Cervical disc arthroplasty was introduced on the market to replace some anterior cervical discectomy and fusion, or ACDF, surgeries. The goal was to come up with a similar procedure that would limit the number of adjacent segment degeneration complications that occur after ACDF, which has been calculated at 2.9 percent.
The cervical disc arthroplasty, much like its predecessor ACDF, aims to correct problems and reduce pain associated with degenerative disc disease. In cervical disc arthroplasty removing the affected discs from the intervertebral space and replacing them with artificial discs that have been approved by the FDA achieve this. Unlike during ACDF surgery, cervical disc arthroplasty does not require fusion of vertebrae in the spine, and instead relies on the artificial implant to create stability in the spine after the damaged disc has been removed. The inserted disc is created so that patients maintain movement in their spine after the procedure by allowing patients to flex, extend, bend and rotate.
Studies have shown cervical disc arthroplasty to be just as effective as ACDF surgery with a possible (though still widely unproven) reduction in adjacent segment degeneration post-surgery. At their core, however, these two surgeries do the same thing: reduce back pain associated with damaged discs. Because the discs in the cervical spine allow for mobility in the neck, damaged discs in this area can lead to neck pain as well as difficulty achieving full range of motion. Patients also often experience pain, numbness, weakness, muscle spasms and loss of coordination due to pressure put on the nerve roots by affected discs and subsequent bone spurs.
To determine if a cervical disc arthroplasty is the right treatment for you doctors will look at a number of factors through both physical examination and diagnostic testing, including: failure of more conservative treatments, diagnosis of cervical radiculopathy or myelopathy, appearance of bone spurs or disc herniation, potential issues with other areas of the spine, skeletal maturity, and that the patient is not pregnant or nursing.
During the procedure a small incision is made at the front (anterior) part of the neck. Soft tissues and the trachea are moved aside so the surgeon can access the affected disc(s). The disc is then removed along with any bone spurs or broken disc fragments that may be putting pressure on the spinal nerves and/or spinal cord. The artificial disc is then secured into the intervertebral space, everything is put back in place and the patient is closed and moved to recovery.
Most patients are up and walking by the end of the first day after surgery, however, patients should expect to spend a few days in the hospital for recovery.
The purpose of a cervical disc arthroplasty is to treat pain and other symptoms in the neck, back, arms and legs caused by degenerative disc disease, disc herniation or other complications with invertebral discs in the cervical spine. The procedure was created by surgeons looking to limit cases of post-surgical adjacent segment degeneration experienced by patients who underwent an ACDF, currently the gold standard in disc decompression and replacement surgery. This is possible because in a cervical disc arthroplasty vertebrae are not fused together but rather artificial joints that are capable of natural movements are installed in the intervertebral space.
A cervical disc arthroplasty relieves pain throughout the body caused by issues with the discs in the cervical spine. Patients are often relieved from pain, weakness, numbness, loss or coordination and other painful symptoms in their back and extremities. Patients who choose this procedure over an ACDF may have a smaller likelihood of developing adjacent segment degeneration thought to be caused by spinal fusions. The artificial discs are also created to allow for natural movement, something that is commonly lost when a fusion is done during an ACDF procedure.
All surgeries come with risks including anesthesia complications, infection, blood clots and allergic reactions. For those who are not healthy or have underlying health problems, the likelihood of these and other risks are increased. This procedure carries with it other risks, including difficulty swallowing, issues with the implants breaking or loosening, pain in the neck or arms, nerve or spinal cord injury, speech impairment, numbness or tingling in the extremities, bleeding, swelling, loss of sexual function, loss or motion, cervical spine disease and even death. In some cases the surgery fails to relieve symptoms including pain.
This procedure typically reduces or relieves pain, increases mobility and relieves symptoms such as tingling, weakness and numbness in the back, neck, arms and legs.
Those who choose not to undergo a cervical disc arthroplasty may opt for the more traditional anterior cervical discectomy and fusion. Spine surgery is, however, only recommended when more conservative therapies have failed including exercise, pain medication and chiropractic care.
The average cost of artificial disc replacement surgery ranges from $35,000 to $45,000 in the United States. While some insurance companies will pay for all or part of the procedure it is not common for the entire surgery to be covered by Medicare or Medicaid. More recently outpatient cervical disc arthroplasty has been performed and studies suggest it is both safe and cost effective.
Disc Replacement Information. (n.d.). Retrieved from http://www.discreplacementinfo.com/cost-of-artificial-disc-replacement-surgery/
Moatz, B., & Tortolani, P. J. (2012). Cervical disc arthroplasty: Pros and cons. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3422089/
Cervical Disc Arthroplasty. (2015, September 10). Retrieved from https://www.roushspine.com/cervical-disc-arthroplasty.html
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