Cervical Disc Replacement

Neck pain sometimes means surgery.
Neck pain sometimes means surgery. Sebastian Meckelmann/E+/Getty Images

Cervical Disc Replacement

Decisions, decisions.  Your doctor says you need neck surgery because you’ve been getting pain and/or pins and needles down one arm, not to mention other symptoms associated with cervical radiculopathy.  She tells you the most common surgery for this condition is anterior cervical decompression with fusion (ACDF.)

In fact, ACDF is a long-time surgery standard - and the most commonly done neck surgery.

Related: Learn about ACDF

But then the doc informs you that because ACDF involves fusion of (one or more) intervertebral joints, you’ll be giving up the ability move your neck at the surgery site – completely.  Not only that, she tells you, but again, because of the fusion, you run the risk of developing adjacent segment degeneration.

Next, either your doctor mentions it or you find out by doing further research that a procedure called a total disc replacement has helped some people, especially in Europe. 

But what, exactly is a total disc replacement? 

Total disc replacement is a relatively new technique that uses an anterior approach - which means the surgeon cuts into the front of your neck rather than into the back - to replace your ailing disc with an artificial one.  It’s used to address cervical radiculopathy and/or discogenic pain.  It’s also used in revision surgeries.

Related:  What Are Traction Spurs?

Total disc replacement goes by a few other names, as well.  These include: Artificial disc replacement, disc arthroplasty, total disc arthroplasty, and cervical disc arthroplasty or cervical disc replacement when the procedure is done in the neck.  When it’s done the low back, it’s called lumbar disc arthroplasty or lumbar disc replacement.

 FYI, arthroplasty is another name for joint replacement or reconstruction.  Acronyms for disc replacement include TDR (total disc replacement) and TDA (total disc replacement.)

One big benefit of cervical disc replacement, according to Caridi, Pumberger, Matthais, and Hughes (in their 2011 article entitled, “Cervical Radiculopathy: A Review,” which was published in the journal of the Hospital for special Surgery) is that it maintains the height between the two adjacent spinal bones, while at the same time preserving the joint’s ability to move.

As a newcomer procedure in the U.S.  (it is more established in Europe,) you may be wondering if TDA works, and what the up and downsides are. 

A number of research studies, as well as at least one spine-specific medical association may give the green light to cervical disc replacement.  For example, the North American Spine Society says that in the short term, for single level degenerative cervical radiculopathy, ACDF and total disc arthroplasty may be comparable treatments.

Related: Discectomy

Rao, et. al. found cervical disc replacement to be superior to ACDF in several ways. Their 2015 analysis which was published in Archives of Orthopedic Trauma Surgery and was entitled, “Cervical disc arthroplasty versus anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease: a meta-analysis of randomized controlled trials,” lists the following:

  • Better success with improving nerve symptoms.
  • More motion preservation at the operated level.
  • Fewer reported problems or complications related to the procedure.
  • Less need for revision surgery.

But even with this promising set of outcomes, the authors say, other benefits have yet to be proven, including blood loss during surgery, length of time you’ll spend in the hospital and improved functioning.

Ren, et al., in their 2014  study entitled, “Mid- to long-term outcomes after cervical disc arthroplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis of randomized controlled trials,” which was published in the European Spine Journal also found a lower rate of revision surgery for the total disc replacement, as compared with ACDF.  The authors also say that disc replacements may result in better recovery of function in the mid and long term. 

But unlike Rao, et. al. (from above), Ren and his researchers assert that too few studies have been done to determine if the claim that a cervical disc replacement can help avoid ASD is true.

Resources Outside the Medical Research Sphere

In the U.S., cervical disc replacement is currently done in only a small sliver neck surgery cases. Because of this, it's probable that few spine surgeons have honed the skill to the point where their patients can honestly give them rave reviews.

Word on the (internet) street is that people are quite willing to travel to find a doctor with whom they feel comfortable.  In fact, many go to Europe - particularly Spain and Germany to get the procedure done.

Many of the questions about safety and outcomes remain unanswered.  There is, however, a “water cooler” discussion forum called ADR Support, started by a man who had a successful TDR surgery.  The people on that forum give straight answers, that, while not proven by research, are taken directly from disc replacement patients’ experiences and stories.  

Sources:

Caridi, John M., M.D., Pumberger, Matthias, M.D., Hughes, Alexander, P., M.D. Cervical Radiculopathy: A Review. Hospital for Special Surgery. Sept. 2011. Accessed Jan 2016.

North American Spine Society. Diagnosis and Treatment of Cervical Radiculopathy from Degenerative Disorders. North American Spine Society. 2010.

Ren, C., Song, Y., Xue, Y., Yang, X. Mid- to long-term outcomes after cervical disc arthroplasty compared with anterior discectomy and fusion: a systematic review and meta-analysis of randomized controlled trials. Eur Spine J. 2014 May;23(5):1115-23. doi: 10.1007/s00586-014-3220-3. Epub 2014 Feb 11.

Rao, M., Nie, S., Xiao, B., Zhang, G., Gan, X., Cao, S. Cervical disc arthroplasty versus anterior cervical discectomy and fusion for treatment of symptomatic cervical disc disease: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2015 Jan;135(1):19-28. doi: 10.1007/s00402-014-2122-5. Epub 2014 Dec 5.

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