of these devices to other applications. These include surgeries for patients who have had previous disc fusion and surgeries that may include both fusion and disc replacement. The benefits of these surgeries, although not studied by the FDA, may actually exceed the benefits demonstrated for single level disc replacement. The post operative recovery of patients who are treated with these procedures mirror that of the standard procedure though multilevel cases may be kept overnight for observation.
IBJI's own Dr. Stanford Tack has performed cervical disc arthroplasty since the initial FDA release of the devices. He has experience in single level procedures as well as the newer applications. In his experience Dr. Tack has had excellent results with success rates generally equaling, and in most cases exceeding, disc fusions for similar problems. Dr. Tack also notes that patients needing to obtain insurance approval may experience a significant wait and possibly go through an appeal process to obtain coverage.
The performance of cervical disc arthroplasty by IBJI physicians is just another example of how IBJI is the right choice for orthopedic care. Our goal is to deliver patient centered state of the art procedures with optimal restoration of function and an increase in quality of life. Find one our back and spine specialists near you and find the right treatment for you back and neck problems.
Cervical Disc Repalcement Case Studies
This patient experienced progressive recurrence of neck pain several years after undergoing a successful ACDF (fusion)at the C5-6,C6-7 levels. After a prolonged attempt of conservative therapy including medications, physical therapy, and spinal injections, surgical treatment was considered. Evaluation prior to treatment included an MRI which demonstrated progressive degeneration of the C4-5 disc above the prior fusion. Cervical discography was performed at this level (injection of the presumed painful disc) which confirmed this as the origin of the patients disabling symptoms. Cervical disc arthroplasty with a Synthes Pro-disc C device was performed without removal of previously placed hardware. The patient was discharged less than 23 hrs after surgery and returned to work within 2 weeks. The disabling symptoms have been dramatically reduced allowing the patient to progressively discontinue analgesic medications on which they were previously dependent. X-rays performed after surgery demonstrate normal motion at the replaced disc and the non-fused segments of the spine.
This patient sought treatment for chronic neck pain with associated numbness, pain, and weakness in her arms. Previous treatment had included medications, spinal injections and physical therapy. X-rays and MRI demonstrated a congenital fusion at C2-3, advanced disc space narrowing with spinal stenosis at C5-6, with disc degeneration and spinal stenosis at C6-7. Surgical treatment was performed with an ACDF (fusion) at C5-6 and disc arthroplasty with a Medtronics Prestige implant at C6-7. Following surgery the patient experienced dramatic pain relief and returned to full occupational activities without restriction. Traditional treatment would have required a two level fusion in addition to the patients congenital fusion resulting in a three level fusion with significant risk of further breakdown of the untreated levels. Disc arthritic change at C5-6 was sufficiently advanced to preclude disc replacement at this level.
This patient was injured during the course of his employment as a firefighter. He sustained an acute disc herniation at the C6-7 level below an assymptomatic degenerative disc at C5-6. Despite 3 months of symptomatic treatment he continued to experience pain, weakness and numbness in his arm. The patient was seen by a Professor of Orthopedic Surgery at a local University who recommended a two level fusion. After evaluation he was offered the option of a single level disc arthroplasty at the C6-7 level leaving the assymptomatic disc at C-6 untreated. A Synthes Pro-Disc C arthroplasty was performed This option was made possible by the fact that a disc arthroplasty does not increase stress at adjacent spinal levels. After treatment the patient experienced dramatic relief of his symptoms and was allowed to return to unrestricted physical activity.
This 30 year old patient was previously treated with a fusion at C4-5 and C5-6. Several years after surgery symptoms of pain and numbness in the patients arms and hands developed which markedly impaired their activities of daily living. Evaluation demonstrated severe spinal stenosis at the adjacent C3-4 and C6-7 levels. Due to the severity of symptoms surgical treatment was deemed necessary, The surgical options included ACDF (fusion) at C3-4 and C6-7 or decompression and cervical disc arthroplasty at the C3-4 and C6-7 levels. The patient opted for cervical disc arthroplasty which was performed with Medtronics Prestige disc implants. After surgery the patient experienced symptomatic relief while maintaining normal mobility at the previously unfused levels. Had ACDF been performed a 4 level fusion would have resulted which would have significantly diminished neck mobility with significant risk for further breakdown and additional surgery.
This patient was previously treated for neck pain and nerve pain in her arm with an ACDF at C5-6,C6-7. She experienced excellent pain relief. Several years later neck and arm pain reoccurred and became functionally disabling. Evaluation demonstrated disc degeneration with spinal stenosis at the level above the previous fusion. After failure of symptomatic treatment surgical options were considered. Because of the relatively short interval between the prior ACDF and breakdown of the adjacent disc the patient did not want to undergo another fusion procedure. The option of disc arthroplasty was discussed and selected. A Medtronics Prestige implant was utilized above the previously placed hardware. The patient experienced dramatic pain relief with rapid return to normal function.
This information is not intended to provide advise or treatment for a specific situation. Consult your physician and medical team for information and treatment plans on your specific condition(s).
Posted in: Orthopedics