Fusion not the only option for patients struggling with cervical disc pain
Cervical disc replacement involves removing the damaged disc and replacing it with an artificial one, allowing the neck to move in a normal way.Posted — Updated
Approximately 1.1 million patients in the United States suffer from symptomatic cervical disc disease each year. This occurs when one or more of the cushioning discs in the cervical spine start to break down over the course of time due to wear and tear.
Cervical discs are the "cushions" between the vertebrae of the neck. When they become damaged, the disc can cause discomfort and those with cervical disc disease commonly experience neck and radiating arm pain. This pain can affect a person's ability to sleep, work, drive and participate in daily activities.
Since the 1930s, many patients turned to neck fusion surgery for pain relief.
Cervical fusion involves removing the degenerative disc and inserting a graft that is fused together with bones above and below the disc area. However, recent research and development has led to an emerging procedure — cervical disc replacement. This procedure involves removing the damaged disc and replacing it with an artificial one.
"Disc replacement is designed to maintain normal cervical spine biomechanics and has demonstrated certain clinical advantages over fusion," said Dr. Sameer Mathur, an orthopedic surgeon at Cary Orthopedic.
Since 2009, the FDA has approved six disc replacement devices in the United States, with the goal of accomplishing the same pain relief as neck fusion, while maintaining motion and preventing further degeneration around the disc site.
Globally, disc replacement surgery has been used for decades with proven clinical results and can be an inpatient or outpatient procedure.
"Neck fusion has been a very successful surgery for the past 30-plus years; it was the gold standard of how we treated disc disease," Mathur said. "However, when we started looking at our outcomes, we noticed that patients who had fusions were having problems at the level above and below where we did surgery. They were re-experiencing neck pain and arm pain, and a certain percentage of those people ended up requiring surgery for those additional areas."
Mathur explained fusions can lead to range-of-motion loss, whereas disc replacement preserves motion. With disc replacement surgery, surgeons decompress the nerve and place an implant that replaces the damaged disc instead of fusing it, thus allowing the neck to move in a normal way and alleviating stress on the levels above and below the site.
"With the disc replacement, you preserve motion and decrease the chances of adjacent-level problems from occurring," Mathur said. "The patient continues to have a very good range-of-motion because you haven't fused any segments. Their post-op recovery period is faster. The overall success rate has been really good."
Jennifer Stephenson made an appointment with Mathur after experiencing "pinching" pain in her neck and arm for six months, coupled with numbness that started creeping into her hand. Stephenson categorized her pain as constant.
"I couldn't work, I dropped things, it was very limiting in pretty much everything that I did," Stephenson said of the pain she dealt with before her cervical disc replacement. "The procedure was fairly easy. I woke up in the recovery room and my numbness was gone immediately. I was ecstatic."
Stephenson spent the next six weeks recovering, and with the help of physical therapy, said her lifestyle is back to normal. She said the best part of her experience was the education she received about the procedure from Mathur and his team.
Mathur believes the procedure is an option that patients struggling with disc disease should seriously consider.
"I believe that disc replacement surgery will be the preferred surgery for all cervical disc problems in the future," Mathur said. "The advantages of disc replacement surgery are numerous over traditional cervical fusions in regard to preserving motion and decreasing the need for additional surgery in the future. However, not all patients are candidates for the disc replacement procedure."
Why discs degenerate and cause pain?
As people age, intervertebral discs lose water and decrease in height. Because the daily motion patterns of this mobile area can wear down the dehydrated discs, this can cause discs to bulge and surrounding bone structures to produce spurs.
Both bulging discs and bone spurs can press on sensitive nerve structures, causing pain and other symptoms.
Ideal disc replacement candidates
Patients younger than 50 years old with a disc herniation who are otherwise healthy are ideal candidates for cervical disc replacement surgery, though patients of many ages have benefitted from successful surgeries.
Patients with spinal stenosis — the narrowing of the spaces within your spine — are also good candidates.
Patients with too much disc degeneration, those who have broken bones in the neck, or those who have had an infection in the neck are not good candidates.
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