Until recently, the preferred surgical approach for patients with herniated discs in the cervical region of the spine (the uppermost section extending into the neck) was a Cervical Discectomy and Fusion. That treatment, which fuses the damaged disc is still widely used, and offers very good outcomes for most people.
Today there is a new technology that offers patients another treatment option. Performed in Europe for more than a decade, it involves actually replacing the damaged disk with an artificial one. Cervical Disc Replacement is being performed by a few American orthopaedic surgeons, among them Dr. Stanford Tack of IBJI-Libertyville.
Not all patients with herniated cervical discs are candidates for a disc replacement. Age, activity level, overall spine health and level of disc disease are all considerations. But for many patients, Dr. Tack suggests replacing the disc rather than fusing it to another one.
The earlier technique (called “Fusion”), by molding two vertebrae together, can reduce flexibility at that spot in the spine. “When a vertebra is fused to another one, the adjacent regions compensate,” says Dr. Tack. In other words, nearby discs become more flexible in order to balance the decreased flexibility in the fused area. This can lead to herniated discs above or below the fused area (called Adjacent Segment Disease). “It’s when we fuse two or more discs,” explains Dr. Tack, “that we see stiffness and limited mobility in the neck.” Though long-term U.S. studies haven’t been done – mostly because the technology is new here – there is a strong possibility that disc replacement will avoid that development.
Dr. Tack’s disc replacement patients typically return to full activity sooner than those undergoing cervical discectomy with fusion. “In six weeks, they can be back in the gym,” he says. “In general, their maximum medical improvement happens at 3 months instead of at 6 months.” Post-surgical maintenance is typically just annual exams.
In the past, many neck surgeries were performed primarily by neurosurgeons. But Dr. Tack believes that orthopaedic surgeons are the ideal providers to perform disc replacement, because of their understanding of joint replacement issues. “We know the maintenance and performance issues of these devices,” he states.
Dr. Tack uses a metal-on-metal artificial disc, which was the first one approved by the FDA, because he believes it will last longer. (A second device is made of metal-on-plastic.) Special training was involved, but Dr. Tack points out that the basic elements of this surgery are the same as those for anterior cervical disc fusion. “A successful disc replacement requires attention to detail,” explains Dr. Tack.
Currently, not all insurance companies are covering the costs of Cervical Disc Replacement. More than half of Dr. Tack’s patients who considered this surgery didn’t go through with it for that reason. Typically, the majority of patients with herniated discs improves with non-surgical treatments and can avoid surgery, at least for a while. “Happily, a high percentage of patients with disc degeneration will improve with non-surgical treatment,” says Dr. Tack. “and those facing surgery now have a choice between Fusion and Disc Replacement. Both of these are excellent treatment options. Both offer relief of pain.”