Cervical Artificial Disc

A cervical artificial disc is a synthetically designed device which is used to replace the damaged intervertebral disc that has been surgically removed for decompressing the spinal cord or spinal nerve roots. The purpose of the implant is to maintain mobility and smooth motion at the disc space.

Cervical artificial disc is considered as a better alternative to the fusion procedures which employ bone graft, plates and screws

Cervical artificial disc replacement is employed for managing patients suffering from spinal disorders such as disc herniation, cervical radiculopathy and myelopathy resulting in severe neck pain, and numbness or weakness in the arms. Cervical artificial disc replacement is not recommended for cervical kyphosis, severe stenosis with spinal instability, vigorous facet joint arthritis, or bone infection.

Procedure

The basic steps involved in cervical artificial disc replacement surgery are as follows:

•  The patient is placed on the operation table, face up
• A small incision is made through the skin and muscles present over the front of the neck
• The blood vessels, trachea, esophagus, and the soft tissues are pulled aside with a retractor to approach the spine
• X-ray imaging (fluoroscopy) is employed to identify the damaged intervertebral disc
• The front portion of the disc is then removed with forceps while the back portion is removed with a small rotary cutting tool called a burr
• A special microscope is employed for visualizing the disc and assists in accurate removal of the disc material and any bone spurs present around the spinal cord
• The space between the two vertebrae is adjusted to the normal height of the intervertebral disc, which decompresses the nerves
• The artificial disc is then inserted into the prepared space with the help of a fluoroscope, for accurate implantation
• The proper positioning of the artificial disc is checked by moving the cervical spine in different directions
• Confirmatory X-ray may be taken to confirm the proper placement of the artificial disc
• Finally, all the muscles and the soft tissues are placed in their correct positions and the wound is sutured

Postoperative care

Generally, patients may be discharged from the hospital in a day or two of the surgery. Most of the patients undergoing this procedure have a quick recovery and can walk after a few hours of the surgery.

Some of the postoperative instruction includes:

• Avoid excessive backward bending of the neck
• Use a brace or soft collar for a few days as directed
• Perform activities without exerting excessive stress over the neck, as guided by the physical therapist
• Avoid lifting for 3-4 weeks
• Avoid heavy work for at least 6 weeks

Risk and complications

Some of the complications associated with cervical artificial disc replacement surgery include:

• Complications related to anesthesia
• Conditions such as thrombophlebitis
• Blood loss
• Infection
• Spinal nerve injuries or paralysis
• Improper implantation (requires revision surgery)
• Spontaneous ankylosis
• Sinking of the cervical spine (subsidence)