Not all patients who experience pain in the cervical spine and back need surgery. In fact, most can relieve their symptoms through non‑surgical therapies such as physical exercise, medication, and physiotherapy.
However, in some cases there is no alternative to surgery for a cervical disc herniation, and the optimal option—if there are no contraindications—is cervical disc replacement (cervical disc prosthesis). The artificial disc prosthesis is designed to preserve the motion and flexibility of the degenerated cervical spinal disc.
1‑What is cervical disc replacement?
The latest innovation in the surgical treatment of disc herniation causing myelopathy or radiculopathy is the implantation of a cervical disc prosthesis. This surgical procedure involves removing a damaged or degenerated cervical disc and replacing it with an artificial one. Cervical disc replacement, also known as total disc arthroplasty, is approved in Europe and has FDA clearance for the management of symptomatic disc disease.
2‑In what situations is an artificial cervical disc appropriate?
An artificial cervical disc can be used for disc degeneration or herniated discs in the cervical spine. It is indicated for patients with compression of the spinal cord or nerve roots, as well as those with cervical pain who are candidates for cervical surgery. The specialist will recommend the appropriate treatment for each individual case.
3‑Who is an ideal candidate for cervical disc replacement?
Any patient with symptomatic cervical disc disease that does not improve with conservative therapy and who has no contraindications for this type of surgery, which include:
• Cervical instability.
• Cervical trauma.
• Cervical ossification.
• Long‑term degenerative changes.
• Osteoporosis.
• Significant pain originating from the facet joints.
4‑What material is the artificial disc made of? Has it been safely used in patients before?
The artificial disc is manufactured from various materials, including medical‑grade titanium alloy, polyurethane, and cobalt‑chromium. Implants made from these materials have been used safely in surgery for many years, following relevant guidelines.
5‑How is an artificial disc implanted? Is cervical spine surgery a well‑established technique?
The artificial disc is usually implanted through an incision in the front of the neck—typically on the right side—allowing direct access to the disc space. This is a routine surgical procedure. The surgeon generally follows these steps:
– Retract the soft tissues (skin, fat, and muscles) to expose the anterior cervical spine.
– Remove the cervical disc and any adjacent bone compressing neural structures to create more space for the nerve and spinal cord (discectomy and decompression).
Once the herniated or degenerated cervical disc is removed, the artificial disc is placed in the gap between the adjacent vertebrae. More information is available in the following explanatory video.
6‑What happens after artificial cervical disc replacement surgery?
In most cases, a drain will be left in the wound. The surgeon will prescribe pain medication to manage discomfort.
On the day after surgery, the drain (if placed) is removed and the patient can begin to sit up and walk. The patient may experience mild difficulty swallowing, which will subside gradually.
After two to three days, the patient can usually be discharged home or to a hotel if traveling. A soft cervical collar is recommended—though not mandatory—to remind the patient not to make sudden neck movements during the first 10 days after surgery.
Two weeks post‑surgery, patients can generally resume their daily routine. However, they should avoid lifting heavy objects and strenuous physical activity.
During the first month after surgery, walking is encouraged as it is considered the best exercise for recovery.
Around three months after the operation, follow‑up X‑rays are performed to confirm that the prosthesis is correctly positioned and functioning properly. Once confirmed, the patient may safely return to other sports activities such as cycling or running.
It is important to note that although most cervical implants are metal or partly metallic, they rarely trigger metal detectors.
7‑Risks associated with cervical disc herniation surgery
• Nerve injury: extremely rare.
• Low rates of bleeding and infection.
• Temporary swallowing difficulty: quite common.
• Malpositioned implant or postoperative device migration, which may require revision surgery.
• Spontaneous fusion at the level of the disc replacement.
• Injury to the esophagus or vocal cords: very uncommon.
8‑Benefits of cervical disc replacement surgery
• Over 90% satisfaction in relief of cervical and radicular pain.
• Protective effect on adjacent discs: preserving motion at the treated level may prevent accelerated degeneration of neighboring discs.
• Early neck mobility after surgery.
• Maintenance of normal neck motion.
• No bone grafts required.
• Lower reoperation rate compared to cervical fusion.
• No need for an anterior cervical plate.
• Preservation of spinal motion, which may protect adjacent levels from wear.
• Soft cervical collar recommended only for a few days versus 4–6 weeks after fusion.
• Short hospital stay: discharge on the same day or the day after surgery.
• Minimal postoperative pain, usually resolving within 2–3 days.
• Short recovery period: light activities in 1–2 weeks and more vigorous activities by 6 weeks.
For more information click the following link: https://drgilete.com/specialties/cervical-surgery/cervical-disc-replacement/
Sources:
Dr. Vicenç Gilete, Neurosurgeon & Spine Surgeon.
Neurosurgery Volumes I–III. Edited by Robert H. Wilkins and Setti S. Rengachary. McGraw‑Hill.
Handbook of Neurosurgery. Mark S. Greenberg, Seventh Edition. Thieme
