I am a 47-year-old woman working for an American company in China. I've had a work-related injury that has finally trashed my neck. The surgeon here (Chinese) is recommending either a neck fusion or a disc replacement. I've done a little research and found out that disc replacement for the neck hasn't been around very long and only in China since around 2003. Would you consider it safe to have this surgery here or better to come back to the States?
Before artificial disc replacements (also called cervical disc arthroplasty) were developed, patients with chronic neck pain and instability were treated with neck fusion. The fusion stopped motion at the diseased level and thus reduced pain. But the strain on the adjacent spinal levels contributed to further disc degeneration. This is considered a negative consequence of spinal fusion procedures. Disc replacement preserves motion without putting increased stress on the spinal segments on either side of the disc replacement. Over the years, several companies have made different types of implants. The three major disc replacement devices currently on the market include: 1) BRYAN cervical disc, 2) ProDisc-C, and 3) Bristol Disc. Most of the studies comparing results of cervical (neck) disc replacement to neck fusion have been done in the United States and Europe. Cervical artificial disc prostheses were first used in China around 2003. As a result, the first study comparing these two procedures among the Chinese population has been published. Everyone in the study (120 adults) had a diagnosis of painful cervical disc disease. They were randomly placed in one of these two treatment groups. The group receiving a cervical disc implant were given the BRYAN cervical disc. The group having a fusion were treated with the Anterior Cervical Deompression and Fusion (ACDF) technique. Results were compared over a two-year period of time. Pain, motion, and disability (measured by the Neck Disability Index) were compared between the two groups. Operation time, blood loss, and length of time in the hospital were also recorded and compared. As expected, patients with the implant had more motion than the fusion group. Levels of pain and changes in neck disability from before to after surgery were not different between the two groups. Results were similar to outcomes reported in other studies making the same comparison between artificial disc replacement and neck fusion. The authors concluded that using the BRYAN disc replacement is an acceptable alternative to neck fusion for adults with painful and unstable cervical disc disease. Although anterior cervical decompression and fusion (ACDF) is still the most common surgical procedure used in China for this condition, more and more surgeons are considering using disc replacements. More studies like this are needed to confirm the success of the artificial implants instead of the fusion procedure. Since this was the first study in China and results so far are only short-term (two years), the authors themselves suggested further long-term follow-up over the next 10 years. Attention should be paid to whether the spinal motion and mechanics at the level where the disc was put in is preserved and maintained. Efforts should be made to monitor adjacent levels (above and below the artificial disc) for break down (and especially faster deterioration than expected). Until this kind of study can be done and data confirm successful results, you may want to look for a surgeon who has completed many of these procedures successfully. Don't be afraid to ask the prospective surgeon for information on success/failure rate, definition of failures, and how often re-operations are required. This type of information may help you decide where and when to have surgical intervention.