Spine surgery

Cervical disc replacement (total disc replacement)

This article provides general information about cervical disc replacement, and it is not a substitute for advice from Dr Reddy. It does not account for your individual health, diagnosis or treatment plan.

 

Cervical disc replacement, also known as total disc replacement (TDR) or cervical disc arthroplasty (CDA), is a surgical procedure that involves replacing a damaged intervertebral cervical disc (disc in the spine of the neck) with an artificial one. The surgery happens in two parts:

  • The damaged disc is taken out – this is called a cervical discectomy. This allows the spinal cord and spinal nerves to be decompressed.
  • The space is filled with an artificial cervical disc that imitates a natural disc, aiming to maintain the neck’s motion and flexibility, and protect adjacent segments.

Together, this procedure is called an anterior cervical discectomy and disc replacement – ‘anterior’ refers to the surgeon accessing the spine from the front of the neck.

Who may need a cervical disc replacement?

A TDR may be suitable if a damaged cervical disc:

  • leads to severe or ongoing pain in the neck, and/or pain, weakness, numbness and tingling in the arms that do not respond to nonsurgical treatment
  • affects vital anatomy like the spinal cord, causing serious symptoms, like bowel and bladder problems, and difficulties standing or walking

Getting older or injured can weaken and damage the soft discs in your spine, and sometimes this can cause disc herniation in which part of the spinal disc bulges out. Damaged discs can lead to spinal stenosis and change how your spine is supposed to work, which can put pressure on the spinal cord and nerves. This may cause pain in the neck, as well as pain, sensory changes and weakness in other body parts, since the spinal cord and nerves travel through the spine to different parts of the body.

However, not everyone with cervical disc problems is suited to a TDR. Dr Reddy will assess factors like age, health, medical conditions and the person’s anatomy to determine the suitability for this procedure.

How is a cervical disc replacement done?

The surgery begins by putting you to sleep with a general anaesthetic. Once you’re asleep, the surgeon makes a small incision (surgical cut) at the front of your neck and carefully parts the muscles to reach the affected part of your spine.

The surgeon will then remove the damaged disc and any loose disc material or other structures, such as osteophytes (bone spurs or overgrowths), that are pinching the spinal nerves and spinal cord. They will also enlarge the intervertebral foramen (the tunnel through which the nerves exit the spinal canal) and make sure the disc space is the right shape for the artificial one. After this, they will insert the artificial disc into the space and secure it into place.

Last, they will close the incision with sutures before a dressing is placed over the top.

What are the benefits of a cervical disc replacement?

A TDR proves effective at relieving a person from pain and weakness caused by spinal cord and nerve compression. Improvement rates range from 75% to 90% in the short-to-mid-term, with arm pain and weakness showing the most reliable improvement.

Neck pain often improves but this is more difficult to predict than arm pain. Sensory symptoms (numbness, tingling and pins and needles) may take longer to resolve, and in some people, pain may persist despite surgery.

However, this procedure is also unable to treat other sources of pain in the spine and fewer people are suited to this surgery.

It is important to remember that each person’s circumstances are different and how a person benefits from surgery depends on many factors. Dr Reddy will discuss these with you during your consultation.

What are the risks of a cervical disc replacement?

While any surgery has some risk, a TDR is generally a safe procedure. However, since it is relatively new, it is difficult to predict how an artificial disc affects the spine over a long time.

Some potential risks of this procedure include but are not limited to:

  • bleeding, infection, blood clots, and reaction to anaesthesia, as with any type of surgery
  • difficulty swallowing – this often subsides within days to weeks; however, rarely this may persist, requiring treatment.
  • voice hoarseness – the recurrent laryngeal nerve, which supplies the vocal cords (voice box), may be damaged from movement during the surgery; however, this is uncommon and often improves within 3 months.
  • persistent symptoms despite surgery
  • adjacent level disease – disc replacement puts extra stress on the vertebrae and discs above and below, so these levels may have an increased rate of degeneration and may cause pain over time
  • movement or misplacement of the artificial disc
  • reaction to the artificial disc

Very rare risks include:

  • nerve or spinal cord damage leading to worsening pain weakness/numbness/tingling
  • cerebrospinal fluid leak – the dura mater (membrane covering the spinal cord) may be inadvertently punctured, leading to leakage of fluid and requiring repair during the operation
  • perforation of the oesophagus (food pipe)
  • Horner’s syndrome in which a separate group of nerves in front of your spine becomes damaged.
  • stroke
  • failure of artificial disc motion after surgery, with abnormal or no motion.
  • heterotopic ossification (bone in soft tissue where it does not belong)
  • kyphosis (increase of the forward angle of the cervical spine)

Dr Reddy will discuss these risks thoroughly during your consultation.

How should I decide to have a cervical disc replacement?

To decide whether to have a TDR, it is important to discuss your medical condition and the procedure with your doctor, and carefully consider the benefits, risks and limitations. There may be risks with not having surgery to stop the pressure on your spinal cord and nerves.

If you decide to have surgery, you will need to sign a consent form. Please read this carefully before signing it. If you have any questions, ask Dr Reddy. 

How do I prepare for surgery?

Tell Dr Reddy about all the prescription and over-the-counter medicines, supplements, including vitamins, and natural medicine that you are taking. Medicines and supplements may affect blood clotting and healing after surgery, so you may need to stop taking them beforehand.

You may need to fast (not eat or drink) for several hours before your procedure. You may also have to stay in the hospital for a few days so it’s a good idea to bring anything you need with you.

Smokers should stop smoking since this can delay recovery and increase the risk of wound infection.

Speak with Dr Reddy to learn exactly what to do before your procedure.

What happens after surgery?

After surgery, you will monitored closely in the recovery ward until you wake up and are moved to the regular ward.

You may experience some pain afterwards, which will be managed with medication. Most people can sit up and walk within a few hours – it’s important to move after surgery to prevent blood clots from occurring.

Most people can leave hospital about 1 to 2 days after surgery.

 

Please only refer to this information in consultation with Dr Reddy. If you have any questions, ask Dr Reddy.

 

Sources
  • Robinson J, Kothari M. Treatment and Prognosis of cervical radiculopathy. UpToDate, Shefner, J.(Ed), UpToDate, Waltham, MA.
  • Fehlings MG, Tetreault LA, Riew KD, Middleton JW, Aarabi B, Arnold PM, et al. A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression. Global spine journal 2017;7(3_suppl):70S-83S.
  • Kuijper B, Tans JTJ, Schimsheimer RJ, Van Der Kallen B, Beelen A, Nollet F, et al. Degenerative cervical radiculopathy: diagnosis and conservative treatment. A review. European Journal of Neurology 2009;16(1):15-20.
  • Gao Y, Liu M, Li T, Huang F, Tang T, Xiang Z. A meta-analysis comparing the results of cervical disc arthroplasty with anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic cervical disc disease. The Journal of bone and joint surgery. American volume 2013;95(6):555.
  • Hu Y, Lv G, Ren S, Johansen D. Mid-to long-term outcomes of cervical disc arthroplasty versus anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease: a systematic review and meta-analysis of eight prospective randomized controlled trials. PLoS One 2016;11(2):e0149312.