Cervical Disc Replacement


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 Artificial Cervical Disc Replacement

While hip and knee joint replacement surgery or arthroplasty has grown increasingly common since its advent in the early 1960s with a high degree of patient satisfaction, spine arthroplasty (or artificial disc replacement) has not been a viable option until recently.

The challenge has been to develop a suitable replacement for the intervertebral discs. The replacement must not only be safe to implant, reliable and long lasting, it also must have the ability to mimic the complex range of movement required of a disc implant. Efforts to find a solution to these challenges have been ongoing for more than 40 years.

Several artificial disc replacements for both the neck (cervical) and back (lumbar) spine are currently being offered to appropriate candidates at our centre.

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. Full NICE guidelines and patient information is here.
 

   


Above Left:  Single Level Cervical Disc Replacement.
Above Right: 2 Level Cervical Disc Replacement.

An Alternative to Traditional Spinal Fusion

Age, genetics and everyday wear-and-tear of routine activities eventually can contribute to damage and degeneration of the discs that cushion the bones of the spine (the vertebrae). To treat degenerative disc disease, doctors usually begin with conservative (nonsurgical) medical treatment. When conservative therapy fails, other approaches, possibly including surgery, may be recommended. Currently, the gold standard for surgical treatment of problematic degenerative disc disease is spinal fusion. This procedure attempts to permanently lock two or more spinal vertebrae together so they cannot move except as a single unit. This may alleviate pain in a motion segment.

Spinal fusion, however, has well known potential disadvantages, including:

  • Loss of motion and flexibility
  • Permanently altered motion characteristics and biomechanics
  • Potential for accelerated degeneration of the discs above and below the fused level that can lead to more pain and the need for more surgery

Artificial disc replacement offers a  viable alternative to fusion that possibly avoids the accepted shortcomings of fusion. By inserting an artificial disc instead of performing spinal fusion, there is the possibility of reducing damage to nearby discs and joints. This is because artificial disc replacement allows for motion preservation, near normal distribution of stress along the spine and restoration of pre-degenerative disc height.

How a Disc Is Replaced

The evolution for hip and knee replacement has taken more than 40 years to reach its current stage of technology in materials, design and technique. Although the idea of an artificial disc is not new, artificial disc replacement technology has just in the recent decade become mature enough to be used clinically in extensive testing in Europe. The unique biomechanical challenges of artificial disc replacement have presented a challenge of both design and material.

Although revolutionary in material and design, the technique to install an artificial disc (whether in the neck or back) is routine and safe. In both traditional disc surgery and artificial disc replacement the procedure begins by removing the gelatinous disc between the vertebrae.

Prestige II Cervical Artificial Disc

The surgical procedure to implant a cervical artificial disc is similar in approach and technique to traditional cervical spine surgery that has been used for more than five decades. A small incision, usually less than an inch long, is made in the skin of the neck just off the midline of the spine. Vital structures like nerves, arteries and the oesophagus (the tube that connects the mouth and the stomach) are gently pulled out of the way so the surgeon can have access to the spine.

The disc is removed using a microscope and surgical instruments made for this purpose. Once the disc has been safely removed in its entirety, the empty disc space is prepared by milling or shaping the endplates (bottom of each vertebrae) to incorporate the Prestige cervical artificial disc replacement. The artificial disc is fixed in place while the disc space between the two vertebrae (the bones of the spine) is held open.

Once firmly in place, tension is taken off the vertebral bodies above and below compressing the artificial disc and holding it in place. Both surfaces of the cervical artificial disc are made of porous coated metal that will incorporate and encourage bony ingrowth for long-term stability. Care and restrictions following surgery, as well as potential complications, are similar to those that occur with spinal fusion.

We provide a multidisciplinary approach to ensure our patients the highest standards in spine care and treatment.

 





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Copyright Orthopaedics.Com Ltd Dr M Akmal MD FRCS(Orth)