Cervical disk replacement

Overview

The cervical spine consists of seven cervical vertebrae, forming the neck area. These vertebrae are separated by cervical discs, which act as shock absorbers, enabling neck mobility. Additionally, the cervical spine provides protection for the upper spinal cord, housing the spinal nerves responsible for upper body sensation and movement.

When the space between these vertebrae narrows, it can lead to pressure on the spinal cord or nerves, resulting in pain, numbness, or weakness. When non-surgical treatments are ineffective, cervical disc surgery may be recommended.

Cervical disc replacement surgery involves replacing a diseased disc with an artificial one, offering more mobility and reducing stress on remaining vertebrae compared to traditional fusion surgery.

Reasons for undergoing the procedure.

Cervical disc degeneration, often due to wear and tear, is a common occurrence, leading to a loss of space between cervical vertebrae. This process typically starts as people age, and by the age of 60, it affects most individuals. However, it remains unclear why some people experience more noticeable symptoms from cervical disc degeneration compared to others. Some symptoms could be:

• Headache
• Neck pain
• Stiffness of the neck
• Weakness in your hands, arms, legs, or shoulders
• Arm numbness or a “pins and needles” sensation
• Aching that radiates into your arms or shoulders

Risks

The risks of surgery vary from person to person. Prior to undergoing surgery, you will be required to sign a consent form that provides a detailed explanation of both the advantages and disadvantages associated with the procedure. The following are some possible risks of cervical spine surgery:

• Stroke
• Bleeding
• Infection
• Nerve damage
• Swallowing problem
• Voice alterations
• Leakage of spinal fluid
• Breathing problem
• Inability to alleviate symptoms
• A damaged or displaced artificial disk
• Anesthesia side effects
• Potential further surgery

Before the procedure

Before surgery, it’s important to follow these common steps:

• Medications: Inform your surgeon about all your home medications, including herbal supplements and over-the-counter drugs. Some medications, like aspirin, may need to be stopped because they can thin your blood and increase bleeding.
• Anesthesia allergy: Make sure your surgeon knows if you or a family member has had a reaction to general anesthesia in the past.
• Smoking: If you smoke, you may be asked to quit smoking well ahead of the surgery and avoid smoking for some time after the procedure.
• Eating and drinking: You will receive instructions on when to stop eating and drinking before surgery. Typically, you won’t be allowed to eat or drink anything after midnight on the night before the procedure.

During the procedure

Before the procedure begins, an intravenous line (IV) will be started to allow for the administration of fluids and medications that will help you relax and induce sleep. This procedure typically takes place under general anesthesia, meaning you will be asleep throughout. Medication may be administered through the intravenous line to induce sleep, and a tube may be inserted into your throat to protect your airway and assist with your breathing. The procedure itself may last for a few hours, and here is a breakdown of what typically occurs during it:

• Monitors are positioned to keep a check on your heart rate, blood pressure, and oxygen levels.
• The area on your neck where the incision will be made is cleansed using a specialized solution to eliminate germs on the skin.
• A surgical incision, approximately one to two inches in length, is made on the side or front of your neck.
• The important structures in your neck are gently moved aside until the surgeon gains visibility of the vertebrae and cervical disk.
• The cervical disk that requires replacement is removed.
• An artificial disk is securely placed in the vacant disk space.
• The incision is closed using absorbable sutures (stitches) beneath the skin. Special sutures are used to minimize scarring.
• A small dressing is applied over the incision, and you may be provided with a rigid or soft neck collar to limit movement. Afterward, you will be transported to the recovery area.

After the procedure

After disk replacement surgery, patients are closely monitored in the recovery area until anesthesia wears off. Pain is a common post-surgery symptom, and patients receive pain relief medication as necessary.

During Hospital Stay:

• Typically, patients spend a day or two in the hospital.
• Intravenous fluids may continue until patients can drink normally.
• Once patients can eat and drink comfortably, they resume their regular diet.
• Pain medication is administered as needed.
• Nursing staff tend to dressings, assist with getting out of bed, and aid in bathroom visits.
• Patients might receive a support collar to wear.
• Early mobility is encouraged.

Recovery at Home:

• Some patients may still require a neck support.
• The diet returns to normal.
• Suture removal may be necessary during a follow-up visit.
• Gradual return to daily activities; patients should consult their surgeon for activity guidelines and bathing instructions.
• Physical therapy may commence after a few weeks.
• Full activity resumption typically occurs within 4 to 6 weeks.

Contact your surgeon if you experience:

• Fever
• Headache
• Issues like bleeding, redness, swelling, or discharge from your incision site
• Persistent pain unresponsive to medication
• Numbness or weakness
• Difficulty swallowing
• Voice changes or hoarseness
• Breathing difficulties

Outcome

Patients typically have scheduled appointments at four to six weeks, three months, six months, and one year following disk replacement surgery. After the initial year, they should continue to be seen annually or every two years, much like patients with hip or knee replacements, throughout the lifespan of the disk replacement.