﻿In this video, we’ll be taking a look at the recent research on cervical
artificial disc replacement (ADR).
If you have persistent neck pain with shooting arm pain that has not improved despite the appropriate
treatments prescribed by your doctor, it can be frustrating. For a specific group of people,
a cervical artificial disc replacement may be an option.We
should avoid sugar coating this discussion. The decision for cervical disc replacement
is not one based solely on pain and frustration. It works well for specific complaints coupled with
specific findings on tests and physical examination. Understand your complaints,
and have the discussion about the chances of success with your surgeon.
The surgical technique is as follows: a cut is made to the front of your neck,
and your surgeon will carefully move the muscles, arteries, wind pipe and food pipe away from the
front of your spine. The specific disc and the corresponding boney vertebrae are identified.
The surgeon will enter the vertebral disc space, and mark the center of each of the two adjacent
vertebrae. This helps facilitate accurate placement of the implant. A self-retaining
retractor is placed over the disc space and a discectomy and decompression are then performed.
Once the disc is removed, the spinal cord and nerves are unpinched. Extra steps are
taken to ensure proper fit, placement, and positioning of the artificial disc implant.
What are the indications? Specifically, it depends on the
patient. Cervical artificial disc replacement may be preferable to cervical spinal fusion surgery.
If you have intolerable pain, despite time, activity changes, and therapies,
and diagnostic tests such as MRIs or CT scans demonstrate a pinching that corresponds to your
physical exam findings, you may benefit from surgery. Your options may include removal of
the disc and replacement with an artificial disc implant. But each person must consider their
individual considerations before selecting the disc replacement option. Remember, there is never
a guarantee, and you, the patient, must understand why a disc replacement, vs a traditional fusion,
versus no surgery would be recommended. There are nuanced differences, but some
situations would cause a surgeon to recommend one option over another. For example, patients with
poor bone quality or auto fusion findings are not good candidates for a cervical disc replacement.
The longevity of cervical disc replacements.
Although there is data that demonstrates the favorable short-term outcomes of cervical disc
replacement, there are very few studies that have monitored the long-term outcomes of this
option. A few long-term studies show superior Disc replacement outcomes compared to fusion surgery,
which is a promising future for cervical disc replacement. The concern is that ADR
surgery may need better implants to minimize the wear and tear of the implant and to extend
its longevity. The rationale for ADR is the preservation of the motion,
thus decreasing the stresses on the adjacent level. Theoretically this should avoid or lessen
future complaints associated with degeneration of the level below or above the artificial disc.
Prevention of Adjacent Level Disease In a two-year post-surgery follow up study,
2 level disc replacement patients showed a lower incidence of adjacent segment disease and a lower
rate of reoperation compared to that of a standard two-level fusion. In general,
cervical disc replacements showed better outcomes compared to the fusion. But we must be cautious
because it's a short term study. On the other hand, the results are positive. The FDA has
approved two-level cervical disc replacement for certain devices. Longer-term studies still
need to be reviewed regarding cervical disc replacement for more than two levels. While the
preliminary data looks encouraging, it is still too soon for approval. In the future, hopefully,
artificial disc replacements will prove to lessen the development of adjacent level complaints.
Compared to five years ago, cervical disc replacement has become a more mainstream surgery
with some studies showing better outcomes compared to 2 level fusions. Longer-term studies still need
to be conducted to ensure consistency of outcomes and to prove the longevity of the replacement
option. The results thus far have been promising. Cervical disc replacement remains a reasonable
option for those considering cervical disc surgery. But always remember there are risks,
benefits, and alternatives to every situation. Even more so as technology continues to advance.
Just make sure you’re selecting the best option for your particular situation. Remember that the
reason for use of the technique, or the choice to NOT pursue an operation are legitimate issues that
should be explored by anyone considering any form of surgery. Until next time, this is Dr. Shim.