By Mark B. Kerner, MD
Over the past two years, multiple studies have clearly demonstrated the benefits of cervical disc replacement for one- or two-level pathology as compared to cervical fusion, the longtime gold standard of care.
Cervical disc arthroplasty, an outpatient procedure performed through an inch-long incision in the neck, has improved outcomes by combining two trends in orthopaedics: the growth of minimally-invasive procedures and motion-preserving techniques. Confirmation of its effectiveness via randomized, controlled trials has caused a sea change in treatment.
Removing herniated discs without having to immobilize any segments of the neck decreases the rate of future surgery from 17 percent to less than 6 percent over seven years, all while decreasing recovery time. Three out of four patients see early significant improvements in their symptoms, including neck and arm pain, weakness, tingling and numbness.
Patients generally experience little discomfort from surgery, don’t have to wear a restrictive neck brace, and can return to most normal activities within just two or three weeks.
Backing up a bit, I should emphasize the importance of initially attempting conservative therapies to delay or even avoid any type of surgery. The least invasive surgery is in fact no surgery at all. Many patients can gain relief from a variety of oral medications, targeted injections and/or physical therapy.
However, surgery is a valuable option for patients who continue to deal with unbearable pain, an inability to work or function well in daily life, or a neurologic injury. Determining the best, least invasive approach must be a highly individualized decision based on each patient’s pathology, age, post-recovery goals and life circumstances.
We live in high-stress times, when people tend to feel immense anxiety about quickly returning to work and daily activities. Disc replacement surgery allows patients to avoid the months of healing required for vertebral bones to fuse. This is especially beneficial for patients who smoke or have other risk factors for delayed bone healing.
After cervical disc arthroplasty, patients often need minimal pain medication and maintain their neck motion. Today’s artificial discs are designed to absorb stress and relieve pressure on nerves while conserving quality range of motion at the repaired spinal level.
Wear on adjacent discs is minimized, thereby preserving healthy discs. This is an important protective measure in patients who have already shown a vulnerability to degenerative disc disease.
Finally, unlike knee and hip joints, artificial cervical discs are engineered to last for the remainder of a patient’s life.
Studies now are examining whether cervical disc replacement might also be effective in other challenging patients, including those with greater than two-level cervical spine pathology or those who have had previous fusions.
Patients and referring physicians should be confident that cervical disc replacement is not a temporary fad or marketing ploy. Rather, it has become a proven, successful treatment – one that we hope will alleviate patients’ fears about tackling their debilitating neck pain.
Dr. Kerner is an orthopaedic spine surgeon with Hampton Roads Orthopaedics Spine & Sports Medicine, with offices in Harbour View and Newport News. www.hrosm.com