My best friend had a disc replacement in her neck and she hasn't stopped raving about all the things she can do now that she couldn't do before. She is just sure that I should have the same thing done for my neck arthritis. Can anyone have this operation?
Artificial disc replacement (ADR) is relatively new. In June 2004, the first ADR for the lumbar spine (low back) was approved by the FDA for use in the US. Replacing a damaged disc in the cervical spine (neck) is a bit trickier. The disc is part of a complex joint in the spine. Making a replacement disc that works and that will last is not an easy task.
The artificial disc is inserted in the space between two vertebrae. The goal is to replace the diseased or damaged disc while keeping your normal neck motion. Disc replacement can be done instead of fusing the neck and losing neck motion.
When a new treatment like disc replacement comes along, it takes a while before it's clear who should have this surgery. So patient selection is extremely important. At first, it's just a limited group of patients who qualify for the procedure. That's okay because surgeons want the best results for their patients.
Who's the best candidate for a cervical disc replacement? Well, for starters, anyone who is also a candidate for cervical fusion. These patients have obvious cervical disc disease with herniated disc, bone spurs, and/or neck/arm pain from myelopathy or radiculopathy. Myelopathy is any damage to the spinal cord as it travels down the spine. Pressure on the spinal cord can cause significant symptoms and disability. Radiculopathy is pressure or irritation of the spinal nerve roots as they exit the spinal cord and travel down the arms (or legs).
In Europe where disc replacements have been done much longer than in the U.S., there is a broader patient selection. For example, patients with a failed cervical fusion, patients with multilevel degenerative disease, and patients with segmental disease after fusion are also candidates for cervical disc replacement.
Even with expanded patient selection criteria, certain patients still may not be good candidates for this type of surgery. Brittle bones from osteoporosis or other significant diseases may keep a patient from having this type of surgery. Local problems in the spine such as infection or severe degeneration of the facet (spinal) joints are also possible contraindications (reasons NOT to have the operation).
If the spine has already started to fuse itself (autofusion) with bone spurs crossing the disc space, then disc replacement is not advised. And if the patient has an unnaturally straight cervical spine called kyphosis, cervical disc replacement may not be a good choice. The kyphosis can get much worse after surgery. The result can be worse neck pain than before surgery. In time, with the right design and placement, this problem may be resolved. But for right now, preoperative kyphosis is considered a contraindication for cervical disc replacement.
Disc replacement surgery is safe and effective but must be used on the right patients. The best thing to do is go see an orthopedic surgeon who does disc replacements and find out if you are a candidate. There may be some other less invasive, more conservative treatment that might be helpful.