How does cervical disc replacement work?

A cervical disc replacement (CDR) is a procedure that replaces a damaged disc between the vertebrae in your neck with an artificial disc. Discs are gel-like cushions that reduce friction between your vertebrae.

The goal of CDR is to improve mobility in your neck and reduce pain. CDR is also called anterior cervical disc arthroplasty (ACDR) and total disc replacement (TDR).

CDR is an alternative to more rigid spinal fusion procedures where two vertebrae are permanently connected.

The discs in our spine can become damaged with age, injury, or certain health conditions. If a damaged disc in your neck presses on nearby nerve roots, it can cause pain, numbness, or weakness in your arm.

Read on to learn more about CDR, including who is eligible, what to expect, and how it compares to other procedures.

The ideal candidate for CDR has a herniated disc that is causing neurological (nervous system) symptoms or movement problems.

A herniated disc, also called a herniated disc, occurs when the jelly-like core of a disc pushes through the rubbery outer layer. It can develop as a result of sudden injury or disc degeneration caused by many years of use.

People who have neurological symptoms like weakness or numbness in the arms due to a cervical disc may be eligible for CDR if they:

  • have one or two damaged discs between the C3 to C7 vertebrae
  • are an adult with a fully developed skeleton
  • did not feel relief after 6 weeks of conservative treatment

Some people may not be eligible for CDR. Conditions that may make you ineligible include:

Your doctor will assess your condition and risk factors to decide if CDR is right for you.

The most common symptoms of cervical disc degeneration are neck pain and stiffness.

A large bundle of nerves called your brachial plexus runs from your cervical spine and controls the sensation and movement of your arms. A herniated disc in your neck can cause neurological symptoms in your arms if it presses on the root of these nerves.

You may encounter:

  • pain
  • tingling
  • numbness
  • weakness

Spinal stenosis can also cause problems with the lower extremities, leading to problems with walking and balance.

CDR is usually performed under general anesthesia so you won’t feel any pain. Your surgeon may insert a tube down your throat to help you breathe during the procedure. You will have monitors connected to your body to check your blood pressure, oxygen levels and heart rate.

Your healthcare team can give you the best idea of ​​exactly what will happen during your surgery. The exact procedure can vary, but here’s what usually happens:

  1. During the procedure, you will lie on the operating table with your face up. Your head and shoulders will be secured in place. Your skin will be cleansed to kill microorganisms on your skin.
  2. Your surgeon will make a 2 to 3 inch incision in the front of your neck or on one side.
  3. They will push back the structures in your neck to gain access to your vertebrae.
  4. Your surgeon will remove your disc and any bone spurs that press on your nerves.
  5. They will insert an artificial disc into your neck.
  6. Your surgeon will close the incision with stitches and apply a dressing. You may be given a collar to keep your neck still and prevent you from moving your head.

The whole procedure usually takes less than 2-3 hours.

A procedure called anterior cervical discectomy and fusion (ACDF) has been the gold standard for many years to relieve the symptoms of cervical disc disease.

In ACDF, the surgeon removes the damaged disc and replaces it with a bone graft from another place in your body, a bone graft from a donor, or an artificial disc. The surgeon then fuses your adjacent vertebrae together using metal plates and screws.

ACDF can be effective in improving symptoms caused by a damaged disc, but the fusion of the vertebrae limits movement through the neck. It can also cause problems with your other vertebrae.

According to a 2018 research literature review, up to half of people experience degeneration of nearby discs within 5 years of surgery.

Another 2018 review analyzed several high-quality studies of these procedures over the past 10 years. Researchers have found that single-disc CDR can result in a similar outcome to ACDF and with less chance of requiring a second surgery.

There is less research examining the effectiveness of CDR for replacing two disks, but two-disk CDR is becoming an increasingly common procedure. There are proof it can be as efficient as a single-disc CDR.

It is important to note that there is a lack of long-term data on these medical devices and implants. Some people may require additional surgery to fix them. More research is needed.

For most people, it usually takes about 4-6 weeks to resume daily activities after CDR.

A minority of surgery recipients, about 1.8 to 5.4 percent, will need a second operation within 5 years, a 2021 research review reports.

CDR is generally effective in reducing the symptoms of a herniated disc. Researchers in one clinical trial 2017 found that the overall CDR success rate was 60.8% for two-drive replacements and 55.2% for single-drive replacements.

For the ACDF, the researchers found that the overall success rate was 34.2% for two-drive replacements and 50% for single-drive replacements.

A 2020 review out of 139 CDR procedures found that among people who received three- or four-disc replacements, patient satisfaction was 88% 7 years after surgery. The mean improvement in the neck disability index was 45.9%.

CDR is considered a safe procedure, but all surgeries carry a risk of complications.

General risks of surgery include:

  • bleeding
  • infection
  • adverse reaction to anesthesia

Potential short-term complications of CDR may include:

Long-term complications can include:

  • degeneration of neighboring discs (occurs in approximately 15 percent of cases)
  • disc implant failure
  • abnormal bone calcification around the disc replacement

CDR is a procedure that replaces a disc between the vertebrae in your neck with an artificial implant. It is generally used to treat a herniated disc that is causing pain or neurological or motor problems.

Research has found CDR to be a safe and effective treatment for symptom relief in the majority of surgery recipients.

Your doctor can help you determine if you are a good candidate for CDR and prepare you for what to expect during and after your surgery.

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