Cervical Artificial Disc Replacement
What is cervical artificial disc replacement ?
An ALIF procedure is a minimally invasive spine operation. Dr. Ghasem approaches the selected lumbar spine level(s) from the front through the abdomen. The abdominal contents are safely mobilized and retracted out of the way to provide wide visual access to the desired disc. The injured disc is then replaced with a structurally supportive spacer. This spacer acts to stabilize the spine as well as recreate the natural height and curvature of the spine.
Symptoms of nerve root compression (radiculopathy) or spinal cord compression (myelopathy) can include but are not limited to arm numbness, weakness, radiating pain, hand coordination difficulties, and balance disturbances. When these symptoms are caused by bone spurs or disc herniations in the cervical spine, an artificial disc replacement is a potentially viable treatment.
When compared to anterior cervical spinal fusions, cervical disc replacements have been shown to be similar or superior in neurologic improvement, adjacent level degeneration rates, return to work time, and pain scores. Several disc replacements are available on the market and Dr. Ghasem reviews which of these are most appropriate for each patient’s specific clinical needs during consultations.
Do I qualify as an Artificial Disc Replacement candidate?
Patients experiencing intractable pain as a result of degenerative disc disease in the subaxial cervical spine (C3-C7) resulting in nerve compression that have failed conservative management are potential candidates. Additional indications include:
- Cervical Myelopathy in up to 2 spinal levels
- Cervical Radiculopathy in up to 2 spinal levels
Contraindications to Cervical Disc Replacements
In certain instances, performing cervical disc replacements may be harmful to the patient or has not been adequately studied adequately in the biomechanical and clinical research arena. Conditional considerations that may preclude patients from being able to undergo a cervical disc replacement include but are not limited to:
- Significant angulation across the indicated level (>11 degrees)
- Immobility across the indicated level
- Active or preexisting spinal infection
- Severely compromised bone quality (osteoporosis)
- Significant vertebral body anatomical deformity
- Certain metal allergies
- Significant vertebral instability/spondylolisthesis (> 3 mm)
- Severe facet joint disease or degeneration with associated pain
Artificial Disc Replacement Procedure in Detail
The procedure is performed under general anesthesia with the patient positioned supine on their back. The neck is prepped with disinfectants and a small approach through the front is performed.
Through a muscle sparing approach, the soft tissues are gently moved to the side and the interval between the vasculature and the trachea (windpipe) and esophagus is passed through to safely reach the front of the spine.
The overlying musculature is carefully lifted and the desired disc is identified under intraoperative imaging.
Once the targeted disc is confirmed under imaging as the injured level, it is methodically removed in a careful manner to minimize the risk of excess bone formation postoperatively. This is performed with the disc under distraction.
The posterior longitudinal ligament is removed and both nerve roots are inspected to ensure complete decompression and mobility.
An optimally sized trial implant is then selected after the disc space is prepared for implant delivery. Depending on the implant, keels in both adjacent vertebrae are made to allow a perfect press fit of the final artificial disc replacement implant.
The disc replacement is confirmed to be in its desired position using imaging at the final stages of the operation. Each overlying layer of tissue is then repaired in its native position.
The procedure is performed with the spinal cord under neuromonitoring to closely evaluate nerve conductivity.
In certain situations, depending on the patient’s pathology, this process may be repeated at an adjacent or skip level.
Artificial Disc Replacement Post Op Recovery
Post operative functional recovery and the need for an acute rehabilitation facility is in large part dependent on the baseline pre operative function. The vast majority of patients are walking the same day after surgery with expert physical and occupational therapists.
Time to return to work as well as driving varies depending on the job description, pain requirements, and reaction time, but on average is between 1-4 weeks. Post operative restrictions with gradual return to daily activities will be discussed in detail before the operation and should be adhered to very closely to avoid adverse events. A tremendous advantage of the procedure is the short recovery time. In general, Dr. Ghasem either performs this operation on an outpatient basis or during an overnight stay. Immediate range of motion after cervical disc replacement surgery is encouraged with minimal immobilization recommended postoperatively.