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Cervical Spine Replacement

What is the Cervical Spine
The vertebrae (spinal column bones), which encircle and protect your spinal cord, are separated by shock-absorbing discs. The discs give your spine the flexibility to move. Nerves branching from the spinal cord pass through openings in the vertebrae to other parts of your body

Why do I need surgery?
As discs lose their water content because of disease or age, they lose their height and bring the vertebrae closer together. The consequence is a weakening of the shock absorption properties of the disc and a narrowing of the openings for the nerves in the sides of the spine. Additionally, a loss of disc height may cause the formation of bone spurs, which can push against your spinal cord and/or nerves.

When a disc ruptures in the cervical spine, it puts pressure on one or more nerve roots (called nerve root compression) or on the spinal cord, causing pain and other symptoms in the neck and arms. Living with this pain or weakness and tingling in the arms can be disabling.

How is this procedure different from a fusion?
A fusion procedure may certainly treat your short-term symptoms, alleviating neck and arm pain. However, clinical evidence suggests that physical stress to vertebrae involved in a fusion may accelerate disc degeneration elsewhere in your neck especially in the young patients with single level disc degeneration.

Artificial cervical disc technologies are being developed in an effort to treat symptomatic degenerative disc disease more effectively. The main goal of this type of technology is to maintain spinal motion following anterior discectomy, to reduce the incidence of degeneration of adjacent disc levels of the spine (adjacent-segment disease), and to permit more rapid return to normal activity.

Theoretically, the artificial disc is designed to take the place of the real intervertebral disc and be placed between two vertebral bodies where the disc has been surgically removed in order to decompress the spinal cord or nerve root in the neck. Ideally the artificial disc acts like a normal disc, providing motion while acting as a shock absorber in the spine (unlike a fusion, which eliminates both motion and shock absorption in the fused segment of the spine).

What is involved in surgery?
This surgery involves the use of a new medical device, which is designed to replace the disc which sits between the vertebrae in your neck. Your disc, which is damaged or diseased, is surgically removed through an incision made in the front of the neck.

In its place, your surgeon will prepare a space and insert the artificial cervical disc prosthesis, which is designed to allow for motion to be preserved.

What should I expect from the surgery?
This surgical procedure is expected to relieve the symptoms of a nerve root or spinal cord compression caused by the damaged disc. The surgery associated with the artificial disc replacement is designed to allow for motion at the operated disc level, unlike a fusion surgery.

What are the possible complications?
As with all surgery there are potential risks to be aware of.

1- Disc prosthesis migration was noted in 2% of patients undergoing prosthetic
cervical disc implant, although no migration was greater than 3.5 mm from initial implant site.
2- Haematoma (blood clot) at site of surgery in 0.5% which may require removal of the clot
3- Infection in 1%.
4- Temporary hoarseness due to recurrent laryngeal (voice box) nerve palsy 1%
5- moderate dysphagia (swallowing difficulties) 1%
6- Major neurological deficit as paralysis, less than 1 in 400

Preparing for surgery
You will be called to attend the neurosurgical pre-admissions clinic before your surgery, to check your overall health. Please tell the medical staff at this clinic what medications you are taking, and ask if you should stop taking any medications before surgery.

You will most likely be told not to eat or drink the night before the surgery. Your hospital stay should be between 2 and 5 days, depending on individual circumstances.

To make your recovery easier, prepare your home for life after surgery. Place important things within easy reach. Arrange for someone to help you at home and around the house after surgery.

After surgery
After surgery your surgeon may refer you to a physiotherapist who will teach you exercises to improve your strength and increase your mobility. The goal of physiotherapy is to help you become active as soon as possible, using safe body movements that protect your neck. Recovering from pain and surgery is an ongoing process. How fast you recover depends on your commitment to working closely with your physiotherapist, and moving and exercising correctly, as recommended by your surgeon.

Your role in recovery
The ongoing health of your neck really depends on you. You should always follow your surgeonís recommendations, such as seeing your physiotherapist regularly. Remember to move and exercise properly as you return to a more active lifestyle.

Good body mechanics keep your spine well aligned and reduce pain, but maintaining a safe, balanced position may require some changes in how you go about daily activities. For instance, you may need to learn different ways of standing, sitting, or lifting to avoid re-injuring your neck.

You and your surgeon will continue to work together during your recovery. Before you leave the hospital, your surgeon may schedule follow-up visits with you so he can evaluate your progress, advise you about your activity level, and adjust any medication.

Our role
We are one of the few organisations in the UK performing this procedure. We have started using cervical disc replacement surgery since it was approved by the National Institute for Clinical Excellence.

 


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